| 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0550 Level of harm – Actual harm Residents Affected – Few | Honor the resident’s right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0550 Level of harm – Actual harm Residents Affected – Few | (continued… from page 1) -Minimal depression; -No behaviors or rejection of care; -Required extensive assist of one staff with bed mobility, dressing, and bathing; -Required limited assist of one staff with personal hygiene and eating; -Dependent on one staff for toileting and two staff for for transfers; -Always incontinent of bowel and bladder; -Had one fall; -Received 51% or more of daily nutrition and 501 cubic centimeters (cc) or more of daily fluids through tubefeeding; -At risk for pressure ulcers. Review of the resident’s care plan, dated 6/19/18, showed staff assessed the resident as at risk for his/her needs not being met related to memory impairment and relying on staff for most decision-making. Staff are directed to anticipate and provide daily care as indicated, provide/encourage activities that promote memory, promote dignity, converse with the resident and ensure privacy while providing care, and identify themselves with each contact. Additionally, staff documented the resident is at risk for episodes of pain and may forget to alert staff. Staff should monitor for s/s of pain. Staff are directed to administer/observe for effectiveness and possible side effects from pain medication, administer as needed pain medication, notify physician if resident does not state/demonstrate relief or reduction of pain after one hour of receiving the first intervention, and observe and report to nurse signs/symptoms of pain such as crying, resists moving, resists cares, agitation, grimaces, signs/symptoms of worsening pain. Review of the resident’s physician order [REDACTED]. -Assess pain every shift; -[MEDICATION NAME] 325 milligrams (mg) two tabs per gastronomy-tube ([DEVICE]) every six hours as needed; and -[MEDICATION NAME] (pain medication) 50mg/325 mg one tab by mouth as need prior to wounds treatment change ordered on [DATE]. Review of the resident’s Medication Administration Record [REDACTED] -[MEDICATION NAME] 5 mg/325mg on tablet administered on 8/22/18 at 1:30 P.M., 8/23/18 at 08:00 A.M., and 8/29/18 at 12:00 P.M. -[MEDICATION NAME] 325 mg two tablets on 08/21/18 at 8:00 A.M., 8/28/18 at 9:45 A.M., and 8/30/18 at 7:20 P.M. Observation on 08/28/18 at 09:14 A.M., showed the resident lay on his/her left side with tube feeding infusing and head of bed slightly elevated. Observation showed the resident moaned out loud and staff walked by the room without stopping to assist the resident. Observation on 8/28/18 at 04:29 P.M., showed the resident lay flat in bed, and screamed out. Observation showed the resident stared at a blank TV screen and no staff stopped to address the resident’s needs. Observation on 08/29/18 at 08:36 A.M., showed Registered Nurse (RN) R entered the resident’s room, without pulling the privacy curtain, turned off the resident tube feeding, disconnected the tubing, administered the resident’s medication, and reattached the tube feeding. RN R did not speak to the resident or inform the resident what he/she was doing. Observation on 8/29/18 at 9:00 A.M., RN R said the resident is out of pain medication that he/she needs before his/her treatment is completed. The RN said he/she will have to pull some from the emergency kit (e-kit). Observation on 8/29/18 at 10:58 A.M., showed the resident on his/her left side with |
| 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0550 Level of harm – Actual harm Residents Affected – Few | (continued… from page 2) feeding infusing, moaning out loud Help. Observation showed no staff enter the resident’s room. Observation on 08/29/18 at 03:30 P.M., showed physical therapy (PT) assistant complete the resident’s wound treatment. Observation showed the resident moan out with facial grimacing multiple times through the procedure. The PT assistant did not address the resident’s moaning and facial grimacing. The PT assistant said he/she has been working with resident for about 2 weeks because the resident’s wound deteriorated. Observation on 08/29/18 at 04:34 P.M., showed the resident hollered out help and could be heard at the nurses station. Further observation showed the unidentified nurse enter the resident’s room and tell the resident that he/she knows how to use his/her call light. The nurse said he/she would be back after administering medication and then walked past the room. Observation showed the resident continued to yell please help me. Observation on 08/29/18 at 04:40 P.M., showed an unidentified nurse enter the resident’s room. Observation showed the nurse tell the resident to keep it in the bed referring to the resident’s call light. Continuous observations on 08/30/18 from 02:41 A.M. to 03:47 A.M., showed the resident’s door shut to his/her room. Upon entering, observation showed the resident lay on his/her back with the head of bed flat, the resident’s tube feeding machine beeping, and the resident moaning out loud with intermittent coughing. No staff entered the room to address the resident’s needs. Observation on 08/30/18 at 03:48 A.M., showed LPN E placed a new bottle of tube feeding and flush bag and connect the feeding to the resident. Observation showed the resident continued to moan out with head of bed not elevated. Observation showed the LPN hold a wash cloth up to the resident’s mouth and tell him/her to spit out the saliva and mucous in his/her mouth. The LPN left the room and the resident continued to moan. Observation 08/30/18 at 03:56 A.M., showed CNA C placed the tube feeding on hold and asked the resident to spit into a towel. The CNA pulled down the resident’s blanket and removed his/her brief from the front, then turned the resident side to side providing pericare. Observation showed the resident cried out with facial grimacing with turning and repositioning. The CNA asked the resident what was wrong after he/she positioned the resident’s legs in the bed and the resident said ouch. The resident did not respond. The CNA asked if the resident needed something for pain and the resident shook his/her head yes. Observation on 08/30/18 at 04:18 A.M. to 5:24 A.M., showed the CNA did not report to the nurse when he/she left the resident’s room that the resident was in pain and asked for medication. Observation showed the resident continued to holler out help me and loudly moaned. During an interview on 08/30/18 at 05:25 A.M., LPN E said the resident moans out sometimes when he/she has stuff in his/her mouth. The LPN said he/she gave him Tylenol earlier and he/she plans on going back. Review of the resident’s MAR, dated (MONTH) (YEAR), showed no documentation of Tylenol administered to the resident on 8/30/18 during the 11:00 P.M. to 7:00 A.M. night shift hours. 4. Review of Resident #21’s quarterly MDS, dated [DATE], showed staff assessed the resident as: -Severe cognitive impairment; -Required extensive assistance of two staff with bed mobility, toileting, and transfers; -Required extensive assistance of one staff for dressing and personal hygiene; -Dependent on one staff for bathing; |
| 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0550 Level of harm – Actual harm Residents Affected – Few | (continued… from page 3) -Always incontinent of bowel and bladder; and -Receives 51% or more of daily nutrition by tubefeeding. Observation on 08/28/18 at 08:57 A.M., showed the resident positioned in front of the nurses station with blanket off to the side, shirt raised and abdomen showing, and pant legs pulled up to the resident’s knees. Observation showed staff at the nurses desk and staff walking by the resident. Observation on 08/28/18 at 04:20 P.M., showed the resident reclined back in his/her geri-chair with shirt pulled up exposing [DEVICE] and pant legs pulled up above the residents knees. Observation on 08/31/18 at 10:22 A.M., showed the resident up in his/her geri-chair by the nurses station with his/her eyes open. Observation showed the resident’s [DEVICE] exposed with his/her shirt up raised up to the resident’s chest. 5. Review of Resident #23’s quarterly MDS, dated [DATE], showed staff assessed the resident as: -Mild cognitive impairment; -Minimal depression; -No behaviors, rejection of care, wandering, or [MEDICAL CONDITION]; -Required extensive assistance of one staff for bed mobility, dressing, eating, and personal hygiene; -Required extensive assistance of two or more staff for transfers; -Dependent on one staff for bathing; -Required set-up assistance with eating; -No limitations in range of motion (ROM); -Wheelchair for mobility; -Always incontinent of bladder; -Frequently incontinent of bowel; -No falls; -At risk for pressure ulcer development with pressure reducing device in chair and bed; -Received antidepressant medication for the last seven days; -No plans for discharge. Review of the resident’s care plan, updated 6/20/18, showed the resident is at risk for psychosocial well-being problem related to the [DIAGNOSES REDACTED]. -Arrange for clergy or spiritual leader of choice to visit, if requested or desired; -Assist in learning stress management/relaxation technique; -Assure the resident that symptoms of grieving are normal and will improve with time; -Determine the resident’s executions and discuss each in realistic terms; -Discuss coping strategies with the resident; -Discuss with the resident concerns/fears of being unwanted or feeling useless; and -Give positive reinforcement as initiative/involvement improves/attempts to solve conflicts. Additionally, staff are directed to invite, encourage, remind, and escort the resident to activity programs consistent with the resident’s interests, promote dignity, and converse with the resident and ensure privacy while providing care. Review of the resident’s Social Service Assessment, dated 12/17/17, showed the social service director (SSD) assessed the resident as: -Adjusting well; -Alert and oriented to person, place, time, and occasionally situation, modified independence with decision making; -Able to make needs known; |
| 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0550 Level of harm – Actual harm Residents Affected – Few | (continued… from page 4) -Received [MEDICATION NAME] (antidepressant) 60 milligrams (mg) daily; -Anticipated discharge to an assisted living facility (ALF); and -Enjoys cooking, sewing, singing, reading, and use to play the piano. Review of the resident’s Social Services note, dated 8/23/18, showed the SSD documented the resident’s daughter reported that the resident expressed that he/she has thought about suicide. When the daughter asked why the resident had thought about suicide, the resident replied, They don’t like me here. The resident’s daughter asked why he/she thinks that no one likes him/her at the facility, the resident replied, He/she has been stealing all of their men/women. The SSD spoke with the resident whom stated that she has thought about suicide. The SSD asked the resident if he/she had a plan and the resident replied he/she has been thinking about what he/she will wear and he/she will use gas. The resident did not report any further plans. The resident stated that he/she feels useless and has no friends. The SSD provided active listening, validation, and encouragement. The Daughter and SSD spoke with the nurse practitioner (NP) who said that he/she will review the resident’s medications. an order for [REDACTED]. The DON and administrator made aware. The DON stated that he/she will have staff observe the resident. Social Services will continue to follow as appropriate. Further review of the social services notes, did not show any further documentaion regarding the resident’s suicidal thoughts or follow-up. Review of the resident’s nurses note, dated 7/22/18, showed staff documented the resident had been screaming out and crying at the start of the shift. Also the resident has shown this behavior over the past week around the same time of day. When asked if something is wrong, the resident is unable to verbalize any specific complaints. When the resident was asked if he/she would like to lay down, the resident agreed. After laying down in bed, the resident became more calm. Review of the resident’s nurses note, dated 7/31/18, showed staff documented the resident was yelling out this afternoon in dining room and was redirected a few times by SSD, CNA, and occupational therapist (OT). At this time the resident is by the nursing station showing no apparent unmet needs after he/she was assisted to the restroom. Observation on 8/27/18 at 02:10 P.M., showed the resident sat up in his/her wheelchair, positioned by CNA H at the nurses station, crying. CNA H said to the resident, You are really going to have to quit that crying. There is nothing wrong with you. Observation showed the resident began crying louder and harder. The CNA then asked the resident what he/she had for lunch. The resident responded, I did not eat lunch, and the CNA said, Yes you did. The resident continued to cry harder. Further observation showed the resident stopped crying, began to smile, and answered in a positive manner, when the surveyor asked the resident about his/her stuffed animal that he/she held. During an interview at the same time, RN R said the resident has been crying out more here lately. Staff just have to talk to him/her and he/she will stop crying and perk up. Observation on 08/28/18 at 09:09 A.M., showed the resident sat up in his/her wheelchair, with wheelchair positioned against the wall and facing the nurses station. Observation showed the resident’s feet on the foot pedals, eyes closed, and head down with a blanket over him/her. Observation on 8/28/18 at 10:30 A.M., showed the resident remained his/her wheelchair facing the nurses station, with his/her eyes closed and no change in position. Observation on 08/28/18 at 01:24 P.M., showed the resident sat up in his/her wheelchair facing the nurses station, with his/her eyes closed. Continuous observations on 8/29/18 from 8:45 A.M. to 9:15 A.M., showed the resident 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0550 Level of harm – Actual harm Residents Affected – Few | (continued… from page 5) his/her wheelchair with both foot pedals, sitting in common TV area staring at the TV. Observation on 8/29/18 at 9:26 A.M., showed the resident say to CNA H, he/she did not want to watch the show on TV. The CNA did not acknowledge or speak to the resident. CNA H walked by the resident and went down hall without addressing the resident Continuous observation on 8/29/18 at 9:30 A.M. to 9:55 A. M, showed the resident remained in the common area staring at the TV. Observation on 8/29/18 at 9:56 A.M., showed the resident in the common area repetitively screaming, I have to get out of here, my daughter is waiting for me. An unidentified CNA walked by and said, Give me just a minute, I will be right back after I finish this. The CNA went into another resident’s room. The resident began repetitively screaming loudly, I can’t get out. Observation showed the resident began crying. Continuous observations on 8/29/18 from 9:57 A.M. to 10:03 A.M., showed the resident continued to repetitively scream, I cant get out while crying. Continuous observations on 8/29/18 from 10:04 A.M. to 10:09 A.M., showed the resident hollered out HELP, I am going to freeze, while continuing to cry. Further observations showed a CNA walk down the hall multiple times and did not stop to assist the resident. Observation on 8/29/18 at 10:10 A.M., showed the resident continued to holler out and cry. The administrator propelled the resident in front of nurses station and positioned the wheelchair next to other residents against the wall facing the nursing station, and talked with the resident. The resident smiled and talked calmly. Continuous observations on 8/29/18 from 10:11 A.M. to 10:18 A.M., showed the resident continued to holler out and cry. During the observation at 10:14 A.M., the resident hollered out I’m still breathing to four different staff members as they walked by. Staff did not stop to assist the resident. Observation on 8/29/18 at 10:19 A.M., showed the housekeeping supervisor stop and inform the resident that exercise will be at 10:30 A.M. in the dining room. The resident said I do not want to do that. Staff asked the resident what he/she wanted to do and the resident said, I want to go to bed. Observation showed the housekeeping supervisor propel the resident to his/her room and position the wheelchair next to his/her bed. Continuous observations on 8/29/18 from 10:20 A.M. to 10:28 A.M., showed the resident in his/her room crying. During the observation at 10:28 A.M. an unidentified CNA exited another resident’s room and asked Resident #23, What is wrong? Before the resident could respond the CNA said, We are going to get you down to activities and exited the room. Observation showed the resident started crying out loudly and repetitively saying I want to get out of here. Observation on 08/29/18 at 10:29 A.M., showed the Activity Director asked the resident What is wrong as he/she was walking by the resident’s room. The resident said, I want to get out of here. An unidentified CNA entered the room and began propelling the resident down the hall without informing the resident where they were going. The resident asked where they were going and the CNA told the resident that they were going to activities. Observation showed the resident said to the CNA that he/she did not want to go to activities. The CNA continued to propel the resident into the main dining room. Observation on 8/29/18 at 10:30 A.M., showed the Activity Director and Activity Assistant position multiple residents in a circle and hand them a handle attached to a parachute. Activity personnel placed a ball in the center of the parachute. Further observation showed the resident positioned by a table several feet away from the group performing the activity by himself/herself. Staff did not encourage or ask the resident if he/she would like to participate. Continuous observation on 8/29/18 from 10:30 A.M. to 11:29 A.M., showed 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0550 Level of harm – Actual harm Residents Affected – Few | (continued… from page 6) remained positioned off to the side of the activity. Further observation showed staff did not encourage or attempt to get the resident to participate. Observation on 8/29/18 at 11:30 A.M., showed staff moved the resident from his/her position during the activity to the dining room table for lunch. Continuous observations on 8/29/18 from 11:31 A.M. to 12:27 P.M., showed the resident remained in the dining room Observation showed the resident fed himself/herself and staff did not engage in conversation with the resident. Observation on 8/29/18 at 12:28 P.M., showed staff propelled the resident down the hall and positioned the resident facing the nurses station. Observation showed staff did not offer to toilet or lay the resident down in bed. Continuous observation on 8/29/18 from 12:30 to 1:00 P.M., showed the resident remained at the nurses station without staff acknowledging the resident. Continuous observations on 8/29/18 from 02:00 P.M. to 3:26 P.M., showed the resident positioned against the wall facing the nurses station with a blanket on his/her lap. The resident cried and said he/she needed to go home. Observation showed staff walked by the resident without addressing the resident’s needs. Observation on 8/29/18 at 3:27 P.M., showed the resident drank water out of a plastic cup and straw. Resident #35 place his/her hand on the resident’s arm and the resident began to cry and holler out. Observation showed staff did not address the resident crying and hollering. Continued observations on 08/29/18 from 03:28 P.M. to 03:38 P.M., showed the resident sat in his/her wheelchair positioned against the wall facing the nurses station, crying out I want to go home. Observation showed two unidentified nurses sat at the nurses station and staff walked by. Staff did not acknowledge that the resident was crying or attempt to redirect the resident. Observation on 08/29/18 at 03:39 P.M., showed the resident continued to cry. Licensed practical nurse (LPN) Q asked the resident if he/she wanted to take a nap. The resdient did not respond to the nurse. Observation on 08/29/18 at 04:07 P.M., showed an unidentified CNA propel the resident to the dining room and position him/her at a table in the center of the dining room with only one other resident in the dining room, and the CNA exited the dining room. Observation on 08/29/18 at 04:15 P.M., showed the resident in the dining room crying with no staff present. The surveyor asked the resident how he/she was doing and the resident replied not good but was unable to answer why he/she was not good. Observation showed the resident calmed down and quit crying when the surveyor spoke with the resident. Observation on 08/29/18 at 04:21 P.M., showed the Activity Director walked into the main dining room and positioned the resident at his/her dining room table without telling the resident what he/she was doing. Observation showed the Activity Director talking to another resident about playing bingo earlier. Resident #23 said I do not like bingo, and the Activity Director responded loud and harsh, I know that’s why I didn’t bring you down here. The resident looked down at the table. Continued observations on 8/29/18 from 04:22 P.M. to 04:40 P. M, showed the resident remained positioned at the dining room table. Observation at 4:41 P.M. showed the surveyor requested staff to toilet the resident. CNA U propelled the resident to his/her room. The resident said he/she has not gone to the bathroom all day and probably leaked a little bit. Observation on 8/29/18 at 04:45 P.M., showed CNA U left the resident’s room and CNA T provided pericare. Observation on 08/31/18 at 10:28 A.M., showed the resident sat up in his/her wheelchair |
| 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0550 Level of harm – Actual harm Residents Affected – Few | (continued… from page 7) positioned facing the nurses station. Observation showed the resident had a blanket on his/her lap and sang with intermittent crying. CNA J asked the resident what was wrong as he/she walked by but did not stop for the resident to respond. Continuous observations on 8/31/18 from 10:29 A.M. to 10:42 A.M., showed the resident remained in the same position and continued to sing and cry out without staff attempting to stopping to see what the resident needed. Observation on 08/31/18 at 10:43 A.M., showed the resident remained positioned against the wall facing the nurses station crying and asking to go to his/her room. The Staffing Coordinator asked RN R if it was ok for the resident to go to his/her room and the RN said yes. The staffing coordinator propelled the resident to his/her room and positioned him/her by his/her bed During an interview on 8/29/18 at 2:40 P.M., CNA H said the resident had recently started crying out and doesn’t tell staff what is wrong. The resident does this frequently now and the other day he/she had been doing this all shift. If staff talk with him/her, the resident will normally stop crying and that is why he/she was at the nurses station with the CNA. The CNA said the other day he/she had lost patience because he/she was at the end of shift and attempting to document for the day. The CNA said he/she just got frustrated. Usually when we ask the resident if he/she needs to use the restroom or wants to lay day, or if he/she needs something else, the resident will calm down and is able to answer yes or no, but that day he/she was not saying what he/she needed. 6. Observation on 8/29/18 at 11:45 A.M., showed Resident #29 in his/her wheelchair rolling up to a table in the dining room and reaching for the salt shaker. At this time, the Activity Director approached the resident and hollered out and said harshly Don’t you get into that! I will get you! The resident tensed up and hollered back at the Activity Director, I will get you! 7. Review of Resident #278’s quarterly MDS, dated [DATE], showed staff assessed the resident as: -Severe cognitive impairment; -No behaviors; -Required extensive assistance of one staff with bed mobility, toilet use, eating, and personal hygiene. -Required limited assistance of one staff with dressing; -Dependent on one staff for bathing; -Frequently incontinent of bladder and always incontinent of bowel; -[DIAGNOSES REDACTED].>-Had a fall in the last month; -Had an unstageable pressure ulcer and a lesion on the foot; and -Received antidepressants three out of the last seven days prior to the assessment. Observation on 08/27/18 at 01:55 P.M., showed the resident lay in bed. An unidentified CNA entered the resident’s room without knocking or announcing themselves. Observation on 8/27/18 at 5:30 P.M., showed the resident lay in his/her bed uncovered, with no pants on his/her lower extremities, brief showing and legs off the side of the bed. Further observation showed the resident was visible from the hallway as staff and visitors walked by the resident’s room. Observation on 08/31/18 at 10:37 A.M., showed the resident’s shirt had multiple spots with food on it. 8. Review of Resident #429’s MDS, dated [DATE], showed: – Modified independence in decision making, short and long term memory okay; – No mood or behavior issues; – Required extensive assist of one staff for all activities of daily living; |
| 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0550 Level of harm – Actual harm Residents Affected – Few | (continued… from page 8) – Incontinent of bladder and bowel; – One stage II pressure sore (partial thickness loss of dermis presenting as a shallow open ulcer with a red or pink wound bed, without slough. (MONTH) also, present as an intact or open/ruptured blister); -[DIAGNOSES REDACTED]. Observation on 08/27/18 from 5:43 P.M. to 5:48 P.M., showed an unidentified CNA stood to the side of Resident #429 and fed the resident. Observation showed the CNA entered and exited the assisted dining room multiple times while he/she assisted the resident with eating. During an interview on 09/04/18 at 02:55 P.M., the resident said over the weekend he/she had been up in his/her geri-chair since early morning and was not put to bed until 12:00 A.M. The resident said he/she asked the staff to please put him/her to bed as his/her leg and bottom were hurting. He/she said staff never got the nurse to assess for pain medication. He/she said the two staff took him/her to his/her room and said they were going to put others to bed and be back to help him/her. The resident said staff just left me in the room and I was hurting so bad. When staff returned to assist the resident to bed they wouldn’t listen to him/her before trying to transfer him/her. The resident said he/she told the staff to get his/her chair closer to the bed. The staff picked him/her up without using a gait belt, one staff grasped his/her arms and the other staff grasped his/her legs. The resident said one staff complained about his/her back hurting. The resident said staff never notified the nurse of his/her pain and he/she did not receive any pain medication. 9. Observation on 8/27/18 at 05:35 P.M., showed an unidentified CNA delivered trays to the assisted dining room. Observation showed the CNA tell another CNA Resident #435 is a feeder as he/she walked away from the food cart. Observation on 8/27/18 at 5:39 P.M., showed an unidentified CNA stood and fed Resident #435 a bite, then walked over to another resident and cut up their food. Observation showed the CNA then left the dining room. 10. Review of Resident #436’s medical record showed the resident admitted to facility on 7/22/18, with [DIAGNOSES REDACTED]. Review of the resident’s admission MDS, dated [DATE], showed staff assessed the resident as: – BIMS score of 15 out of 15 (cognitively intact); – Required limited to extensive assistance of one staff with all activities of daily living; – Frequently incontinent of bowel and bladder; – At risk for pressure sore development; – Occupational and physical therapy five days a week. Review of the resident record showed the 48 hour care plan was blank. During an interview on 08/29/18 at 09:28 A.M., Resident #436 said staff woke him/her up at 3:30 AM to pre-dress him/her in bed. The resident said that was very unusual. He/She said the staff did not know how to get his/her brace on and had to find the therapy aide to assist them. The resident said sometimes he/she has to wait two hours for staff to come change him/her. A few time he/she had incontinence accidents with urine all over the floor. He/She said residents have to wait for assistance on all shifts. 11. Review of Resident #437’s medical record showed the resident admitted to the facility on [DATE], from the hospital for physical therapy after suffering a fall at home. Review of the 48 hour care plan on 8/30/ (TRUNCATED) |
| 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0550 Level of harm – Actual harm Residents Affected – Few | ||
| F 0582 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered. Based on interview and record review, the facility failed to obtain the decision to appeal | |
| F 0623 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. **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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0623 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 10) (Residents #29) who transferred to the hospital and two residents (Residents #49 and #60) who transferred to another skilled nursing facility. Further, the facility failed to provide a written notification of transfer to home for one resident (Resident #431). The facility census was 80. 1. Review of the facility discharge plan policy, dated 10/1/17, showed the following: – Purpose: Interdisciplinary team participates in developing an effective discharge planning process based on the patient’s active participation in determining his/her discharge goals to effectively transition him/her to post-discharge care and reduce factors leading to preventable readmissions 2. Review of Resident #29’s Discharge Assessment showed staff sent the resident to an acute care hospital on [DATE] with his/her return anticipated. Review of the resident’s Reentry Tracking Form showed the resident returned to the facility on [DATE]. Review of the resident’s medical record showed staff did not provide written notification to the resident or resident’s representative upon transfer to the hospital. 3. Review of Resident #431’s discharge summary, dated 9/4/18, showed the following: – Reason for resident’s discharge, therapy/insurance based discharge; – List of the resident’s current diagnosis; – List of vital signs: blank; – Medications listed; – Recapitulation of Stay: – Dietary summary – blank; – Activity summary – blank; – Nursing summary – blank, – Pertinent lab tests and results – blank; – Pertinent Radiology and other test results – blank; – Pertinent Consultations Findings and Recommendations – blank; – Rehabilitation Therapy – blank; – Social services discharge summary: Resident will be discharged to home with medications, standard wheelchair (16 x 16) with seat cushion, removable arm rest and elevating leg rest, raised toilet seat, tub transfer bench. Home health support provided; – Further review showed the discharge did not include a statement of the resident’s appeal rights, including the name, address (mailing and email), and telephone number of the entity which receives such requests; and information on how to obtain an appeal form, assistance in completing the form, and submitting the appeal hearing request. The name, address (mailing and email) and telephone number of the Office of the State Long-Term Care Ombudsman was not included in the discharge information. Review of the resident’s record showed the resident discharged home on[DATE], with a family member. 4. Record review of Resident’s #49’s face sheet showed he/she was admitted to the facility on [DATE] with [DIAGNOSES REDACTED].>-Intestinal Obstruction- (gastrointestinal condition in which digested material is prevented from passing normally through the bowel); -Alcoholic [MEDICAL CONDITION] of Liver- (advanced form of liver disease related to drinking alcohol); -Chronic Pain – (persistent pain that last weeks to years); and -Abdominal Pain. Record review of the resident’s Care Plan, dated 7/13/18, showed: -The resident had a decline in mobility and strength; |
| 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0623 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 11) -Required assistance with all Activities of Daily Living Needs (ADL’s); -Required minimal assistance with bed mobility, dressings, locomotion, toilet use and personal hygiene. Record review of the resident’s undated discharged Summary, showed: -The resident was discharged to a skilled nursing facility on 8/21/18. Record review of the resident’s closed record, dated 8/31/18, showed the facility did not provide the resident and/or the resident’s representative with written notice of transfer or discharge when the resident was transferred to a skilled nursing facility. 5. Record review of Resident’s #60’s face sheet showed he/she was admitted to the facility on [DATE] with [DIAGNOSES REDACTED].>-Mild Cognitive Impairment (the stage between the expected concisely decline of normal aging and the more serious decline of dementia. It can involve problems with memory, language, thinking and judgement); -Dysphasia (language disorder marked by deficiency in the generation of speech or due to brain disease or damage); and -Type II Diabetes. Record review of the resident’s medical record, dated 8/31/18, showed there was no written notice of transfer or discharge to the resident and/or the resident’s representative when the resident transferred to a skilled nursing facility or home. During an interview on 8/31/18 at 1:30 P.M., the Medical Records staff said he/she was unable to find a copy of the resident’s Discharge Summary in the resident’s medical record. Record review of the resident’s Medical Record dated 8/31/18, showed no record of the Discharge Summary in the resident’s medical record. During an interview on 09/04/18 at 4:47 P.M., the administrator said he sends the transfer form (Nursing home transfer form for hospital), but does not send anything to the resident or resident representative. | |
| F 0637 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | Assess the resident when there is a significant change in condition **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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0637 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 12) -Severe cognitive impairment for daily decision making with a BIMs (brief interview for mental status) score of 3; -Required extensive assistance of one staff for bed mobility, dressing, toileting, personal hygiene, and bathing; -Required extensive assistance of two or more staff for transfers; -Dependent on one staff for eating; -No limitations to range of motion (ROM) to both upper and lower extremities; -Rarely had mild pain; -No falls; -Had a significant weight loss, weight 106 pounds (lbs); -Received 25% or less of daily calories by a feeding tube; -At risk for pressure ulcers; and -No current skin breakdown. Review of the resident’s quarterly MDS, dated [DATE], showed staff assessed the resident as the following: -Severe cognitive impairment for daily decision making with a BIMs score of 6; -Required extensive assistance of one staff for bed mobility, dressing, and bathing; -Required limited assistance of one staff for eating and personal hygiene; -Dependent on two or more staff for transfers; -Dependent on one staff for toileting; -Had limited ROM to both lower extremities; -No pain; -Had one fall since the previous assessment; -No significant weight loss, weight 115 lbs; -Received 50% or more of daily calories by a feeding tube; -At risk for pressure ulcers; -No current skin breakdown. Further review of the resident’s annual MDS and quarterly MDS, showed staff did not complete a significant change MDS assessment, as directed by the RAI manual, for the resident’s changes in his/her Activities of Daily Living (ADL’s) care requirements, cognitive status, tube feeding caloric intake, and falls. Review of the resident’s physician order [REDACTED]. -[MEDICATION NAME] 1.2 calorie 0.6 gram (gm), 1.2 kilocalorie (kcal)/milliliter (ml) liquid to infuse via [DEVICE] ([DEVICE]) at 70 ml/hour continuously (ordered 5/18/18); -Barrier cream to affected areas with pericare as needed (5/18/18); -Cleanse wound to sacrum with normal saline, may apply skin prep to the peri wound, apply Manuka Pli (sterile honey gel ointment) to wound bed and cover with a dry dressing daily and as needed (ordered 7/3/18); -Mechanical soft diet for pleasure eating (ordered 5/18/18). Review of the resident’s nurses notes, dated 5/16/18, showed the nurse documented the resident readmitted from the hospital and is alert and oriented to two. The resident had an admitting [DIAGNOSES REDACTED]. Review of the the nurse’s notes, dated 5/17/18, showed the resident is alert and oriented to one or two (person, place, and time), requires total care, is incontinent of bowel and bladder, [DEVICE] checked for placement, and the resident receives nothing by mouth. Review of the nutrition note, dated 7/24/18, showed the Registered Dietician (RD) documented the resident was being reviewed due to an unstageable wound. The resident’s tube feeding meets nutritional needs. Diet is mechanical soft for pleasure feeding only and has chosen to not eat by mouth recently. |
| 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0637 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 13) Review of the nurses notes, dated 6/4/18 through 8/14/18, showed the resident had a non-injury fall and staff found the resident on the floor on 6/4/18 and 6/17/18. Further review showed the resident had a fall out of bed receiving an abrasion to the chin and complained of pain all over on 8/13/18. Review of the resident’s physician progress notes [REDACTED]. The resident is to continue with local wound treatment. Further review of the resident’s medical record, showed staff did not complete a significant change MDS assessment within 14 days of identifying a significant change in status, after the resident’s quarterly assessment on 6/18/18. Review showed the resident had a minor injury fall on 8/13/18, developed a facility acquired unstageable pressure ulcer, and declined in his/her ADL abilities in (MONTH) through August. 3. Review of Resident #23’s admission MDS, dated [DATE], showed staff assessed the resident as the following: -Moderate cognitive impairment for daily decision making with a BIMs of 10; -Felt tired or had little energy 12-14 days (nearly every day); -Required extensive assistance of one staff for bed mobility and dressing; -Required extensive assistance of two or more staff for transfers; -Required limited assistance of one staff for eating, toileting, and personal hygiene; -Dependent on one staff for bathing; -Frequently incontinent of bladder; and -Occasionally incontinent of bowel. Review of the resident’s quarterly MDS, dated [DATE], showed staff assessed the resident as the following: -Cognitively intact for daily decision making with a BIMs of 15; -Felt tired or had little energy zero days (none); -Required extensive assistance of one staff for bed mobility, transfers, dressing, toileting, and personal hygiene; -Required limited assistance of one staff for eating; -Dependent on staff for bathing; -Always incontinent of bladder; and -Frequently incontinent of bowel. Review of the resident’s quarterly MDS, dated [DATE], showed staff assessed the resident as the following: -Moderate cognitive impairment for daily decision making with a BIMs of 13; -Felt tired or had little energy 2-5 days (several days); -Required extensive assistance of one staff for bed mobility, dressing, toileting, and personal hygiene; -Required extensive assistance of two staff for transfers; -Required set-up assistance with eating; -Dependent on staff for bathing; -Always incontinent of bladder; and -Frequently incontinent of bowel. Further review showed the resident had a decrease in cognitive impairment and mood, required more assistance with toileting and personal hygiene, less assistance with transfers, and an increase in incontinence status for bowel and bladder between the resident’s admission MDS and the 3/19/18 quarterly MDS. Additionally, the resident had an increase in his/her BIMs, mood, and an increase in the number of staff required to transfer the resident. The facility staff did not complete a significant change MDS within 14 days of identifying a significant change. |
| 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0637 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 14) 4. Review of Resident #278’s admission MDS, dated [DATE], showed staff assessed the resident as the following: -Moderate cognitive impairment with a BIMs score of 13; -Felt tired or had little energy 2-6 days (several days); -Required limited assistance of one staff for transfers and personal hygiene; -Required limited assistance of two or more staff for bed mobility, dressing, and toileting; -Required extensive assistance of one staff with bathing; -Occasionally incontinent of bladder; -Frequently incontinent of bowel; -No falls; -No skin breakdown or wounds; -Did not receive antidepressants. Review of the resident’s quarterly MDS, dated [DATE], showed staff assessed the resident as the following: -Severe cognitive impairment; -Felt tired or had a little energy zero days (none); -Required limited assistance of one staff with dressing; -Required extensive assistance of one staff with bed mobility, eating, toileting, and personal hygiene; -Dependent on staff for bathing; -Frequently incontinent of bladder; -Always incontinent of bowel; -Had a fall in the last month; -Had one unstageable pressure ulcer with slough and a lesion on the foot; -Received antidepressant medication three out of the seven look back days or since admission. Further review showed staff did not complete a significant change MDS within 14 days of identifying the resident developed an unstageable pressure ulcer, had a decline in cognitive status, ADL ability, bowel and bladder continence, began receiving antidepressants and had falls. 5. During an interview on 9/5/18 at 6:33 P.M., MDS/Care Plan Coordinator A said he/she reviews residents’ notes, physician history and physicals (H&P), Certified Nurses Aide (CNA) ADL documentation, interviews with residents and nurses, and looks at the nurses notes before completing the MDS assessments. A significant change requires three things to change such as a weight loss, decline in ADL’s, significant change in cognitive status, discharge from hospice or removal of a foley catheter. He/she compares the information between the quarterly assessments, if the resident develops a wound. The wound nurse will provide him/her with the wound measurements. | |
| F 0655 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | Create and put into place a plan for meeting the resident’s most immediate needs within 48 hours of being admitted **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, facility staff failed to complete a baseline care |
| 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0655 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 15) reviewed with the resident or responsible party for eight residents (Residents #23, #278, #77, #433, #431, #436, #60, and #178) out of 23 sampled residents. The facility census was 80. 1. Review of Resident #23’s admission Minimum Data Set (MDS), a federally mandated assessment tool, dated 12/24/17, showed staff assessed the resident as follows: -admitted [DATE]; -Moderate cognitive impairment; -Required extensive assistance of one staff for bed mobility, dressing, and bathing; -Required extensive assistance of two or more staff for transfers; -Required limited assistance of one staff for eating, toilet use, and personal hygiene; -Frequently incontinent of urine; -Occasionally incontinent of bowel; -Had falls in the last six months prior to admission; -At risk for pressure ulcers; and -Received antidepressants six out of seven days and antibiotics four out of seven days, during the last seven days or since admission/entry if less than seven days. Review of the resident’s baseline care plan, undated, showed staff documented the following: -The resident is a do not resuscitate (DNR); -At risk for falls related to unsteady ambulation; -Needed assistance with Activities’s of daily living (ADLs) related to impaired mobility. The resident wished to improve ability to dress, perform personal hygiene, walking, and transferring; -Resident to receive Physical therapy (PT), Occupational therapy (OT), and Speech therapy (ST); and -Occasionally incontinent of bowel and bladder and needs toileting assistance. Further review of the resident’s 48 hour baseline care plan, showed staff did not document problem start dates, include signatures of staff who added the intervention, did not complete all sections, did not include the care plan conference review, and signatures that the resident or resident representative reviewed and received a copy of the baseline care plan, and physician orders. 2. Review of Resident #278’s admission MDS, dated [DATE], showed staff assessed the resident as the following: -Date of admission 3/7/18; -No cognitive impairment for daily decision making; -No behaviors; -Minimal depression; -Required limited assistance of two staff for bed mobility, dressing, and toileting; -Required limited assistance of one staff for transfers, eating, and personal hygiene; -Required extensive assistance of two staff for bathing; -Occasionally incontinent of bladder; -Frequently incontinent of bowel; -No falls; -At risk for developing pressure ulcers; -Received antibiotics for six out of seven days prior to assessment; -Had an active discharge plan to the community; and -Received PT, OT, and ST. Review of the resident’s 48 hour admission baseline care plan, dated 8/30/18, showed staff documented 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0655 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 16) -Safety goal of home with caregiver with scheduled appointments (no discipline marked); -At risk for falls initiated by nursing services related to new environment, unable to understand safety strategies, recent falls. The staff are to provide education with the mechanical lift and minimizing fall risk, call light use, wearing nonskid footwear; -Incontinence problem start 8/30/18. The resdient is occasionally incontinent and requires assistance with toileting and hygiene. Staff are to educate and provide pericare as needed. Further review showed staff did not complete the baseline care plan within 48 hours of admission, did not complete all care areas related to the resident, and did not contain signature from the resident or resident representative that the baseline care plan and physician orders [REDACTED]. 3. Review of Resident #178’s Admission MDS, a federally mandated assessment tool, dated 3/5/18, showed the staff assessed the resident as follows: -admitted [DATE]; -Required extensive assistance with bed mobility, transfers, dressing, toileting, and personal hygiene; -[DIAGNOSES REDACTED]. -Falls prior to admission; -Received insulin in last 7 days; -Received Physical Therapy, Occupational Therapy and Speech Therapy. Review of the resident’s 48 hour baseline care plan, showed staff did not complete the form and it was not signed by the resident or his/her representative. 4. Review of Resident #60’s Admission MDS, dated [DATE], showed the staff assessed the resident as follows: -admitted [DATE]; -Required extensive assistance with bed mobility, transfers, dressing and toilet use; -Occasional incontinence of urine; -Frequently incontinence of stool; -[DIAGNOSES REDACTED]. -Falls since admission; -Received insulin injections in last 7 days; -Received Physical Therapy, Occupational Therapy and Speech Therapy in the last 7 days. Review of the resident’s 48 hour baseline care plan, showed staff did not complete the form and it was not signed by the resident or his/her representative. 5. Review of Resident #77’s physician order [REDACTED]. Review of the physician order [REDACTED]. Review of the resident’s 48 hour admission care plan showed the form was not completed and signed by the resident or his/her representative. 6. Review of Resident #431’s medical record showed the resident admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. Review of medical record showed the 48 hour care plan was blank. Review of the resident’s minimum data set (MDS), an assessment instrument required to be completed by facility staff, dated 6/15/18, showed staff assessed the resident as follows: -admitted : 6/1/18; -Cognitively intact; -Required assisting of one staff for activities of daily living; -Incontinent of bowel and bladder; -Had mild to moderate pain frequently; -At risk for pressure sore development. |
| 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0655 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 17) During an interview on 8/29/18 at 2:21 P.M., the resident said he/she: -Had a catheter when he/she first came to facility, but it was removed; -Received IV antibiotics for urinary tract infection; -Receives physical therapy and they assist him/her with ambulating/using prosthesis; -Plans to return home upon discharge; -Not aware or provided a copy of care plan upon admission. 7. Review of Resident #433’s medical record showed the resident admitted on [DATE], with [DIAGNOSES REDACTED]. Review of the resident’s medical record showed the 48 hour care plan was blank. During an interview on 8/28/18 at 10:18 A.M., the resident said he/she had a recent hip replacement and [MEDICAL CONDITION]. The resident said the surgeon must have hit a nerve during the surgery, as he/she has pain that goes all down his/her leg. The resident said he/she had his/her other hip replaced and didn’t have any problems. He/She said the staff have to be very careful when getting him/her up into the chair or to bed. The resident said he/she did not receive a copy of a care plan after admission. 8. Review of Resident #436’s medical record showed the resident admitted on [DATE], with [DIAGNOSES REDACTED]. Review of the resident’s admission MDS, dated [DATE], showed staff assessed the resident as follows: -BIMS score of 15 out of 15, cognitively intact; -Required limited to extensive assistance of one staff with all activities of daily living; -Frequently incontinent of bowel and bladder; -At risk for pressure sore development; -Occupational and physical therapy five days a week. Review of the resident record showed the 48 hour care plan was blank. During an interview on 8/29/18 at 9:28 A.M., the resident said he/she developed a pressure sore on his/her foot after coming here. The wound nurse got him/her boots to wear at night. He/She said it is getting better. The resident is not sure how/why the wound developed. He/She said he/she couldn’t get up when first admitted . He/She said staff had him/her doing his/her own repositioning and the wound developed a few weeks after admission to facility. The resident said he/she did not know about the initial plan of care and staff did not provide him/her with a copy of it. Review of the resident’s wound report, dated 8/8/18, showed the following: – Date of origin 8/02/18; – Stage II pressure sore measuring 2 cm by 2 cm with no depth; – Wound base closed blister; – Treatment response- improving; – Assess every seven days; – Physician order [REDACTED]. 9. During an interview on 9/05/18 at 6:51 P.M., Licensed Practical Nurse (LPN) A said the charge nurses are responsible for completing the 48 hour care plan for new admissions. Staff talk with the resident face to face and assess health needs they have. The nurses also receive and review reports from the hospital. LPN A said staff perform skin assessments and orient the residents to the facility. 10. During an interview on 9/05/18 at 7:03 P.M., the social service designee (SSD) said she was involved in the 48 hour care plan. The SSD said for a while it was the admission staff’s responsibility and sometimes social services. She was not aware a copy of the 48 hour care plan is to be provided to resident or representative. She said she completes 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0655 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 18) brief interview for mental status, nursing performs the physical assessment, and each department head completes their assessment portion. 11. During an interview on 9/5/18 at 6:58 P.M., the director of nursing (DON) said the charge nurses are responsible for filling out the 48 hour baseline care plan. The baseline care plan is part of the admission paperwork that goes to the nurse. There is not currently a plan in place to ensure the baseline care plan is completed. | |
| F 0658 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | Ensure services provided by the nursing facility meet professional standards of quality. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** |
| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/31/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0658 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 19) -Received 51% or more of daily nutrition and 501 cubic centimeters (cc) or more of daily fluids through tube feeding; -At risk for pressure ulcers. Review of the resident’s care plan, dated 6/19/18, showed staff assessed the resident as at risk for his/her needs not being met related to memory impairment and relying on staff for most decision-making. Staff are directed to anticipate and provide daily care as indicated, administer fluids per [DEVICE] ([DEVICE]) as ordered, administer tube feeding formula and flushes as ordered, check the [DEVICE] placement by draw back aspiration and auscultation prior to administering any bolus enteral feeding, keep head of bed up at least 30 degrees, observe for [MEDICAL CONDITION] activity and report to the resident’s physician, observe for side effects of anticonvulsant medications, observe lab values for therapeutic level, observe status after [MEDICAL CONDITION], and report any changes in cognition or behavior to resident’s physician. Review of the resident’s physician orders, dated (MONTH) (YEAR), showed the physician ordered the following: -Check and verify placement of the [DEVICE] prior to enteral feedings, water flushes, and medication administrations; -Flush [DEVICE] with 10 milliners (ml) of water between each medication during administration; -[MEDICATION NAME] 1.2 Cal 0.06 gram/1.2 kilocalories (kcal)/ml liquid at 70 ml/her continuously; -[MEDICATION NAME] ([MEDICAL CONDITION] medication) 500 mg table by mouth two times daily; -[MEDICATION NAME] ([MEDICAL CONDITION]) 5 mg tablet by mouth daily; |
| 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0658 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 20) (MONTH) (YEAR), showed the following: -[MEDICATION NAME] 5 mg tablet at 9:00 A.M., circled on 6/23 and 6/24 without documentation to show why the medication was not given; -[MEDICATION NAME] 50mg tablet at 6 A.M., 1 P.M., and 5 P.M., missing initial of administration on 6/3 at 1 P.M.; and -[MEDICATION NAME] 500 mg by mouth at 9 A.M. and 5 P.M. showed missing initials and documentation of administration on 7/7, 7/16, 7/20, 7/23, 8/3, 8/20, and 8/24 at 5 P.M., and 8/2 and 8/24 at 9 A.M.; -[MEDICATION NAME] Sprinkles 125 mg 3 capsules missing initials on 8/27 at 9 A.M., and 7/16, 7/20, 7/25, 8/3, 8/20, 8/24, and 8/25; -Prosource 30 ml per [DEVICE] at 9 A.M. and 5 P.M., showed circled medication on 8/29 and 8/30 circled at 9 A.M., and 8/28, 8/29, 8/30, and 8/31 circled at 5 P.M. Review showed staff documented on 8/29/18 at 8:30 A.M.-out of prosource. Review of the resident’s treatment administration record (TAR), dated (MONTH) (YEAR) to (MONTH) (YEAR), showed the following: -After cleansing wound to sacrum with normal saline, apply skin prep to the periwound, apply Manuka pli to wound bed and cover with dry dressing, change daily and as needed (7/3/18). Review showed no staff initials to show completion of the treatment on 7/4, 7/5, 7/6, 7/9, 7/10, 7/14, 7/19, 7/30, 7/31, 8/18, and 8/19. Observation on 8/29/18 at 8:36 A.M., showed Registered Nurse (RN) R placed the resident’s [MEDICATION NAME] 500 mg 1 tab and [MEDICATION NAME] sprinkle 125 mg 3 caps into a medicine cup after crushing the [MEDICATION NAME]. The RN popped the resident’s Losartan 100 mg, [MEDICATION NAME] 50 mg, [MEDICATION NAME] 10 mg, and [MEDICATION NAME] 25 mg, crushed the medication and placed in a medication cup and last crushed [MEDICATION NAME] 5 mg and [MEDICATION NAME] 10 mg and placed them into a third medication cup. The RN added about 10 cc water to each cup and and mixed the medication into the water. The RN entered the resident’s room, turned off the tube feeding and disconnected it from the resident, hung the tubing over the pole without a cap on the end, and placed the syringe into the resident’s [DEVICE]. Observation showed the RN poured 30 cc water into the syringe without checking placement with auscultation and/or aspiration. The RN poured the resident’s blood pressure medications into the syringe, followed by the [MEDICATION NAME] and [MEDICATION NAME] and last the [MEDICATION NAME] and [MEDICATION NAME] sprinkles. The RN did not flush with any water between the medications. After the [MEDICATION NAME] and [MEDICATION NAME] sprinkles drained into the tube, the RN flushed with 30 cc of water, reconnected the tube feeding and turned on the tube feeding pump. During an interview at the same time, the RN said he/she checked the placement of the [DEVICE] earlier and he/she didn’t need to check placement again. Observation on 8/30/18 at 3:48 A.M., showed the resident lay flat in the bed with a moist cough. LPN E hung a new bottle of [MEDICATION NAME] tube feeding, and attached the tubing to the pump. The LPN used a flush syringe to pull back 30 cc of water, inserted the syringe into the [DEVICE] and pushed the water through the [DEVICE]. Observation showed the LPN attached the tubing to the [DEVICE] and primed the tubing into the resident’s [DEVICE]. Further observation showed the LPN did not check placement of the [DEVICE] prior to the flush or initiating a new bottle of tube feeding. The LPN raised the head of the bed and assisted the resident in spitting out a mouth full of mucus/saliva. 3. Review of Resident #278’s POS’s, dated (MONTH) (YEAR) to (MONTH) (YEAR), showed the physician directed staff to administer the following: -Prosource 10 gm-100 kcal/30 ml twice daily; -Santyl 250 unit/G topical ointment, apply twice daily to affected area; |
| 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0658 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 21) -[MEDICATION NAME] (reduces gastric acid) 40 mg tablet, delayed release twice daily; -Accuchecks daily at bedtime; -[MEDICATION NAME] (diabetic) XR 50 mg -100 mg twice daily with morning and evening meal; -[MEDICATION NAME] (antibiotic) 300 mg twice daily. Review of the POS’s, showed no order for manuka pli and dry dressing change daily and as needed. Review of the resident’s TAR, dated (MONTH) (YEAR) to (MONTH) (YEAR), showed the following: -After cleansing sacral/coccyx wound with normal saline, apply manuka pli, cover with dry dressing change daily (ordered 5/25/18). Review showed no staff initials to show completion of the treatment on 5/29, 6/1 and 6/4. On 6/8/18 documentation showed the resident was in the hospital; -After cleansing right posterior foot under 2nd digit with normal saline, apply [MEDICATION NAME], cover with dry dressing, and change daily and as needed. Review showed no staff initials to show completion of the treatment on 5/29, 6/1 and 6/4. On 6/8/18 documentation showed the resident was in the hospital; -After cleansing sacral/coccyx wound with normal saline, apply manuka pli/max, may apply skin prep to periwound, cover with gauze, abdominal pad, and change daily and as needed (ordered 6/12/18). Review showed no staff initials to show completion of the treatment on 7/4, 7/5, 7/6, 7/12, 7/14, 7/19, 7/20, and 7/23; -Santyl 250 units/gram topical ointment apply twice daily to affected area (ordered 6/11/18), showed on the (MONTH) TAR with a line through the treatment with changed (undated) written across the order. Review of the (MONTH) TAR showed no line through the order and staff administered the treatment on 8/1 and 8/6 days and evenings, 8/2, 8/3, 8/4 on days. No staff initials for evenings on 8/2, 8/3, 8/4, 8/5 and days on 8/6/18. Review of the resident’s MAR, dated (MONTH) (YEAR) to (MONTH) (YEAR), showed the following: -[MEDICATION NAME] 40 mg at 6 A.M. missing staff initials and no documentation on the back of the MAR on 7/9, 8/4, and 8/5 and 5 PM on 7/2, 7/20, and 7/23; -Accuchecks missing initials and documentation on the back of the MAR on 6/1, 6/4, 6/5, 6/15, 6/25, 7/5, 7/6, and 7/16; -[MEDICATION NAME] XR 50 mg -100 mg twice daily with morning an evening meal, missing initials and documentation on the back of the MAR on 7/4 and 7/22 at 8 A.M., and 7/23, 8/3 and 8/4 at 5 P.M. 4. During an interview on 9/05/18 at 6:58 P.M., the Director of Nurses (DON) said when the nurse changes a resident’s tube feeding to a new bottle or is administering medications, the nurse should date and time the new feeding, initial, connect and prime the tubing, ensure the head of the bed is elevated to a 45 degree angle and is not lying flat. Before the nurse attaches the tubing to the [DEVICE] the nurse needs to check for residual/placement. The nurse also needs to look at the site to ensure no signs of infection or stomach acids leaking around the tube. Staff are expected to check placement prior to administering medication even if they checked it a little while earlier. The DON said staff are expected to initial the MARs and TARS and if the the medication or treatment was not completed they need to circle their initials and document a reason on the back. If they were not able to get a treatment completed on their shift they need to pass that onto the next shift to complete and document it on the 24 hour nurse shift report. The facility is going to a different software and medications will be online and there will be a report that he/she can run. |
| 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0658 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | ||
| F 0661 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** |
| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/31/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0661 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 23) assistance in completing the form and submitting the appeal hearing request. The name, address (mailing and email) and telephone number of the Office of the State Long-Term Care Ombudsman were not included. Review of the resident record showed the resident discharged home on[DATE] with a family member. 4. Record review of Resident’s #49 Discharge Summary, dated 8/20/18, showed staff did not include the following information: -Medication information; -Resident’s needs, strengths, goals, life history and preferences; -Dietary summary; -Pertinent lab tests and result notes; -Rehabilitation/therapy; -Advance Directives; -The right to appeal to the State; -Information on how to request hearing; -Had no written information on how to obtain assistance in completing and submitting the appeal request; -No contact information such as name, address (mail and email), and telephone number of the State entity which receives appeal hearing requests. 5. Record review of Resident’s #60’s Discharge Assessment, dated 8/31/18, showed the resident discharged from the facility with return not anticipated. Record review of the resident’s medical closed record on 8/31/18 showed staff did not document a Discharge Summary for the resident. During an interview on 8/31/18, the administrator said: -He/she was unable to find a copy of the resident’s Discharge Summary in the resident’s medical record. 6. During an interview on 9/5/18 at 6:40 P.M. the Social Services Designee said she was not aware of the requirements that needed to be addressed in the discharge summary and only filled out the sections she thought were required. Further, the Social Service Designee was not aware the resident or representative had to sign the discharge summary and a copy had to be provided to the transferring provider. | |
| F 0677 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | Provide care and assistance to perform activities of daily living for any resident who is unable. **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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 – Some | (continued… from page 24) -Always incontinent of bowel and bladder; -At risk for the development of a pressure ulcers; -[DIAGNOSES REDACTED]. -Received 51% or more of nutrition through a feeding tube. Review of the resident’s comprehensive care plan, dated 3/19/18, showed staff addressed the resident’s care needs as follows: -A hoyer lift for all transfers; -Always incontinent, the resident relies on staff to provide incontinent care; -At risk for the the development of a pressure ulcer. Review of the resident’s comprehensive care plan, dated 3/19/18, instructed staff to: -Provide assistance with incontinent care every two hours and as needed; -Minimize pressure over bony prominences; -Reposition at least every 2-4 hours as consistent with over all patient goals and medical condition. Observations on 9/4/18 from 1:00 P.M. to 4:44 P.M., showed the resident in a reclined position in a geri-chair in his/her room with eyes closed. The hoyer lift pad remained positioned underneath the resident. Observation on 9/4/18 at 4:45 P.M. to 5:59 P.M., showed the resident in a reclined position while in a geri-chair in his/her room with eyes closed. Observation showed the resident’s tube feeding pump alarmed and facility staff walked back in forth outside of the resident’s room. Observation on 9/4/18 at 6:00 P.M., showed the resident in a reclined position while in the geri-chair in his/her room with eyes closed. During an interview on 9/5/18 at 6:40 P.M., Certified Nurses Aide (CNA) L said staff are expected to provide incontinent care and/or reposition the resident every two hours for residents who are dependent upon staff for assistance. 2. Observation on 8/30/18 at 2:45 A.M., showed CNA A entered Resident #11’s room and applied gloves without washing his/her hands. Observation showed the resident’s pants pulled down to his/her ankles under the covers. The CNA cleansed the resident’s abdominal fold and frontal perineal area with a wipe. The CNA turned the resident to his/her right side. Observation showed a strong urine odor and brown ring on the cloth incontinence pad with the resident’s brief saturated through to the pad. Observation showed a large amount of scattered superficial (shallow) open #2 pencil eraser size red areas and scarring to the resident’s gluteal crease, ischium (lower back part of the hip bone), and left thigh. The CNA provided perineal care to the resident. CNA A placed the soiled linens in bag on bedside table and left the room with gloves on and bagged linens. Further observation showed the soiled linens leaked through the plastic bag and left a wet spot on the bedside table. The CNA said he/she was the only CNA on that hall during the shift. 3. Observation on 8/30/18 at 10:00 A.M., showed Licensed Practical Nurse (LPN) G and CNA Z entered the room to provide a treatment for [REDACTED]. The resident lay in bed incontinent of urine and stool. CNA Z applied gloves and assisted to remove the resident’s soiled brief. CNA Z and LPN G assisted the resident to his/her side and CNA Z cleansed the resident’s back, buttocks and groin areas. CNA Z then turned the resident back over onto his/her back and placed the clean brief up through the resident’s legs and fastened the brief. CNA Z did not not provide perineal cleansing to the front peri area within the folds of the skin after the incontinent episode. 4. Observation on 8/28/18 at 10:00 A.M., showed Resident #3 sat in his/her restroom on the toilet, and CNA J cleansed liquid stool off of the resident’s wheelchair and placed clean washcloths into the sink. CNA H removed the resident’s liquid stool covered pull-up and |
| 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 – Some | (continued… from page 25) assisted the resident to a standing position. CNA H cleansed the stool off of the resident’s periarea. Observation showed the CNA used the same cloth and cleansed back and forth from the frontal periarea to the back, and back to the front, then used a dry towel and wiped back and forth to dry the resident. The CNA’s assisted the resident to his/her chair and placed a clean brief and pants. 5. Observation on 8/30/18 at 3:56 A.M., showed CNA C pushed the hold button on the feeding pump, asked Resident #19 to spit into a towel, and then lowered the head of the bed. The CNA pulled down the resident’s covers, cleansed the front creases by the resident’s legs. Observation showed the CNA did not provide thorough frontal pericare and cleansing to the frontal folds. The CNA turned the resident onto his/her side, tucked a clean brief under the resident. Observation showed the resident had a small stool and cleansed the stool off of the resident from back to front. 6. Review of Resident #23’s quarterly MDS, dated [DATE], showed staff assessed the resident as: -Mild cognitive impairment; -Minimal depression; -No behaviors, rejection of care, wandering, or [MEDICAL CONDITION]; -Required extensive assistance of one staff for bed mobility, dressing, eating, and personal hygiene; -Required extensive assistance of two or more staff for transfers; -Dependent on one staff for bathing; -Required set-up assistance with eating; -No limitations in range of motion (ROM); -Wheelchair for mobility; -Always incontinent of bladder; -Frequently incontinent of bowel; -No falls; -At risk for pressure ulcer development with pressure reducing device in chair and bed; -Received antidepressant medication for the last seven days; -No plans for discharge. Review of the resident’s care plan, updated 6/20/18, showed staff documented the resident is frequently incontinent of bladder and occasionally incontinent of bowel. The plan directed staff to: -Observe for non-verbal cues that the resident may need to use the toilet; -Provide prompt peri-care as needed for incontinent episodes; -Provide extensive assistance for toileting; -Resident uses the toilet and bedpan for elimination; -Use adult brief for dignity. Continuous observations on 8/29/18 from 8:45 A.M. to 9:15 A.M., showed the resident in his/her wheelchair with both foot pedals, sitting in the common TV area staring at the TV, with no change in position. Observation on 8/29/18 at 9:26 A.M., showed the resident say to CNA H he/she did not want to watch the show on television. The CNA did not acknowledge or speak to the resident. CNA H walked by the resident and went down hall without addressing the resident. The resident remained in the same position and no staff assisted the resident. Continuous observation on 8/29/18 from 9:30 A.M. to 9:55 A. M, showed the resident remained in the common area staring at the TV with no changes in position or staff assistance. Observation on 8/29/18 at 9:56 A.M., showed the resident in the common area repetitively |
| 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 – Some | (continued… from page 26) screaming, I have to get out of here, my daughter is waiting for me. An unidentified CNA walked by and said, Give me just a minute, I will be right back after I finish this. The CNA went into another resident’s room. The resident began repetitively screaming loudly, I can’t get out. Observation showed the resident began crying. No staff stopped and assisted the resident or assisted with toileting or changing position. Continuous observations on 8/29/18 from 9:57 A.M. to 10:03 A.M., showed the resident continued to repetitively scream, I cant get out while crying. Observation showed staff did not address the resident’s needs or attempt to change his/her position. Continuous observations on 8/29/18 from 10:04 A.M. to 10:09 A.M., showed the resident hollered out HELP, I am going to freeze, while continuing to cry. Further observations showed a CNA walk down the hall multiple times and did not stop to assist the resident. Observation showed the resident remained in the same position without staff assisting the resident with his/her needs. Observation on 8/29/18 at 10:10 A.M., showed the resident continued to holler out and cry. The administrator propelled the resident in front of nurses station and positioned the wheelchair next to other residents against the wall facing the nursing station, and talked with the resident. The resident smiled and talked calmly. Observation showed staff did not help the resident change position or provide toileting. Continuous observations on 8/29/18 from 10:11 A.M. to 10:18 A.M., showed the resident continued to holler out and cry. During the observation at 10:14 A.M., the resident hollered out I’m still breathing to four different staff members as they walked by. Staff did not stop to assist the resident, address his/her needs, or offer toileting. Observation on 8/29/18 at 10:19 A.M., showed the housekeeping supervisor stopped and informed the resident that exercise will be at 10:30 A.M. in the dining room. The resident said I do not want to do that. Staff asked the resident what he/she wanted to do and the resident said, I want to go to bed. Observation showed the housekeeping supervisor propelled the resident to his/her room and position the wheelchair next to his/her bed. Staff did not assist the resident to reposition in the wheelchair or offer fluids or toileting. Continuous observations on 8/29/18 from 10:20 A.M. to 10:28 A.M., showed the resident in his/her room crying. During the observation at 10:28 A.M., an unidentified CNA exited another resident’s room and asked Resident #23, What is wrong? Before the resident could respond the CNA said, We are going to get you down to activities and exited the room. Observation showed the resident started crying out loudly and repetitively saying I want to get out of here. The CNA did not address the resident’s needs or offer fluids or toileting. Observation on 8/29/18 at 10:29 A.M., showed the Activity Director asked the resident What is wrong as he/she was walking by the resident’s room. The resident said, I want to get out of here. An unidentified CNA entered the room and began propelling the resident down the hall without informing the resident where they were going. The CNA continued to propel the resident into the main dining room and positioned the resident outside of the group. The CNA did not offer toileting or fluids to the resident. Observation on 8/29/18 at 10:30 A.M., showed the Activity Director and Activity Assistant position multiple residents in a circle and hand them a handle attached to a parachute. Activity personnel placed a ball in the center of the parachute. Observation showed staff did not address the residents needs or offer toileting or fluids. Continuous observation on 8/29/18 from 10:30 A.M. to 11:29 A.M., showed the resident remained positioned off to the side of the activity. Further observation showed staff did not encourage or attempt to get the resident to participate or offer to get nursing 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 – Some | (continued… from page 27) for toileting or repositioning. Observation on 8/29/18 at 11:30 A.M., showed staff moved the resident from his/her position during the activity to the dining room table for lunch, without offering fluids or toileting. Continuous observations on 8/29/18 from 11:31 A.M. to 12:27 P.M., showed the resident remained in the dining room Observation showed the resident fed himself/herself and staff did not engage in conversation with the resident. Observation on 8/29/18 at 12:28 P.M., showed staff propelled the resident down the hall from lunch and positioned the resident facing the nurses station. Observation showed staff did not offer to toilet or lay the resident down in bed. Continuous observations on 8/29/18 from 12:30 to 1:00 P.M., showed the resident remained at the nurses station without staff acknowledging the resident. Staff did not address the resident’s needs, offer fluids, or toileting assistance. Continuous observations on 8/29/18 from 02:00 P.M. to 3:26 P.M., showed the resident positioned against the wall facing the nurses station with a blanket on his/her lap. The resident cried and said he/she needed to go home. Observation showed staff walked by the resident without addressing the resident’s needs, offering fluids, or toileting. Observation on 8/29/18 at 3:27 P.M., showed the resident drank water out of a plastic cup and straw. Resident #35 placed his/her hand on the resident’s arm and the resident began to cry and holler out. Observation showed staff did not address the resident crying and hollering. Additionally, staff did not offer to take the resident to the bathroom. Continued observations on 8/29/18 from 3:28 P.M. to 3:38 P.M., showed the resident sat in his/her wheelchair positioned against the wall facing the nurses station, crying out I want to go home. Observation showed two unidentified nurses sat at the nurses station and staff walked by. Staff did not acknowledge that the resident was crying or attempt to redirect the resident. Additionally, staff did not offer to assist the resident with toileting or address the resident’s needs. Observation on 8/29/18 at 3:39 P.M., showed the resident continued to cry. Licensed Practical Nurse (LPN) Q asked the resident if he/she wanted to take a nap. The resident did not respond to the nurse. The nurse did not offer the resident toileting assistance or address any other needs before walking away from the resident. Observation on 8/29/18 at 4:07 P.M., showed an unidentified CNA propelled the resident to the dining room and position him/her at a table in the center of the dining room with only one other resident in the dining room, and the CNA exited the dining room without offering to take the resident to the restroom and/or offering fluids. Observation on 8/29/18 at 4:15 P.M., showed the resident in the dining room crying with no staff present. The surveyor asked the resident how he/she was doing and the resident replied not good, but was unable to answer why he/she was not good. Observation showed the resident calmed down and quit crying when the surveyor spoke with the resident. Continued observations on 8/29/18 from 4:22 P.M. to 4:40 P. M, showed the resident remained positioned at the dining room table with a foul odor coming from the resident. Observation at 4:41 P.M. showed the surveyor requested staff to toilet the resident. CNA U propelled the resident to his/her room. The resident said he/she has not gone to the bathroom all day and probably leaked a little bit. Observation on 8/29/18 at 4:45 P.M., showed CNA U left the resident’s room and CNA T pulled the resident’s pants down and unfasted the resident’s brief. Observation showed the brief was wet and the resident had a small amount of stool. The resident’s buttock had dried stool in the crease of the buttock and red in color. The CNA cleansed the resident’s buttock, pulled his/her pants up and set the resident back into his/her wheelchair on 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 – Some | (continued… from page 28) pressure relieving cushion. 7. Review of Resident #278’s quarterly MDS, a federally mandated assessment tool, dated 6/14/18, showed staff assessed the resident as: -Severe cognitive impairment; -Required extensive assistance of one staff with bed mobility, toilet use, eating, and personal hygiene; -Required limited assistance of one staff with dressing; -Dependent on one staff for bathing; -Frequently incontinent of bladder and always incontinent of bowel; -Had an Unstagable pressure ulcer and a lesion on the foot. Review of the resident’s care plan, last updated on 8/30/18, showed the resident had activity of daily living (ADL) self-care deficits and is at risk for falls related to weakness, physical limitations, incontinence, and alteration in mobility and safety. Review showed staff were directed to do the following: -Provide the amount of assistance/supervision that is needed; -Report changes in ADL self performance to the nurse. Observation on 8/29/18 at 2:06 P.M., showed CNA H and CNA I transferred the resident from his/her bed to his/her wheelchair using the sit to stand mechanical lift. The CNA’s said the resident had a liquid bowel movement and care was already provided. Observation showed liquid stool on the mattress, sheet, hospital gown, resident’s back, buttocks, and dressing to the coccyx. CNA H tucked the brief around the resident’s frontal periarea, with nothing on buttocks. Without cleansing the resident, the CNA propelled the resident out into the hallway. Further observation showed liquid stool on the resident’s hospital gown and on his/her left leg. CNA I rolled up the section of the hospital gown and placed a blanket over the resident. Observation on 8/29/18 at 2:38 P.M., showed Certified Occupational Therapy Assistant (COTA) A and CNA H and transferred the resident back to his/her bed. Observation showed a dressing on the resident’s coccyx with serosanguineous drainage and feces on the bottom of the dressing and the resident’s groin excoriated. The CNA placed a brief on the resident after tucking in a positioning sheet. LPN G entered the room and assisted CNA H in positioning the lift sheet and incontinence pad under the resident, while smearing liquid stool. Observation showed the resident continued to have liquid stool on the lift sheet, brief, dressing to coccyx, in his/her groin, his/her upper leg, the mattress, and on the incontinence pad. The CNA and LPN left the room without providing incontinence care or cleansing the stool off of the resident or mattress. Observation on 8/30/18 at 3:28 AM, showed the resident slid out of bed and staff assisted the resident back to bed. Observation showed staff pulled on the resident’s brief to stand him/her up to transfer to his/her chair and then bed. The resident’s brief ripped in the center of the backside and was wedged between the resident’s buttocks. Further observation showed the resident had liquid stool and a large amount serosanguineous drainage on the end of his/her dressing to the coccyx. The staff raised the head and foot of the bed, and did not adjust the air mattress setting that was set to fully inflated or provide incontinence care including changing the resident’s ripped brief before leaving the room. Observation on 8/30/18 at 4:07 A.M., showed the head and foot of the resident’s bed elevated, and the resident lay on the right side with legs toward the edge of the bed. Observation showed CNA B lowered the foot of the bed and left the room without providing incontinence care, changing the ripped brief, or getting the nurse to change the resident’s soiled dressing to his/her coccyx. Observations on 8/30/18 showed the resident remained in the soiled ripped brief from 3:28 |
| 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 – Some | (continued… from page 29) A.M. to 5:47 A.M., when the surveyor asked to observe pericare on the resident. Observation on 8/30/18 at 5:47 A.M., showed CNA C unfastened the residents brief. Observation showed dried brown stool to the resident’s buttocks and groin, with excoriation. Further observation showed three yellow/white pimple like areas on the resident’s upper left side of the buttock. The CNA cleansed the crease of the buttock, but did not cleanse the sides or groin to remove feces. The dressing to the resident’s coccyx remained with serosanguineous drainage and feces. 8. During an interview on 9/5/18 at 6:40 P.M., CNA L said staff are expected to provide thorough perineal cleansing after each incontinent episode making sure to cleanse from front to back and in the folds of the skin. During an interview on 9/5/18 at 7:10 P.M., LPN V said staff are expected to cleanse from front to back, groin and back area after each incontinent episode. Interview on 9/05/18 at 6:58 P.M., the director of nursing (DON) said staff are to complete turning and repositioning rounds every two hours and check to see if the resident is soiled and if they are, they need to provide pericare to the resdient. When staff are providing pericare they should cleanse from front to back, and cleanse the entire soiled area to remove all stool and urine from the resident’s skin. Residents need to be turned to the opposite side that they were laying on if they are in bed. If resident’s are observed sleeping in chairs or are very restless, staff need to offer to lay the residents down in bed. Residents that have wounds, he/she would prefer to only see them up in the chair for meals. | |
| F 0686 Level of harm – Actual harm Residents Affected – Some | Provide appropriate pressure ulcer care and prevent new ulcers from developing. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** -A skin assessment should be performed weekly by a licensed nurse; |
| 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0686 Level of harm – Actual harm Residents Affected – Some | (continued… from page 30) turning schedules; -Encourage oral food and fluid intake; -Improve patient’s mobility and activity when potential exists. -Measures to protect the patient against the adverse effects of external mechanical forces, such as pressure, friction, and shear are implemented in the plan of care: -Reposition at least every 2-4 hours as consistent with overall patient goal and medical condition; -Utilize positioning devices to keep bony prominences from direct contact; -Ensure proper body alignment when side-lying; -Heel protection/suspension should be implemented while the patient is in bed; -Maintain head of bed at the lowest degree of elevation consistent with the medical condition; -Use lift devices to move patients in the bed; -A pressure reduction mattress replacement is placed under the patient; -When positioned in a wheelchair, the patient is to be placed on a pressure-reduction device and repositioned; -When positioned in a wheelchair, consideration is given to postural alignment, distribution weight, balance and stability. -Patient and significant others involved in the patient’s care are educated regarding the preventive skin care plan; -When skin breakdown occurs, it requires attention and a change in the plan of care to appropriately treat the patient; -Certain risk factors have been identified that increase a patient’s susceptibility to develop or impair healing of pressure ulcers. Examples include, but are not limited to: -Impaired/decreased mobility and decreased functional ability; -Co-morbid conditions, such as end stage [MEDICAL CONDITIONS] disease, diabetes mellitus, or other end of life concerns; -Drugs, such as steroids, that may affect wound healing; -Impaired diffuse or localized blood flow (for example: generalized [MEDICAL CONDITION] or l lower extremity arterial insufficiency); -Patient refusal of some aspects of care and treatment, especially in multi-system organ failure or end-of-life conditions; -Cognitive impairment; -Exposure of skin to urinary and fecal incontinence; -Under nutrition, malnutrition, and hydration deficits; -[MEDICAL CONDITION]; and -A history of a healed ulcer. 1. Review of Resident #14’s quarterly Minimum Data Set (MDS), a federally mandated assessment tool, dated 9/1/18, showed the facility staff assessed the resident as follows: -Brief interview for mental status (BIMS) score of 9 (moderately cognitively impaired); |
| 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0686 Level of harm – Actual harm Residents Affected – Some | (continued… from page 31) Further review showed staff assessed the resident’s right medial plantar foot wound as a medical device related pressure ulcer on the MDS dated [DATE]. During an interview on 9/5/18 at 6:45 P.M., Licensed Practical Nurse (LPN) G said the wound developed from a brace to the right foot and is located in an area where there is pressure. Review of the resident’s comprehensive care plan, dated 6/6/18, directed staff on the following interventions for friction and shearing to the right foot: -Complete Braden Scale quarterly and PRN (as needed); -Complete weekly skin report; -Inspect skin during bathing, especially over bony prominences; -Observe for signs and symptoms of infection or delayed healing and report to physician as needed any redness, drainage that is bloody or purulent (infection); -Refer to therapy as needed; -Report changes in skin status to physician, provide wound care as ordered, and observe effectiveness of response to treatment as ordered. Review of the resident’s medical record showed staff documented a skin assessment with an open area on the right plantar foot, dated 5/21/18. Record review of the physician’s orders [REDACTED].>Review of the resident’s wound module for the right medial plantar (inner and bottom) foot showed staff documented the following: – 5/21/18- Date of Origin for facility acquired right medial plantar foot, measured 3.00 (centimeter) cm x 3.00 cm x 0.10 cm, serous (watery) drainage, no undermining (destruction of tissue under the skin edges) or tunneling (a passageway of tissue destruction under the skin surface that has an opening at the skin level from the edge of the wound), 25% [MEDICATION NAME] in the wound bed. Further review showed staff did not indicate a Stage for the wound; – 5/29/18- Staff documented the wound measured 3.00 cm x 3.00 cm x 0.10 cm with light serosanguineous (bloody) drainage, no undermining or tunneling, 40% [MEDICATION NAME] and 60% other in the wound bed. Further review showed staff did not indicate a Stage for the wound; – 6/7/18- Staff documented the wound measured 1.00 cm x 1.00 cm with no drainage, no undermining or tunneling, 40% [MEDICATION NAME] (thin tissue covering body surfaces) and 50% eschar (dead tissue) in the wound bed. Further review showed staff did not indicate a depth or a stage for the wound; – 6/20/18 (13 days since last wound assessment)-Staff documented the wound measured 0.50 cm x 0.50 cm with no drainage, no undermining or tunneling, 100 %eschar in the wound bed. Further review showed staff did not indicate a depth or a stage for the wound; – 6/27/18-Staff documented the wound measured 0.40 cm x 0.40 cm with light serosanguineous drainage, no undermining or tunneling, 100% granulation in the wound bed. Further review showed staff did not indicate a depth or a stage for the wound, – 7/13/18 (16 days since last wound assessment)-Staff documented the wound measured 2.00 cm x 2.00 cm with no drainage, no undermining or tunneling, 100% granulation in the wound bed. Further review showed staff did not indicate a depth or a stage for the wound; – 7/25/18 (12 days since last wound assessment)-Staff documented the wound measured 2.00 cm x 2.50 cm with no drainage, no undermining or tunneling, 100% granulation in the wound bed. Further review showed staff did not indicate a depth or a stage for the wound; – 7/31/18-Staff documented the wound measured 1.00 cm x 1.00 cm with no drainage, no undermining or tunneling, 100% eschar in the wound bed. Further review showed staff did not indicate a depth or a stage for the wound; |
| 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0686 Level of harm – Actual harm Residents Affected – Some | (continued… from page 32) – 8/27/18 (27 days since last wound assessment)-Staff documented the wound measured 1.00 cm x 0.80 cm with no drainage, no undermining or tunneling, 100% eschar in the wound bed. Further review showed staff did not indicate a depth or a stage for the wound. Review of the resident’s Treatment Administration Record (TAR), dated (MONTH) (YEAR), showed staff did not provide the treatment using [MEDICATION NAME] (an antiseptic used to kill bacteria and prevent infection) to the right foot wound everyday. Review showed staff did not provide the treatments on 8/2/18, 8/11/18, 8/19/18, 8/25/18, 8/26/18, and 9/4/18. Observation on 8/31/18 at 9:45 A.M., showed LPN G entered the resident’s room to provide wound care. LPN G applied gloves and removed the soiled dressing. Observation showed the wound located on the right outer foot just below the 5th toe (an area over a bony prominence). Observation showed the wound covered with hard eschar, approximate dime size with a hard callus surrounding the wound. LPN G cleansed the wound then applied [MEDICATION NAME] to the wound, covered it with gauze and secured it with roller gauze. During this time, LPN G said the resident developed a blister on his/her right lateral foot from a brace and the resident has had the wound for about two months. LPN G said staff are to provide the treatment daily and keep a pillow under the resident’s right foot for pressure relief. During an interview on 9/4/18 at 3:50 P.M., the resident said she/he developed a blister from the use of a heavy black boot. Further, the resident said that the staff don’t always keep her/his foot elevated at night on a pillow while in bed and staff forget to do the treatment sometimes. Observation on 9/05/18 at 9:10 A.M., showed the last time staff changed the dressing to the resident’s right foot was 9/3/18. Observation showed staff hand wrote 9/3/18 directly on the dressing for the right foot wound. 2. Review of Resident #11’s quarterly MDS, dated [DATE], showed the facility staff assessed the resident as follows: -BIMS 10 (moderate cognitive impairment); -Requires extensive assistance from staff with bed mobility, transfers, dressing and toileting; -Always incontinent of bowel and bladder; -[DIAGNOSES REDACTED]. -At risk for the development of a pressure ulcer; -Pressure relieving devices on the bed and chair. Review of the resident’s comprehensive care plan, dated 2/27/18, showed staff updated the care plan to include pressure ulcers to the left and right heels as a problem to be addressed on the care plan. Staff updated the resident’s care plan to include the following: -8/7/18-wound to left heel, Stage III (Full-thickness loss of skin, in which subcutaneous fat may be visible in the ulcer and granulation tissue and epibole (rolled wound edges) are often present. Slough and/or eschar may be visible but does not obscure the depth of tissue loss), treatment as ordered and heel lift boots, -8/22/18-wound to right heel, Stage III, treatment as ordered and heel lift boots. Further review showed the comprehensive care plan, updated 8/7/18, directed staff with the following interventions: -Assist to reposition and shift weight to relieve pressure; -Complete the Braden scale risk assessment quarterly and PRN; -Complete weekly skin assessments; -Notify nurse immediately of any new areas of skin breakdown, redness, blisters, bruises, discoloration noted during bathing or daily care; |
| 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0686 Level of harm – Actual harm Residents Affected – Some | (continued… from page 33) -Provide pressure relieving or reduction device, pressure relieving mattress and chair cushion; -Refer to therapy as needed; -Report changes to physician. Review of the resident’s medical record, dated 8/7/18, showed staff identified a Stage III pressure ulcer on the resident’s left heel. Further review showed the wound measured 4.6 cm x 5.00 cm, slough tissue present. Further review showed staff did not include in the wound assessment the depth of the wound. Review of the residents wound module for the left plantar calcaneus (heel) showed staff documented the following: – 8/7/18-Staff documented 8/7/18 as the date of origin, facility acquired. Further review showed staff documented the wound measured 4.6 cm x 5.00 cm, Stage III, moderate amount of serosanguineous drainage, no undermining or tunneling, 10% of slough and 90% of granulation in the wound bed. Further review showed staff did not include the depth of the wound in the assessment; – 8/14/18-Staff documented the wound measured 4.5 cm x 5.00 cm, Stage III, light amount of serosanguineous drainage, no undermining or tunneling, 5% of slough and 95% of granulation in the wound bed. Further review showed staff did not include the depth of the wound in the assessment; – 8/14/18 (Staff documented two different wound assessments for the same date)-Staff documented the wound measured 2.5 cm x 5.00 cm, Stage III, light amount of serosanguineous drainage, no undermining or tunneling, 10% of slough and 80% of granulation in the wound bed. Further review showed staff did not include the depth of the wound in the assessment. Review of the physician’s orders [REDACTED]. Further review dated 8/22/18, showed the physician ordered to cleanse with normal saline then apply manuka pli to the right heel wound, cover with a dry dressing and roller gauze everyday and as needed. Review of the resident’s TAR for (MONTH) (YEAR), showed staff did not provide the treatment using manuka to the left heel wound everyday as ordered by the physician. Review of the TAR showed staff did not document that the treatment was provided to the left heel on 8/11, 8/12, 8/18, 8/19 and 8/21. Review of the resident’s medical record, dated 8/22/18, showed staff first identified a Stage III pressure ulcer to the resident’s right heel. Further review showed the wound measured 3.0 cm x 5.00 cm, slough tissue present, full thickness, red and beefy tissue and loose skin to the edges. Staff did not include in the wound assessment the depth of the wound. Further, staff documented the wound started out as a blood blister. Review of the resident’s wound module for the right plantar calcaneus (heel) showed staff documented the following: – 8/22/18-Staff documented 8/22/18 as the date of origin, facility acquired. Further review showed staff did not include an assessment of the right plantar calcaneus wound with measurements, drainage, wound bed and stage; – 8/27/18- Staff documented the right plantar calcaneus measured 3.00 cm x 5.00 cm, light serosanguineous, no tunneling or undermining, granulation 70%, slough 20% to the wound bed. Further review showed staff assessed the resident’s wound as a Stage III and did not address the depth of the wound. Observation on 8/30/18 at 2:45 A.M., showed staff did not apply the heel boots while the resident was in bed. Staff placed a pillow underneath the resident’s heels, but observation showed both heels lying directly on the mattress. Observation on 8/30/18 at 11:30 A.M., showed LPN G provided the treatment to the resident’s heels. LPN G said the right heel wound is new and currently measured 2.5 cm x |
| 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0686 Level of harm – Actual harm Residents Affected – Some | (continued… from page 34) 4.7 cm. Observation showed the right heel wound bed pink, surrounding skin red and [MEDICAL CONDITION] (swollen). Observation showed the left heel wound measured 2.2 cm x 5 cm with approximately 25% of slough in the wound bed, red and [MEDICAL CONDITION]. During this time, LPN G said both pressure ulcers were facility acquired, full thickness and at a Stage III. LPN G said the staff are expected to keep the pressure relieving boots on the resident at all times. During an interview on 8/31/18 at 9:45 A.M., LPN G said she/he is the wound nurse and provides all of the treatments during the week and weekly wound assessments, but has been pulled from her/his position to perform charge nurse duties. LPN G said she/he was pulled from her/his wound treatments to perform charge nurse duties three times in the last seven days. During an interview on 9/5/18 at 6:15 P.M., LPN V said professional staff are responsible for providing the wound treatments as ordered by initialing the TAR to show documentation that they were completed. 3. Review of Resident #435’s medical record showed [DIAGNOSES REDACTED]. Review of the resident’s MDS, dated [DATE], showed staff assessed the resident as follows: -BIMS score of 12 out of 15 (cognitively intact); -Required extensive assistance of one to two staff with all activities of daily living; -Incontinent of bowel and bladder; -admitted with three Stage III pressure sores measuring 4.0 centimeters (cm) by 4.0 cm, slough and one pressure sore healed; -Received antibiotics seven out of seven days. Review of the resident’s care plan, dated 3/7/18, showed an unstageable pressure sore on coccyx, and directed staff to: -Assist as needed to reposition/shift weight to relieve pressure; -Complete weekly skin checks; -Discuss non-compliance issue with resident/responsible party; -Notify nurse immediately of any new skin breakdown; -Observe effectiveness of treatment as ordered; -Monitor labs as ordered by physician; -Provide incontinence care after each incontinence; -Pressure relieving mattress and chair cushion; -Provide diet as ordered, provide protein supplement; -Wound care as directed by physician. Review of the resident’s POS dated 6/06/18, showed an order to cleanse coccyx wound with normal saline (may apply skin prep to peri wound) apply Manuka Pli and cover with dry dressing daily. Review of the resident’s wound reports showed the following: -Coccyx pressure sore date of origin 2/27/18, prior to admission; -First documented assessment dated [DATE] showed staff assessed the coccyx area wound as a Stage III, measuring 2.80 cm by 3.50 cm with 0.30 cm depth, total area measured 9.80 cm, light serosanguineous drainage with no undermining/tunneling, no incision, wound base 10% [MEDICATION NAME], 80% granulation, 10% slough, wound edge unattached, and surrounding skin intact and response to treatment improved; -7/4/18 and 7/12/18, blank except documentation that surrounding skin intact and response to treatment improved; -7/16/18, Stage III measuring 1.00 cm by 1.00 cm with 0.50 cm depth, light serosanguineous drainage with no undermining/tunneling, no incision, 10% [MEDICATION NAME], 80% granulation, 10% slough, wound edge unattached and surrounding skin intact, response to |
| 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0686 Level of harm – Actual harm Residents Affected – Some | (continued… from page 35) treatment improved; -7/25/18, Stage III measuring 3.00 cm by 3.00 cm by 0.50 depth, light drainage, 10% [MEDICATION NAME], 80% granulation, 10% slough, wound edge attached, surrounding skin intact, response to treatment deteriorated; -8/7/18, stage III measuring 3.00 cm by 2.50 cm by 0.40 depth, moderate drainage, 90% granulation, 10% slough, wound edge unattached, surrounding skin intact, response to treatment improved. Review of the medical record showed the resident was sent out to hospital for left above the knee amputation and resident was re-admitted on [DATE]. Review of the wound report, dated 8/22/18, showed the coccyx pressure sore was unstageable (full-thickness skin and tissue loss in which the extent of tissue damage within the ulcer cannot be confirmed because the wound bed is obscured by slough or eschar), slough and/or eschar, light drainage, no undermining/tunneling or incision, 20% [MEDICATION NAME], 10% granulation, 10% slough, wound edge unattached, surrounding skin intact [DIAGNOSES REDACTED], macerated, response to treatment not assessed. Review of the resident’s TAR, dated (MONTH) (YEAR), showed staff documented the treatment to the coccyx was not completed on 7/5, 7/6, 7/13, 7/14, 7/16, 7/19, 7/30, and 7/31. Review of the TAR, dated (MONTH) (YEAR), showed staff documented the treatment to the coccyx was not completed on 8/2/18 and 8/11/18. Review of the weekly summary on the back of the TAR, showed staff documented attempted to change resident’s dressings but resident refused. The resident yelled at this nurse to go away and leave him/her alone. Incoming nurse aware. Further review of the TAR dated 8/12/18, showed staff documented the treatment was completed. During an interview on 8/29/18 at 9:00 A.M., the wound nurse (LPN G) said he/she was gone from the facility the entire month of (MONTH) and did not return until (MONTH) (YEAR). LPN G said while he/she was gone the charge nurses were responsible for wound treatments/assessments. LPN G said when he/she returned, he/she tried to obtain information on residents wounds from the charge nurses as there was little documentation. Observation on 08/29/18 at 4:57 P.M., showed Certified Nurses Aide (CNA) W and LPN G wore gowns and gloves and entered the resident’s room. The resident had liquid feces on his/her buttocks. LPN G cleansed the resident’s buttock and changed his/her gloves and removed the resident’s old dressing from his/her coccyx. Observation showed a a large amount of blood tinged drainage on the old dressing and a large uneven circular wound to the resident’s coccyx. LPN G cleansed the wound with normal saline and 4 x 4 inch gauze. The LPN said the wound to the coccyx is unstageable with 80% slough and eschar in the center with maceration around the bottom periwound. Observation showed the resident continued to have liquid stool. LPN G cleansed the stool and changed gloves without washing his/her hands, placed skin prep around the wound edges, then applied a half dollar size amount of manuka pli directly onto 4 x 4 gauze and placed the 4 x 4 gauze onto the wound bed. The LPN cleansed liquid stool from the resident’s bottom, removed gloves, did not wash his/her hands, and applied abdominal wound dressing (used to manage heavy drainage) and adhesive tape over the dressing. Observation showed the LPN applied barrier cream to the buttocks and groin. Further observation showed the LPN changed his/her gloves, without washing his/her hands, removed the resident’s right heel lift boot, cut off the dressing to the right foot. Observation showed scant (small) amount of serosanguineous drainage on the soiled dressing and a moon shaped black eschar wound to the resident’s outer heel and a dime size circle black eschar area to the lateral right foot. The LPN cleansed both areas, changed gloves without washing hands or sanitizing, applied manuka pli to 4 x 4 gauze and wrapped 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0686 Level of harm – Actual harm Residents Affected – Some | (continued… from page 36) foot with kerlix gauze. During the same time, LPN G said when went the resident went to the hospital the wound was a Stage III pressure ulcer with very little slough to the coccyx. The resident was admitted with multiple other areas and some have healed, but these have gotten worse since the resident went back to the hospital. Staff just received a verbal order for the resident to start Closed Pulse Irrigation (CPI) treatment. During an interview on 8/30/18 at 12:19 P.M., the Medical Director/resident’s physician said the resident has very bad [MEDICAL CONDITION], which was the cause of wounds on lower legs/feet. The resident’s toes then became infected and he/she was placed on [MEDICATION NAME]. He consulted with the resident’s podiatrist and they agreed it would be best to amputate above the knee to give the resident the best chance of healing. He said the resident is not compliant with being positioned on his/her side and will move about until he/she gets back on his/her back. He said the resident’s nutrition is bad, some days the resident will eat, but it may be two or three days before he/she will eat very much again. He thought the resident should be on hospice due to the resident’s poor condition. He said the resident developed [MEDICAL CONDITION] as a result to all the antibiotics. He said the resident’s health shakes were held because they can cause diarrhea due to high sugar content. He said the resident’s family brought in protein shakes, which contain 30 grams of protein. During an interview on 8/31/18 at 09:00 A.M., the resident’s family member said the resident had been living at home alone, then had a stroke and was admitted to the hospital. The resident was at another facility and developed pressure sores which got infected and was transferred back to hospital then came to the facility. The family member said the resident’s physician had talked with them about his/her vascular disease causing the pressure sores to develop because of poor circulation. The family member said they are very involved with care, have had meetings with management staff regarding concerns with care issues. The family member said wound care on weekends does not happen. 4. Review of Resident #18’s physician’s progress note, dated 6/17/18, showed the physician documented the resident has a few complaints of some care issues and are not as responsive as they should be. Review showed the physician documented sacral Decubitus (ulcer) healing well. Review of the resident’s quarterly MDS, dated [DATE], showed staff assessed the resident as the following: -Modified independence with cognitive skills for daily decision making; -No behaviors, rejection of care, wandering, or changes in behavior; -Required extensive assistance of one staff with bed mobility, transfers, toileting, bathing, and personal hygiene; -Limited assistance of one staff for dressing; -Set-up help only for eating; -Limited range of motion (ROM) to both upper and lower extremities; -Always incontinent of bowel and bladder; -[DIAGNOSES REDACTED]. -Occasional moderate pain; -Stage III pressure ulcer measuring 1.4 cm by 1.4 cm by 0.2 cm with granulation tissue; and -Has a pressure reducing device in chair and bed, nutrition interventions, and receives pressure ulcer care. Review of the resident’s care plan, dated 6/18/18, showed the resident has a stage III pressure ulcer to his/her bottom, incontinence, and impaired mobility secondary |
| 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0686 Level of harm – Actual harm Residents Affected – Some | (continued… from page 37) to(NAME)Chiari syndrome and sympathetic neuroosteodystrophy (a complex reflex pain disorder). Staff are directed to do the following: -Assist to reposition/shift weight to relieve pressure as needed; -Complete Braden scale risk assessment quarterly as needed; -Complete weekly skin assessment; -Float heels when in bed; -Minimize pressure over bony prominences; -Notify the nurse immediately of any new areas of skin breakdown, redness, blisters, bruises, discoloration noted during bathing or daily care; -Observe lab results as ordered and report abnormal results to physician; -Position with pillows to maintain proper body alignment; -Provide diet as ordered and observe nutritional status and dietary needs, provide supplemental protein, amino acids, vitamins, minerals as ordered by physician to promote wound healing; -Provide incontinence care after incontinence episodes. Apply barrier cream as needed; -Provide pressure relieving or reduction device, pressure reduction mattress, and chair cushion; -Refer to therapy for positioning as needed; -Report changes in skin status to physician; -Turning and repositioning program every two hours as needed; -Use lifting device, draw sheet to reduce friction; -Avoid skin to skin contact; -Discuss non-compliance issues with the resident/responsible party; -Educate resident/responsible party about pressure ulcer etiology, primary risk factors, treatment, and prevention; -Encourage use of the side rails and/or trapeze to assist turning in bed; -Notify resident/responsible party of any new areas of skin breakdown; -Observe effectiveness of/response of treatments as ordered; -Observe for pain and medicate as needed per physician orders. Review of the physician’s progress note, dated 7/26/18, showed the physician documented the resident is upset because he/she was left uncleaned from 12:00 A.M. to 4:00 A.M. Stage IV (full-thickness skin and tissue loss with exposed or directly palpable fascia, muscle, tendon, ligament, cartilage or bone in the ulcer. Slough and/or eschar may be visible on some parts of the wound bed. Epibole (rolled edges), undermining and/or tunneling often occur)sacral wound examined with the corporate nurse. Wound has worsened and enlarged, wound is bone deep. Can palpate bone, however, wound is clean without significant discharge. Discussed wound care, check C-reactive protein (CRP) and Sedimentation (Sed) rate, will be difficult to heal wound. Review of the resident’s Braden Scale Risk Assessment, dated 7/27/18, showed staff assessed the resident at moderate risk for skin breakdown, related to decreased or impaired bed/chair mobility, existing pressure ulcer, history of pressure ulcers, incontinence of bowel and bladder, and pain. Review of the resident’s physician order [REDACTED]. -Health shakes with breakfast and dinner (12/15/17); -Cleanse coccyx with normal saline, apply [MEDICATION NAME] (sterile, freeze dried matrix composed of collagen a ND oxidized regenerated cellulose) to the wound bed and cover with dry dressing daily and as needed, ordered 3/13/18 and discontinued 7/27/18; -Low air loss mattress (ordered 2/27/17); and -Cleanse coccyx wound with normal saline, apply santyl (enzymatic deriding ointment) and |
| 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0686 Level of harm – Actual harm Residents Affected – Some | (continued… from page 38) dry dressing, change daily and as needed (no order date). Review of the resident’s telephone order sheet (TOS), dated 7/27/18, showed the physician directed staff to clean the coccyx wound with normal saline, apply santyl, and dry dressing daily and as needed. Review of the resident’s TOS, dated 8/7/18, showed the physician directed staff to discontinue santyl, after cleaning wound to coccyx with normal saline, apply manuka pli and saline moistened gauze, cover with dry dressing daily and as needed. Further review showed staff initialed the order was placed on the treatment sheet and in the nurses notes. Review showed staff did not initial the order documented on the POS. Review of the resident’s TOS, dated 8/31/18, showed the physician ordered physical therapy (PT) to evaluate and treat wound to coccyx. Review of the resident’s physician progress notes [REDACTED]. Review of the resident’s physician progress notes [REDACTED]. Review of the resident’s treatment administration records (TAR), dated (MONTH) (YEAR) through (MONTH) (YEAR), showed facility staff documented the following: -Cleanse wound with normal saline, apply [MEDICATION NAME] to wound bed, and apply dry dressing daily. Review showed no initials to show completion of treatment on 5/6/18, 5/8/18, 5/26/18, 6/2/18, 6/17/18, 6/22/18, 7/2/18, 7/4/18, 7/6/18, 7/13/18, 7/14/18, 7/18/18, and 7/20/18. Order discontinued on 7/26/18; -Cleanse wound with normal saline, apply Santyl, and dry dressing, change daily and as needed. Review showed staff did not initial to show completion of the treatment on 7/29/18 and 7/31/18, order discontinued on 8/7/18; -Cleanse wound with normal saline, apply manuka pli and saline moistened gauze, cover with dry dressing, change daily and as needed. Review showed staff did not initial to show completion of the treatment on 8/11/18 and 8/19/18. Review of the resident’s electronic medical record (EMR) skin assessments, showed staff documented the following: -5/16/18 coccyx pressure ulcer intact, improving, treatment to coccyx. The resident has an o | |
| F 0689 Level of harm – Immediate jeopardy Residents Affected – Few | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, facility staff failed to assess, |
| 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0689 Level of harm – Immediate jeopardy Residents Affected – Few | (continued… from page 39) -The interdisciplinary team (IDT) will review and revise, if indicated, all patients’ fall management care plans upon the completion of each comprehensive, significant change and quarterly MDS, upon a fall event and as needed thereafter. Care plan revisions will be made at this time as indicated; -Fall management training will be provided to all associates upon hire, annually and as indicated by Fall Management Performance Improvement Plans (PIPs); -Patients and/or family members will receive education on the patient’s fall management care plan and provided opportunity for feedback; -Accurate and thorough assessment of the patient is fundamental in determining indicators for potential falls; -Reporting tools that aggregate and collect patient assessment and other information of fall indicators will be utilized in the facility’s Fall Management Quality Assurance Performance Improvement activities and are therefore not considered part of the patient’s medical record. 2. Review of Resident #278’s face sheet showed the resident was originally admitted on [DATE]. Further review showed the resident had a [DIAGNOSES REDACTED]. Review of the resident’s quarterly Minimum Data Set (MDS), a federally mandated assessment tool, dated 6/14/18, showed staff assessed the resident as: -Severe cognitive impairment; -No behaviors; -Required extensive assistance of one staff with bed mobility, toilet use, eating, and personal hygiene; -Required limited assistance of one staff with dressing; -Dependent on one staff for bathing; -Frequently incontinent of bladder and always incontinent of bowel; -[DIAGNOSES REDACTED]. -Had a fall in the last month prior to admission; -Had no falls since last assessment dated [DATE]; -Had an unstagable pressure ulcer and a lesion on the foot; and -Received antidepressants three out of the last seven days prior to the assessment. Review of the resident’s care plan, last updated on 8/30/18, showed the resident has activity of daily living (ADL) self-care deficits and is at risk for falls related to weakness, physical limitations, incontinence, and alteration in mobility and safety. Review showed staff were directed to do the following: -Provide the amount of assistance/supervision that is needed; -Report changes in ADL self performance to the nurse; -Side rail(s) as an enabler (1/2 rails); -Fall risk assessment; -Provide environmental adaptation such as call light within reach and area free of clutter; -Remind the resident and reinforce safety awareness by locking brakes on bed and chair before transferring, appropriate footwear, and educate/remind resident to request assistance prior to ambulation; -Report falls to physician and responsible party; -Stage IV pressure ulcer (full thickness tissue loss with exposed bone, tendon or muscle) to coccyx, provide treatment as ordered and has a low air loss mattress; -At increased risk for falls related to self reports of alcohol consumption while on leave of absence (undated); -3/21/18 had fall on floor, educate on waiting for assistance; |
| 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0689 Level of harm – Immediate jeopardy Residents Affected – Few | (continued… from page 40) -5/6/18 had a fall with no injury, monitor and redirect, assist with transfers, remind to lock wheelchair, call light within reach, and frequent monitoring required to monitor safe environment; -6/3/18 had a fall in television room, slid off of couch without injury; -8/23/18 bed in low position always, resident tries to get up without assistance, ensure call light is within reach, remind to call for help when needed; -8/30/18 new bed, slid off the bed, ensure bed is as low as possible and call light is within reach. Review of the resident’s hospital records, dated 8/15/18-8/19/18, showed the physician documented the resident was admitted for altered mental status, [MEDICAL CONDITION]-fibrillation (A-Fib)(irregular heart beat), [MEDICAL CONDITION] (kidney infection),[MEDICAL CONDITION] (life-threatening complication of an infection), metabolic [MEDICAL CONDITION] (abnormalities of chemicals that adversely affect the brain function), dementia, and [MEDICAL CONDITION]. Review of the hospital records showed a positive urine culture for [MEDICATION NAME] resistant [MEDICATION NAME] (VRE) and a bone scan on 8/17/18 positive for [MEDICAL CONDITION] metastasis. The resident presented with a fever of 102 degrees Fahrenheit. Review of the resident’s hospital discharge orders, dated 8/19/18, showed the physician ordered the resident to take [MEDICATION NAME] (antibiotic) 875-125 milligrams (mg) by mouth every 12 hours for 10 days, and [MEDICATION NAME] (anticonvulsant) 500 mg twice daily. Review of the resident’s physician order [REDACTED]. Review of the resident’s telephone order sheet (TOS), dated (MONTH) (YEAR), showed staff received the following orders from the physician: -8/21/18 discontinue [MEDICATION NAME] after four days; -8/25/18 send the resident to the emergency room (ER); -8/27/18 obtain an x-ray of the resident’s right lower extremity; -8/27/18 low air loss mattress; -8/30/18 verbal order for resident to receive physical therapy (PT), occupational therapy (OT), and speech therapy (ST) evaluation and treatment; -8/30/18 OT clarification: resident to be seen five times per week for 12 weeks including there-ex, therapeutic activities and wheelchair management. Review of the resident’s treatment administration record (TAR), dated (MONTH) (YEAR), showed the resident is to have a low air loss mattress. Review showed no documentation to show what setting the mattress was to be on for the resident’s weight and firmness. Review of the resident’s nursing notes, showed staff documented the following: -3/21/18 Resident was found on the floor beside his/her bed, had increased lower extremity weakness. Resident reported sliding from the bed, found on his/her knees, and when he/she transferred back to bed could not bear weight; -3/22/18 Resident found on floor at approximately 3:00 P.M. with feces on the floor. Resident had no complaints of pain or discomfort and placed at nursing station for further evaluation; -4/22/18 Resident is alert and oriented to person, place, and time, on follow-up for fall, range of motion (ROM) within normal limits (WNL), no injuries, voiced general discomforts, educated to use call light to prevent further falls; -5/6/18 Resident is alert and oriented, able to transfer self in wheelchair, needs assistance with hygiene care. Resident found sitting on the floor in his/her room. The resident reported he/she was trying to sit in the wheelchair and sat on the floor. ROM to all extremities, no injury, and denies pain. Resident assisted to bed with call light |
| 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0689 Level of harm – Immediate jeopardy Residents Affected – Few | (continued… from page 41) within reach; -5/14/18 Resident up in wheel chair resting in room with some confusion. Therapy assisted into wheelchair but once up CNA and nurse had difficulties. Resident has decreased strength and is unable to stand. Sit to stand mechanical lift is to be used for transfers; -5/26/18 Resident found sitting on the floor diagonal to the wheelchair that is behind the resident. The resident does not appear to have hit his/her head. Resident reported trying to get to bed. Call light was in reach and the CNA and nurse used a gait belt to transfer to bed; -5/28/18 Resident is alert and oriented to name, requires total care including turning/repositioning in bed. Call light is within reach. Monitor resident for kicking his/her legs out of the bed, and keep bed in the lowest position; -6/1/18 Resident continues to be non-compliant with transfers. Refused to allow CNA to assist to wheelchair this morning and then was found 45 minutes later on the floor sitting on bottom with legs in front of him/her. Non skid footwear was in place to both feet. The resident stated he/she thought he/she could do it by him/herself. The resident requires assistance of one to two staff; -6/3/18 Resident found sitting on the floor in front of his/her wheelchair. Resident stated that he/she lowered him/herself from his/her wheelchair to the floor. No injuries noted, will continue to monitor, recommend frequent room checks or remove wheelchair to discourage unassisted transfers to the wheelchair; -6/4/18 Resident on the floor, slid off the couch in the television room. Staff assisted resident into wheelchair and then into bed. Call light is within reach, bed in lowest position, and no injuries observed; -6/5/18 Resident lying in bed with bed in low position, locked, and a low air loss mattress. Requires assistance of one to two staff with ADLs and transfers; -6/7/18 Resident transferred to ER related to being lethargic and unable to bear weight; -6/11/18 Resident returned to the facility with [DIAGNOSES REDACTED]. The resident is able to express wants and needs, but has difficulty following directions at this time. Is on antibiotic for VRE; -6/12/18 Maintenance informed about low air loss mattress low pressure. Maintenance stated that the hose needs to be fixed and reconnected, awaiting completion; -6/22/18 Resident found on floor again next to bed. The resident stated that the bed was too low. Range of Motion (ROM) WNL, neuro checks completed and resident denied hitting head. Recommendation of frequent rounds, bed alarm or keep up in the chair next to nursing station. The resident has been given teaching many times, but continues to try and perform ADLs, and resident is very weak in lower extremities; -7/27/18 Resident found on the floor by staff. Resident stated that he/she slid out of the bed trying to look for his/her book. Bed is in the lowest position and call light is within reach. No injuries observed and resident denies pain. Reminded resident to use call light for assistance; -8/15/18 Resident sent to ER because he/she is unable to follow commands, very confused, and a temp of 102 degrees; -8/19/18 Resident returned to the facility, is dependent on staff for ADLs and transfers, bed lowered to floor, call light within reach. Will continue to monitor; -8/25/18 Resident was at nurses station and started hitting head against the wall, with his/her eyes rolling back, and shaking, resident sent to ER; -8/25/18 Resident found on the floor before breakfast in front of his/her wheelchair on the right side of nurses station. Resident was assisted with two staff back to the wheelchair. The resident complained of pain to the right lower extremity. The resident’s |
| 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0689 Level of harm – Immediate jeopardy Residents Affected – Few | (continued… from page 42) right foot is swollen and no redness/warmth was observed. Physician notified and received order for an x-ray to the right lower extremity; -8/25/18 Resident returned from hospital with new [DIAGNOSES REDACTED]. Received a new order for antibiotic, potassium, and [MEDICATION NAME]; -8/30/18 Resident found sitting on the floor at the side of the bed. Resident stated he/she slid off of the bed. No injuries were observed and message left for physician. The bed was placed as low as it would go. Review of the resident’s medical record on 8/28/18, showed the resident did not have an assessment or consent for the use of bed rails. Review of the resident’s medical record on 8/31/18, showed a blank bed rail assessment in the resident’s chart without a signature of consent. Review of the Gendon Bariatric Bed manufacturer instructions, undated, showed the mattress should be sufficiently wide enough to prevent any part of the patient’s body from falling between the side rail and mattress. Observation on 8/27/18 at 1:55 P.M., showed the resident lay in bed on his/her back with his/her knees bent and feet pressed against the foot board. Low air loss mattress inflated and set on level 3. Observation showed the resident’s call light lay on the floor at the head of the bed. Observation on 8/27/18 at 5:30 P.M., showed the resident lay in his/her bed uncovered, with his/her legs off the side of the bed. Further observation showed the resident was visible from the hallway as staff and visitors walked by the resident’s room. Observation on 8/28/18 at 9:07 A.M., showed the resident sat up in bed eating breakfast, air mattress on and call light on floor at the head of the bed. Observation showed the resident’s bed had 1/2 bed rails with a 2-3 inch opening between the mattress and bed rail, on each side. Observation on 8/28/18 at 3:58 P.M., showed the resident resting in bed with 1/2 bed rails on both sides and the mattress about 2-3 inches from the siderails on both of the sides. Observation on 8/29/18 at 10:24 A.M., showed the resident attempted to remove the pressure relieving boots. Observation showed the head of the bed elevated, lift sheet and resident slid down from head of the bed with the resident unable to straighten his/her legs. The resident lay on his/her right side near the edge of the bed, kicking his/her legs off the side of the bed. Side rails on both sides continue to have a 2-3 inch gap between the mattress and the bed rail and low air loss mattress set at a level 3. Observation on 8/29/18 at 12:33 P.M., showed the resident with his/her head of the bed elevated and feeding him/herself lunch. The low air loss mattress inflated to a level 3 on firmness and both 1/2 side rails up with the mattress 2-3 inches away from the bed rails on each side. Observation on 8/29/18 at 12:27 P.M., showed the resident lay in bed pulling at the sheets and attempting to remove pressure relieving boots. Observation showed the resident pulling at the sheet and both legs off the side of the bed with both 1/2 side rails up and the mattress 2-3 inches away from the bed rails on each side. Observation on 8/29/18 at 2:06 P.M., showed CNA H and CNA I position the sit to stand lift facing the resident, positioned the resdient’s feet on the lift with knees positioned against knee pads. The CNAs placed the sling around the resident’s torso and attached the sling end loops to the machine. CNA I began lifting the resident with the lift. Observation showed the resident remained in a sitting like position with knees bent and arms extended above his/her head with the sling bunched up under his/her arms. Staff asked the resident to stand up and the resident was unable to bear weight. CNA H and CNA I did not lower the resident back to the bed. Observation showed CNA H began turning the lift |
| 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0689 Level of harm – Immediate jeopardy Residents Affected – Few | (continued… from page 43) toward the chair while CNA I pushed on the resident’s bottom. The CNAs lowered the resident into the wheelchair while saying the resident needs to be transferred with a hoyer lift (mechanical lift). CNA H said they are changing the resident’s bed to a bariatric bed, because he/she is too long for his/her current bed. Observation on 8/29/18 at 2:15 P.M., showed housekeeping staff push the resident’s bed out into hall. Observation showed housekeeping staff place the resident’s mattress from his/her bed onto the bariatric frame. Housekeeping staff moved the bariatric bed into the resident’s room, placed the headboard, footboard, new 1/2 bed rails, and air mattress overlay machine for the end of the bed. Observation showed housekeeping staff attached the air mattress to the pump and turn it on. Housekeeping staff attempted to place a positioning wedge at the foot of bed to fill the gap. Observation showed the wedge fell through the gap twice before staff layed it partially on the mattress. Housekeeping staff left the room. Observation showed the resident’s low air loss mattress was set on level 5, the highest setting, indicating the mattress was fully inflated at the firmest level and a three to four inch gap between the resident’s left side bed rail and the mattress. Observation on 8/29/18 at 2:38 P.M., showed CNA H propelled the resident from the hall into his/her room and placed the resident’s feet on the sit to stand lift. Certified occupational therapy assistant (COTA) A and CNA H placed a gait belt around the resident’s chest and then the sling to the the lift, placing the loops on the end of the sling over the knobs on the lift. The CNA instructed the resident to hold onto the lift, while placing the resident’s hands onto the bar of the lift. The CNA lifted the resident with the sit to stand lift, while COTA A held onto the gait belt. Observation showed the resident’s knees remained bent in a sitting position and his/her arms fully extended above his/her head with the sling bunching under the resident’s arms and the resident was unable to bear weight and assist with standing. The CNA and COTA transferred the resident to his/her bed, while holding onto his/her pants and gait belt while positioning the lift feet under the bed. Observation showed three to four inches between the bed rail on the resident’s left side and the mattress. Observation on 8/30/18 at 2:39 A.M., showed the resident lay on his/her left side with one leg off the left side of the bed. Observation showed both 1/2 side rails up with about four inches between the mattress and bed rail on the resident’s left side of the bed and a fall mat on the resident’s right side of the bed. The resident’s roommate moaned out and his/her tube feeding pump beeped. Observation on 8/30/18 at 2:45 A.M., showed the resident’s roommate continued to moan out and his/her tube feeding pump beeped. Observation showed Resident #278 had both legs off the left side of the bed and the sheet pulled away. The resident’s call light was positioned above the resident’s head on the mattress. Observation on 8/30/18 at 3:02 A.M., showed LPN E peek into the room, but did not go in to reposition the resident or fix the resident’s roommate’s tube feeding machine. Further observation showed CNA DD walked down the hall to another resident’s room. Observation on 8/30/18 at 3:26 A.M., showed CNA A entered the resident’s room and the resident was on the floor between his/her bed and his/her roommate’s bed. The CNA got the nurse and re-entered the resident’s room. Observation on 8/30/18 at 3:28 A.M., showed CNA A and LPN E entered the resident’s room. Observation showed the resident’s air mattress set on level 5, fully inflated. The resident lay on his/her back between his/her bed and his/her roommate’s bed. The resident’s head was positioned on his/her roommate’s small wedge at the foot of the bed, with the call light cord wrapped around the resident’s lower legs and the blankets and sheets wrapped around the resident’s torso. A fall mat was positioned on the other side of |
| 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0689 Level of harm – Immediate jeopardy Residents Affected – Few | (continued… from page 44) the bed, but not on the resident’s left side of the bed. The LPN asked the resident if he/she could sit up and the resident said yes. Observation showed the LPN pulled on the side of the resident’s arm and torso, but the resident did not move. The LPN told CNA A to go and get some other staff to help get the resident back to bed. The resident said, I slid out of bed. The LPN and CNA C both placed an arm under the resident’s arms and turned the resident to a sitting position on the floor with his/her back resting against his/her roommate’s bed and feet under his/her bed. The resident moaned out while saying ough as staff sat the resident up. The LPN asked the resident if he/she was okay after sitting the resident up and the resident said yes. The LPN did not complete ROM or ask the resident if he/she hit his/her head to ensure the resdient did not have any pain or injuries prior to moving the resident. CNA C, CNA K, and CNA CC placed a gait belt around the resident’s torso. The three CNAs and LPN unsuccessfully attempted to lift the resident to a standing position and into his/her wheelchair with the gait belt and pulling on his/her brief three times. Observation showed the resident’s legs stayed out in front of the resident and the resident unable to assist the staff. The resident said loudly, No, that’s not going to work. The CNA’s and LPN lowered the resident back down with the resident’s back scraping down the side of his/her roommates’s bed frame and hitting his/her foot on the resident’s bedframe. The LPN asked the CNA’s if the bed would lower down any further and the CNA said this new bed will not go down as far as the other bed would. Observation showed the staff move the resident’s bed closer to the door away from the resident and position his/her wheelchair closer to the resident. CNA B, CNA C, CNA K, CNA CC, and LPN E attempted to lift the resident with the gait belt and pulling on the resident’s brief four more times with the resident’s brief ripping and wedging between the resident’s gluteal crease and staff lowering the resident to the floor each time. On the fifth attempt, observation showed the CNA’s and LPN held onto the gait belt and brief, and lifted on the resident’s buttocks to get him/her in the wheelchair. The CNAs and LPN positioned the wheel chair close to the bed, and with the gait belt and holding onto the resident’s ripped brief stood the resident up and transferred him/her to the bed. Observation showed the resident was unable to bear weight and assist staff and staff started to lower the resident down towards the ground when CNA CC and the LPN lifted under the resident’s upper thighs, barely getting the resident onto the left side of the bed. Staff positioned the resident on his/her right side and covered up the resident. CNA C asked the LPN where to place the single fall mat. The LPN said he/she was on the other side earlier when he/she fell . The CNA placed the fall mat on the right side of the bed and placed the call light by the resident’s head of the bed. CNA B raised the head and foot of the bed 30 to 40 degrees before leaving the room. The CNA’s and LPN did not position the resident at the head of the bed and the resident told the staff that he/she could not straighten his/her legs, because they were pressed against the footboard. The staff did not check the settings of the low air loss mattress prior to leaving the resident’s room. During an interview at the same time, LPN E said the resident’s bed was switched out earlier in the day and is not a good fit for the resident. The LPN said the resident slid out of it twice tonight. Observation on 8/30/18 at 4:07 A.M., showed the resident’s legs toward the edge of the bed on the right side. Observation showed CNA B lower the foot of the bed and the resident was able to straighten out his/her legs. The resident’s 1/2 side rail and mattress remained about 4 inches from each other on the resident’s left side. Observation on 8/30/18 at 4:14 A.M., showed LPN E call the physician and notify him/her that the resident slid off of the bed twice and that there were no injuries either time. Observation on 8/30/18 at 4:30 A.M. showed the low air loss mattress as an Easy Air |
| 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0689 Level of harm – Immediate jeopardy Residents Affected – Few | (continued… from page 45) Pressure Guard. The mattress was shorter than the frame and there was approximately five inches between the mattress and the foot of the bed. The mattress was observed to have slid to the right side of the frame causing a four inch gap between the bed rails and the mattress on the left side of the bed. Observation on 8/30/18 at 5:12 A.M., showed the resident lay on his/her right side toward the edge of the mattress holding onto the side rail. The low air loss mattress remained fully inflated to a level 5 firmness. During an interview on 8/30/18 at 5:19 A.M., CNA A said the resident slid off the bed during transitioning from evening to night shift and then again this morning. When staff arrive to work, the CNA’s conduct rounds about every two hours at 1 A.M., 3 A.M., and 5 A.M. When the resident places his/her feet out of the bed staff should assist the resident in putting them back in bed or ask the resident to put them back if he/she is able to. He/she was conducting rounds when he/she heard the resident’s roommate moaning. He/she entered the room, saw the resident on the floor and went to get the nurse. Review of the nurses 24 hour report of resident’s conditions, dated 8/30/18, showed the nurse documented the resident was found sitting on the floor with no injuries. The resident said he/she slid off the bed. Observation on 8/30/18 at 5:24 A.M., showed the resident remained on his/her right side, with a four inch gap between the left bed rail and the mattress, and the air mattress set at level 5, fully inflated. During an interview on 8/30/18 at 5:25 A.M., LPN E said the resident fell twice tonight, the first time was when night shift staff first came in. The LPN said he/she did not know anything about the settings for the air mattress and what the resident’s should be set at. He/she is unsure who is responsible for adjusting the settings. When the resident is in the bed, the bed is supposed to be in its lowest position, fall mats on the side of the bed, and call light in place. The resident frequently calls out and throws his/her legs over the side of the bed. The resident can have his/her door closed, but it is usually open. If staff find a resident on the floor the nurse is to assess the resident, ask if they are hurt, and get them off of the floor. Staff should take the resident’s vital signs and complete IFU (incident report for falls) in the software, notify the physician and director of nursing (DON) and send to the ER if they are hurt or provide a treatment if they received a wound or injury. LPN E said he/she usually has the resident move his/her extremities, to check for ROM. The LPN said he/she had the resident move his/her extremities with the first fall last night and didn’t ask him/her to do so with the second fall. The resident normally transfers with two staff. The resident is different and more confused. He/she has become more dependent on staff, and he/she is heavy with not being able to bear weight. Trying to get the resident on a hoyer lift pad would have been difficult. At the beginning of the night, he/she was bearing more weight. During an interview on 8/30/18 at 5:38 AM. CNA C said he/she helped transfer the resident back to bed earlier in the night when he/she fell . The resident was able to assist at that time and he/she was able to stand with assistance. The resident was on the side by the bathroom when he/she fell at the change of shift. When a resident is found on the floor, the CNA’s are expected to notify the nurse. The CNA should make the resident comfortable until the nurse can assess him/her prior to getting the resident off of the floor. The resident is always in bed on night shift. The CNA was told in orientation to not lift residents off of the floor after a fall. Staff are expected to use the hoyer lift to get them up. The CNA said he/she suggested using the hoyer with the resident, but the other staff said the hoyer wouldn’t fit. The CNA said he/she even suggested moving the bed out of the way to get the hoyer lift in the room and they said no. The staff should remind |
| 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0689 Level of harm – Immediate jeopardy Residents Affected – Few | (continued… from page 46) residents about the call light. He/she said he/she only used the gait belt to assist with transferring the resident. The CNA said he/she is unsure how to adjust the airflow or what the setting should be on for the air mattress. He/she is unsure who is responsible for ensuring the airlflow is at the right setting. He/she has not received training on the air mattress settings. During an interview on 8/30/18 at 9:41 A.M., the Maintenance Director said that the facility is to get measurements from the bed frame, then fit the air bed to the frame. The Maintenance Director said he did not have the users manual for the bed or the air mattress. The Maintenance Director said nursing staff changed out the mattress. During an interview on 8/30/18 at 10:07 A.M., the DON said during the last week, the resident acted like he/she wanted to get up so staff were getting him/her up in the wheelchair. Staff have been told to do rounds and check on the resident frequently. If staff observe the resident throwing his/her legs off of the bed, staff are expected to ask the resident why he/she is trying to get up. If the resident is up in the wheelchair staff should place him/her in a field of vision. Since the resident has had frequent falls, staff have been instructed to ensure the bed is in the lowest position and they implemented fall mats last Saturday, the same day the resident began having [MEDICAL CONDITION] with no previous history or diagnosis. The resident [MEDICAL CONDITION] with metastasis to the bone and they are thinking that [MEDICAL CONDITION] may be in the brain now. On Monday or Tuesday, staff reported the resident would not stay in the bed so they decided the resident needed a bigger bed. The resident was a little bit too long for the other bed. The DON said he/she was not aware that staff put the resident’s previous mattress on the new bed frame and unaware of the changes to the air mattress pump/machine. The DON said he/she guessed that whoever delivered the bed sets up the mattress. The wound nurse should know the settings, but the DON has never looked at the setting. He/she would go by the manufacturer’s recommendations. Housekeeping staff should not plug in or set up the level of firmness on the air mattress settings. The DON said they already started educating on the sit to stand lift transfer yesterday. If a CNA notices a change in the residents transfer status or a decline, they need to report it to the nurse. The nurse should assess the resident to see if transfer status changed. If the resident is on the floor, the nurse should complete ROM and if the resident has pain, assess to see if they could have bumped their head. The assessment should be done before they are moved off of the floor. ROM assessment should have been completed even if it was completed during the previous fall, because the resident could have still injured him/herself. The resident’s door should be open because staff need to see if the resident’s legs are off of the bed. The resident should have a mat on both sides of the bed. The DON said he/she doesn’t know why the resident did not have fall mats on the floor prior to the one on the right side of the resident’s bed after the resident’s first fall last night. During an interview on 8/30/18 at 12:20 P.M., the Medical Director said the resident’s bed should have been in the the lowest position, because he/she wiggles out and was recently diagnosed with [REDACTED]. If the resident is unable to bear weight, staff should use the hoyer lift to transfer the resident from the floor to the bed. During an interview on 8/30/18 at 4:07 P.M., the bed frame manufacturer representative said a two inch gap on each side is too much. The sides should be flush with the bed rails, and two inches would be okay at the head and foot of the bed only. NOTE: At the time of the survey, the violation was determined to be at the immediate and serious jeopardy level J. Based on observation, interview and record review completed during the onsite visit, it was determined the facility had implemented corrective action to address and low (TRUNCATED) |
| 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0689 Level of harm – Immediate jeopardy Residents Affected – Few | ||
| F 0698 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | Past noncompliance – remedy proposed **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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0698 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 48) Review of the resident’s physician order [REDACTED]. Review of the resident’s progress note, dated 8/26/18, showed resident alert, makes connections, eats intermittently, speech recommended pureed diet with thicken liquids. Family bringing in regular food and sodas against medical advice. Review of a nutrition note, dated 8/28/18, showed interdisciplinary team met to discuss with the resident’s family member diet texture change and family preference. Diet downgraded to puree texture in attempt to increase intake from 10 percent to 75 percent with feeding assistance however significantly decreased back to 10 percent. Diet returned to mechanical soft diet that resident prefers. Review of the resident’s nursing progress notes, dated 9/3/18, showed staff documented received a call from [MEDICAL TREATMENT] center nurse that the resident was sent to hospital emergency room due to low blood pressure. Call placed to spouse to make aware. 4. Review of Resident #29’s annual MDS, dated [DATE], showed staff assessed the resident as follows: -Moderately cognitive impairment; -Required extensive assistance from staff with bed mobility, transfers, dressing, toileting and personal hygiene; -Frequently incontinent of bowel; -Occasionally incontinent of bladder; -[DIAGNOSES REDACTED]. -Diuretic medication in the last 7 days; -Received [MEDICAL TREATMENT] while a resident; -Weight is not present. Review of the resident’s comprehensive care plan, dated 6/27/18, directed staff on the following interventions for potential for complications from [MEDICAL TREATMENT]: -Administer medications and observe effectiveness of medications as ordered; -Check shunt site for signs and symptoms of infection, pain, and bleeding daily and as needed; -Communicate with [MEDICAL TREATMENT] center regarding medication, diet and lab results. Coordinate the resident’s care in collaboration with [MEDICAL TREATMENT] center; -Consult with the dietician for nutritional support related to [MEDICAL CONDITION]; -Ensure that food and fluids offered during activities comply with diet restrictions; -Monitor shunt site by palpating for thrill and auscultating for bruit every shift. Notify physician of absence of thrill or bruit. Review of the resident’s medical record showed staff documented the resident received [MEDICAL TREATMENT] on Tuesday, Thursday and Saturday at an offsite [MEDICAL TREATMENT] clinic. Observation on 9/4/18 at 3:15 P. M., showed staff returned from [MEDICAL TREATMENT] with the resident. Unknown staff assisted the resident back to the nurse’s station. Staff did not immediately assess the resident’s access site or call the [MEDICAL TREATMENT] clinic for a report. Review of the nurse’s notes on 9/5/18 at 2.00 P. M., showed that staff did not document assessment of the resident’s access site for [MEDICAL TREATMENT] immediately upon return from the offsite [MEDICAL TREATMENT] clinic on 9/4/18 at 3:15 P.M. Further record review showed staff did not document communication with the [MEDICAL TREATMENT] clinic after the resident returned from [MEDICAL TREATMENT]. 5. During an interview on 9/5/18 at 11:05 A.M., Licensed Practical Nurse (LPN) F said they do not send any communication to [MEDICAL TREATMENT]. He/She said the charge nurse is responsible for communicating with the [MEDICAL TREATMENT] clinic. He/She said 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0698 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 49) [MEDICAL TREATMENT] center notifies the facility when there is a problem. During an interview on 9/5/18 at 6:45 P.M., LPN V said staff do not call or communicate with the [MEDICAL TREATMENT] clinic unless there is a problem. LPN V said after the resident returns from [MEDICAL TREATMENT] the nurse will assess the access site, but only document in the nurse’s notes if there is a problem. During an interview on 9/5/18 at 2:21 P.M., the DON said that the RD calls [MEDICAL TREATMENT] weekly and gets updates on resident status. She said [MEDICAL TREATMENT] does not send any information to the facility. | |
| F 0700 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail. **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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0700 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 50) -Recommendations and recommended type; -Benefits: Based on the resident’s individual need(s), bed rails may be beneficial for: -Security: Can provide resident with a sense of security if the resident has a fear of falling, his/her movement is compromised or he/she is accustomed to sleeping in a larger bed; -Mobility Aide: Can enable resident to reposition self, or assist in repositioning self either side to side or upward/downward. Can assist resident in safety entering or exiting bed; -Safety: Can act as safety measure by preventing slipping or rolling onto floor for resident with, but not limited to, [MEDICAL CONDITION], neurological or movement disorders; -Potential Risks and Negative Outcomes: The use of bed rail(s) may involve risks such as: getting caught in the rails, getting caught between the rail and mattress, strangulation, suffocation, hitting against the rails causing bruising and/or skin tears, and crawling over the top of the rail risking a fall from a higher level with a risk for greater injury or death. Bed rails can present a hazard to certain individuals, particularly those residents with physical limitations or altered mental status, such as dementia or [MEDICAL CONDITION]. Other negative outcomes may include, but are not limited to: reduce physical mobility and muscle functioning, skin integrity issues, feelings of isolation and increased agitation and anxiety. -I have been informed that I have a medical need that would be addressed by the use of bed rails. I have been advised of the benefits and potential risks and negative outcomes of bed rail use, and the health care professionals’ evaluation/recommendations: I do voluntary consent to use of bed rails recommended above; I do not consent to the use of bed rails recommended above and understand related liabilities; -Resident signature, Resident Representative or Durable Power of Attorney for Healthcare signature, and Facility Representative signature/title. 1. Review of Resident #11’s quarterly Minimum Data Set (MDS), federally mandated assessment tool, dated 5/26/18, showed the facility staff assessed the resident as follows: -BIMS 10 (moderate cognitive impairment); -Required extensive assistance from staff with bed mobility, transfers, dressing and toileting; -[DIAGNOSES REDACTED]. Review of the resident’s comprehensive care plan, dated 3/19/18, directed staff to use 1/2 side rails as an enabler on the resident’s bed. Review of the resident’s medical record showed staff did not complete a bed rail assessment for the resident’s bed and use of side rails and did not receive consent from the responsible party. Observation on 8/29/18 at 12:30 P.M., showed the resident lay resting in bed with eyes closed. Further observation showed the bed had 1/2 side rails pulled up on both sides of the bed. Observation on 8/30/18 at 3:30 A.M., showed the resident lay resting in bed with eyes closed. Further observation showed the bed had 1/2 side rails pulled up on both sides of the bed. Observation on 8/31/18 at 10:30 A.M., showed the resident lay resting in bed with eyes closed. Further observation showed the bed had 1/2 side rails pulled up on both sides of the bed. 2. Record review of Resident #52’s face sheet showed he/she was admitted to the facility |
| 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0700 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 51) on [DATE] [DIAGNOSES REDACTED].>-Fracture left femur (thigh bone); -[MEDICAL CONDITION] (the narrowing of arteries due to plaque buildup on the artery walls. Arteries carry blood from the heart to the rest of the body). Record review of the resident’s physician’s orders [REDACTED]. -Skilled physical therapy (PT) and occupational therapy (OT) five times a week for twelve weeks. Record review of the resident’s Care Plan, dated 8/8/18, showed the resident: -Had a 1/2 side bed rail as an enabler on the right side of the resident’s bed; -Had a recent fall which resulted in a left femur fracture; -Required assistance with all Activities of Daily Living (ADL’s). Observation on 8/27/18 at 1:00 P.M., showed the resident had a 1/2 bed rail attached to the right side of his/her bed. During an interview on 8/31/18 at 11:00 A.M , the resident said: -He/she used the bed rail to pull him/herself up to sit in an erect position; -He/she needed the bed to help him/herself move from the bed to his/her wheelchair; -Has to contact the nurse if there are problems with the bed rails and then the nurse notifies maintenance if bed rails did not work properly. Record review of the resident’s Medical Record on 8/31/18, showed the staff did not complete a bed rail assessment, and there was no consent form that was completed and signed by the resident and/or his/her responsible party found in the resident’s medical record. 3. Record review of Resident #60’s face sheet showed the resident was admitted to the facility on [DATE] with [DIAGNOSES REDACTED].>-Mild Cognitive Impairment; -Dysphasia (language disorder marked by deficiency in the generation of speech or due to brain disease or damage); -Type II Diabetes. Record review of the resident’s Care Plan, dated 8/8/18, showed the resident: -Had right sided weakness and required assistance with all his/her ADL’s and transfer needs; -Needed maximum assistance from staff for all transfer needs, bed mobility, dressing, personal hygiene and toilet use; -Had a 1/2 side rail as an enabler on the right side of the resident’s bed. Record review of the physician’s orders [REDACTED]. During an interview on 8/29/18 at 9:30 A.M., the resident said he/she used the bed rail to move from the bed to the wheelchair. Record review of the resident’s Medical Record on 8/31/18 showed a bed rail assessment was completed for the resident on 8/10/18, but there was no signed consent form by the resident or the resident’s representative in the resident’s medical record. 4. Review of Resident #278’s MDS, dated [DATE], showed the facility staff assessed the resident as follows: -Short and long term memory loss; -Required extensive assistance with bed mobility, eating, toilet use and personal hygiene; -Uses wheelchair for mobility; -Falls prior to admission to the facility. Review of the resident’s comprehensive care plan, dated 3/15/18, directed staff on the following interventions: -Report changes in activities of daily living performance to nurse; -One-half side rails as an enabler; -Provide PT and OT as ordered; |
| 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0700 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 52) -Provide the amount of assistance and supervision that is needed; -5/6/18-Resident fell with new interventions added to provide assistance with transfers, remind to lock wheelchair, call light within reach and frequent monitoring required to maintain safe environment. Observation on 8/27/18 at 1:55 P.M., showed the resident lay in bed on his/her back with his/her knees bent and feet pressed against the foot board. Low air loss mattress inflated and 1/2 side rails on both sides of the bed. Observation on 8/28/18 at 9:07 A.M., showed the resident sat up in bed eating breakfast, air mattress, and 1/2 bed rails with a 2-3 inch opening between the mattress and bed rail, on each side. Observation on 8/28/18 at 3:58 P.M., showed the resident rested in bed with 1/2 bed rails on both sides and the mattress about 2-3 inches from the siderails on both of the sides. Observation on 8/29/18 at 10:24 A.M., showed the resident lay on his/her right side near the edge of the bed, kicking his/her legs off the side of the bed. Siderails on both sides continue to have a 2-3 inch gap between the mattress and the bed rail and low air loss mattress set at a level three. Observation on 8/29/18 at 12:33 P.M., showed the resident with his/her head of the bed elevated and feeding him/herself lunch with both 1/2 side rails up with mattress 2-3 inches away from the bed rails on each side. Observation on 8/29/18 at 12:27 P.M., showed the resident lay in bed with both legs off the side of the bed with both 1/2 side rails up and mattress 2-3 inches away from the bed rails on each side. Observation on 8/30/18 at 2:39 A.M., showed the resident lay on his/her left side with one leg off the left side of the bed and both 1/2 side rails up with about four inches between the mattress and bed rail on the resident’s left side of the bed. Observation on 8/30/18 at 4:07 A.M., showed the resident’s legs toward the edge of the bed on the right side and 1/2 side rail and mattress remained about 4 inches from each other on the resident’s left side. Observation on 8/30/18 at 4:30 A.M., showed the mattress had slid to the right side of the frame causing a four inch gap between the bed rails and the mattress on the left side of the bed. Observation on 8/30/18 at 5:12 A.M., showed the resident lay on his/her right side toward the edge of the mattress holding onto the side rail. Record review of the resident’s medical record showed the facility staff did not complete a side rail assessment to determine the need for side rails, and did not have the resident or responsible party sign a consent for use of the side rails. Further review showed staff initiated a side rail assessment dated [DATE], but did not fill it out. 5. Review of Resident #19’s MDS, dated [DATE], showed facility staff assessed the resident as follows: -Severe cognitive impairment; -Required extensive assistance with bed mobility, transfers, dressing, toilet use; -[DIAGNOSES REDACTED]. -One fall with no injury since most recent admission. Review of the resident’s comprehensive care plan, dated 3/20/18, directed staff on the following interventions: -Report changes in activities of daily living performance to nurse; -One-half side rails as an enabler; -Provide PT and OT as ordered; -Provide the amount of assistance and supervision that is needed. |
| 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0700 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 53) Observation on 8/27/18 at 1:57 P.M., showed the resident lay in bed on his/her back, bed in lowest position and 1/2 side rails on both sides of the bed. Observation on 8/28/18 at 4:00 P.M., showed the resident rested in bed with 1/2 side rails on both sides. Observation on 8/29/18 at 9:19 A.M., showed the resident lay on his/her right side with a wedge behind his/her back and 1/2 side rails up on both sides of the bed. Observation on 8/30/18 at 03:26 A.M., showed the resident lay in bed with 1/2 side rails on both sides of his/her bed and bed in the lowest position. Record review of the resident’s medical record showed the facility staff did not complete a side rail assessment to determine the need for side rails, and did not have the resident or responsible party sign a consent for use of the side rails. Further review showed staff initiated a side rail assessment dated [DATE], but did not obtain a consent with a signature from the resident or responsible party. 6. Review of Resident #23’s MDS, dated [DATE], showed staff assessed the resident as follows: -Mild cognitive impairment; -Required extensive assistance bed mobility, transfers, dressing, toilet use and personal hygiene; -[DIAGNOSES REDACTED].>-No falls since last admission or assessment. Review of the resident’s comprehensive care plan, dated 12/29/17, directed staff on the following interventions: -Report changes in activities of daily living performance to nurse; -One-half side rails as an enabler; -Provide PT and OT as ordered; -Provide the amount of assistance and supervision that is needed; -On 7/27/18 staff documented to encourage the resident to use the call light for assistance. Observation on 8/30/18 at 2:45 A.M., showed the resident lay in his/her bed on the right side. Further observation showed the resident had 1/2 side rails up on both sides of the bed. Review of the resident’s medical record showed the facility staff did not complete a side rail assessment to determine the need for side rails, and did not have the resident or responsible party sign a consent for use of the side rails. 7. During an interview on 9/5/18 at 6:51 P.M., Licensed Practical Nurse (LPN) P said side rails are suppose to have a consent signed to be used. Side rails can be used if the resident is able to use them to assist with sitting up. If the resident is not able to use them for positioning, then they would be a restraint. If a resident is alert and oriented times one, maximum assistance with care, and can’t move themselves, then side rails should not be used. He/she would have to look at the form to verify if the side rails are per family request. During an interview on 9/5/18 at 6:58 P.M., the Director of Nursing (DON) said side rail assessments should be done on admission. If a resident is able to use the side rail to assist with mobility the device is not considered a restraint. | |
| F 0725 Level of harm – Minimal harm or potential for actual harm Residents Affected – Many | Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. |
| 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0725 Level of harm – Minimal harm or potential for actual harm Residents Affected – Many | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility staff failed to provide sufficient staff to meet the needs of the residents. The facility failed to complete restorative nursing services for four residents (Resident #13, #14, #18, #36), and failed to provide wound treatments to eight residents (Resident #11, #14, #18, #19, #26, #53, #435, and #436) as ordered when the facility pulled the treatment nurse to the floor or he/she was not working. Additionally, the facility failed to provide timely assistance and repositioning for five residents (Resident #11, #13, #23, #436 and #437), failed to put interventions in place and provide frequent monitoring for one resident at risk for falls (Resident #278), failed to identify and complete a significant change in status Minimum Data Set (MDS) assessment on three residents (Resident #19, #23, and #278) and failed to complete 48 hour baseline care plans for eight residents (Resident #23, #60, #77, #178, #278, #431,#433, and #436). Further, the the group interview resulted in concerns that staff failed to answer the call lights in a timely manner, assist to reposition residents, provide bedtime snacks and provide meals timely. The facility census was 80. 1. Review of the daily staffing sheets, dated 8/11/18 through 8/16/18, showed no restorative certified nursing aide (CNA) scheduled. Further review showed the following: -8/11/18 three registered nurses (RN), eight licensed practical nurses (LPN) (three worked 16 hour shifts), no treatment LPN, 17 CNA’s, and one CNA on orientation. -8/12/18 three RN’s (one RN worked a 16 hour shift), six LPN’s (one is the LPN treatment nurse and one worked 7:00 P.M. – 7:00 A.M.) and 15 CNA’s (one worked a 12 hour shift, one worked a three hour shift, and one worked a four hour shift), and two CNA orientees; -8/13/18 four RN’s, five LPN’s, no restorative CNA or treatment nurse, 14 CNA’s (one worked worked a three hour shift), and one CNA on orientation on evening shift; -8/14/18 seven RN’s, two LPN’s, one treatment LPN, and 15 CNA’s (one left early), and one CNA on orientation on evening shift; -8/15/18 four RN’s, six LPN’s (one worked a four hour shift), one treatment LPN, and 17 CNAs; -8/16/18 five RN’s, four LPN’s, one LPN treatment nurse, and 17 CNA’s. Review of the daily staffing sheets, 8/24/18 through 9/5/18, showed no restorative CNA scheduled. Further review showed the following: -8/24/18 four RN’s, five LPN’s (one is the LPN treatment nurse), and 20 CNA’s on days (written to outside of CNA’s is 6 on days, 7 on evenings, and 5 on nights); -08/25/18 four RN’s, seven LPN’s, two nurse orientees, no treatment nurse, and 19 CNA’s (written to the outside of the CNA’s is 6 on days, 5 on evenings, and 3 on nights); -8/26/18 one RN, seven LPN’s (one is the MDS Coordinator and one worked 7:00 P.M. to 6:00 A.M.), one LPN orientee and one RN orientee, one certified medication technician (CMT), LPN treatment nurse, and 16 CNA’s (one CNA worked 7 P.M. to 11 P.M.); -8/27/18 four RN’s (one RN worked a 16 hour shift), five LPN’s (one is LPN treatment nurse), and 16 CNA’s (two CNA’s worked 16 hours shifts); -8/28/18 four RN’s (one RN worked a 16 hour shift and one RN worked 7:00 P.M.-11:00 P.M.), one RN orientee, five LPN’s (one is MDS coordinator), one LPN treatment nurse, and 17 CNA’s; -8/29/19 two RN’s, one RN orientee, eight LPN’s (one from a different facility), one LPN treatment nurse, and 18 CNA’s; -8/30/18 three RN’s (one worked a 12 hour shift and one worked 16 hours), five LPN’s (one worked a 12 hour shift and one worked a 16 hour shift), one LPN treatment nurse, and 17 CNA’s (one with weight written next to name, two with late and a line through their names, and one worked a 16 hour shift); |
| 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0725 Level of harm – Minimal harm or potential for actual harm Residents Affected – Many | (continued… from page 55) -8/31/18 three RN’s, seven LPN’s (one worked a 16 hour shift), one LPN treatment nurse, and 16 CNA’s (one CNA worked 12 hours and two CNAs worked a 16 hour shift); -9/1/18 four RN’s (one worked a 16 hour shift and one from a different facility), five LPN’s (one worked a 16 hour shift), no LPN treatment nurse, and 15 CNA’s (two worked 12 hour shifts, two worked 16 hour shifts, and one marked orientation on days and scheduled by him/herself on evening shift); -9/2/18 four RN’s (one from a different facility), seven LPN’s (one worked a 16 hour shift), no LPN treatment nurse, and 14 CNA’s (one worked a 12 hour shift and four worked 16 hour shifts); -9/3/18 three RN’s, six LPN’s (one is LPN treatment nurse and one worked a 16 hour shift), and 14 CNA’s (one worked a 12 hour shift and one worked a 16 hour shift); -9/4/18 four RN’s (one worked a 12 hour shift), six LPN’s (one worked a 12 hour shift and two worked a 16 hour shift), no LPN treatment nurse, and 17 CNA’s (one worked a 16 hour shift and one is the staffing coordinator); and -9/5/18 four RN’s (documented on the staffing sheet as one RN with CMT but no CMT’s were scheduled), six LPN’s (three from a different facility, and one is the facility’s hospital liaison), LPN treatment nurse, and 17 CNA’s (one worked a 12 hour shift). Further review of the daily staffing sheets, dated 8/11/18 through 8/16/18 and 8/24/18 through 9/5/18, showed the LPN treatment nurse was pulled to work as a unit floor nurse four times and did not work six days. 2. Review of the facility assessment tool staffing plan, last updated 8/14/18, showed the facility staff documented the total number of staff needed as the following: -Licensed nurses providing direct care: 11; -Nurse Aides: 18; and -Other nursing personnel (e.g., those with administrative duties): 5. 3. Review of Resident #13’s quarterly Minimum Data Set (MDS), a federally mandated assessment tool, dated 6/16/18, showed staff assessed the resident as follows: -Short and long term memory loss; -Required extensive assistance of staff with bed mobility, dressing, and toileting; -Dependent upon staff for assistance with eating and personal hygiene; -[DIAGNOSES REDACTED]. -Did not receive Restorative Nursing in the last seven days for range of motion. Review of the resident’s comprehensive care plan, dated 3/19/18, showed staff documented the resident is at risk for contractures due to the history of a [MEDICAL CONDITION]. The resident’s comprehensive care plan directed staff on the following interventions: -Provide the assistance of one for transfers and activities of daily living; -Please get me up at least three times a week; -Please transfer me to my wheelchair with a hoyer lift; -Provide restorative nursing as ordered. Observation on 8/29/18 at 12:33 P.M., showed the resident remained positioned on his/her back since 8:45 A.M. in the bed with the head of bed up approximately 45 degrees. Observations on 9/4/18 from 1:00 P.M. to 6:00 P.M., showed the resident remained in the same position in his/her geri-chair, in a reclined position with his/her feet propped up on pillows. Staff did not reposition the resident during this time. 4. Review of Resident #14’s quarterly MDS, dated [DATE], showed staff assessed the resident as follows: -Required extensive assistance with bed mobility, transfers, dressing, eating, toileting and personal hygiene; -[DIAGNOSES REDACTED]. |
| 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0725 Level of harm – Minimal harm or potential for actual harm Residents Affected – Many | (continued… from page 56) -Did not receive restorative nursing services for range of motion in the last 7 days. Review of the resident’s comprehensive care plan, dated 6/6/18, showed the resident problems listed as having contractures, weakness and spasms with inability to achieve full functional range of motion. The resident’s comprehensive care plan directed the restorative aid on the following interventions: -Assist to move, through tolerated range, supporting joints about and below extremity; -Refer to therapy as needed; -Report or document any decline; -Reposition for comfort at end of session; -Dowel exercises three times a week. Review of the resident’s physician’s orders [REDACTED]. Further, the physician ordered the resident to wear the right upper extremity splint five times a week for 4-8 hours and directed nursing to check to see if skin issues or redness noted. Observation on 8/30/18 at 9:45 A.M., showed the resident positioned in his/her wheelchair with the left arm contracted at the elbow as his/her elbow lay against his/her chest area. During the time of this observation the resident did not extend his/her left arm. Observation on 9/5/18 at 10:00 A.M., showed the resident positioned in his/her wheelchair with the left arm contracted at the elbow as his/her elbow lay against his/her chest area. During the time of this observation the resident did not extend his/her left arm. 5. Review of the Restorative Nursing log showed the following residents listed to receive restorative nursing services: -Resident #18-Occupational therapy (OT) recommended right shoulder self range of motion by grasping hands lifting up/down in/out from chest 20 repetitions (reps), the resident is to complete bicep curls and wrist rotation 20 reps using a one pound dumbbell. Further review showed the Restorative Aid (RA) did not document that the restorative exercises that were recommended by (OT) were provided in (MONTH) (YEAR) and (MONTH) (YEAR); -Resident #36-OT recommended RA on 7/26/18 for three times a week passive range of motion exercises to both lower extremities and passive range of motion to both upper extremities three times a week. Further review showed the RA did not document that the restorative exercises that were recommended by (OT) were provided in (MONTH) (YEAR) and (MONTH) (YEAR). 6. During an interview on 8/31/18 at 12:20 P.M., the Therapy Coordinator said the therapist gives the Director of Nursing (DON) the referrals for RA and then nursing sets up the resident for restorative exercises with the restorative aide. 7. During an interview on 08/31/18 at 10:56 A.M., CNA AA said she/he is the restorative aide, but has not been able to provide restorative nursing for the residents since (MONTH) (YEAR) because she/he continually is pulled from her/his duties to provide direct resident care. 8. Review of the Resident Council Meeting Minutes, dated 5/7/18, showed 21 residents in attendance shared the following concerns: – Some of the nurses don’t come; – Nurses don’t want to check anything if you ask, he/she avoids; – Nurses also do not explain what pills they are giving you; – The nurses and aides don’t know what is going on if they come from the other side/hall. Review of the Resident Council Meeting minutes, dated 6/4/18, showed 16 residents in attendance shared the following concerns: – The 11:00 P.M. to 7:00 A.M. shift aides do not do every two hour rounds; – Aides do not help in the main dining room; – One resident said he/she was left in the bathroom for over an hour; |
| 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0725 Level of harm – Minimal harm or potential for actual harm Residents Affected – Many | (continued… from page 57) – Resident beds are not being made; – Resident asked for towels and did not receive any. Review of the Resident Council Meeting minutes, dated 7/2/18, showed 19 residents in attendance shared the following concerns: – Staff were late getting residents up every morning for breakfast. 9. During the Resident Council interview on 8/28/18 at 1:30 P.M., nine residents attended and shared the following concerns related to sufficient/competent nurse staffing: -Medication not available from pharmacy have to wait for it to be delivered or staff have to get it re-filled. One resident said he/she ran out of eye drops used to treat his/her [MEDICAL CONDITION] (a condition of increased pressure within the eyeball, causing gradual loss of sight); – Resident said one time staff shut his/her door and oxygen tank ran out. He/She turned on the call light and waited 45 minutes; -Six residents said they have to wait one to two hours for staff to answer call lights. Sometimes staff come in, turn off call light and say they will be back; -Seven of the residents said they do not feel there was sufficient staff to take care of everyone and staff will tell you they are short staffed. Nights and weekends are worst for staffing; -Staff do not always wear name tags and when residents ask their name staff respond with why you want to know?; -Staff call in on weekends and night shift; -Residents say facility tries to hire more staff but the staff usually don’t stay; -Staff place call light out of reach of residents; -Staffing issues have been brought up in resident council meetings before; -Seven residents said snacks are brought out to nurses stations during evening shift but are not offered to residents. Residents have to go up to the nurses station or ask staff for a snack. The residents would like to have snacks offered to them before bedtime. 10. Observation on 8/30/18 at 03:57 A.M., showed Resident #437 yelling Could I have a little help in here please the resident sat up on the side of the bed with his/her legs hanging off the bed wearing an incontinence brief and t-shirt. CNA F went into the room and told the resident to lay down. The resident said he/she needed to go to the bathroom. CNA F brought the resident a urinal. During an interview on 8/30/18 at 3:57 A.M., CNA F said he/she had 20 patients to care for and has been trying to get the resident to stay in bed all night. CNA F said he/she was working on the north and south halls. 11. During an interview on 8/29/18 at 9:28 A.M., Resident #436 said staff woke him/her up at 3:30 AM to pre-dress him/her in bed. The resident said that was very unusual. He/She said the staff did not know how to get his/her brace on and had to find the therapy aide to assist them. He/she said sometimes he/she has to wait two hours to be changed. As a result, he/she has had accidents and gotten urine all over the floor. This happened a few times. Having to wait long periods for assistance is consistent throughout all shifts. 12. Review of Resident #23’s medical record showed the resident: -Required extensive assistance for his/her ADL’s; -Always incontinent of bladder and frequently incontinent of bowel; -At risk for pressure ulcer development. Observations during the survey showed staff did not consistently assist the resident to determine his/her care needs and provide assistance in a timely manner when he/she hollered out and cried. 13. Observation on 8/30/18 at 2:45 A.M., showed staff did not provide timely incontinence |
| 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0725 Level of harm – Minimal harm or potential for actual harm Residents Affected – Many | (continued… from page 58) care for Resident #11 when staff found the resident with a saturated incontinence brief and pad beneath the resident. Observation showed the soiled linens leaked through the plastic bag in which they were discarded and left a wet spot on the bedside table. The CNA said he/she was the only CNA on that hall during the shift. 14. Review of Resident #13’s medical record showed the resident: -Required extensive assistance from staff for his/her ADL’s; -Incontinent of bowel and bladder; -[DIAGNOSES REDACTED]. -At risk for pressure ulcers. Observations during the survey showed staff did not assist the resident to reposition or provide incontinent care for an extended period of time. 15. Review of Resident #278’s medical record showed the resident: -Required assistance from staff for his/her ADL’s; -Incontinent of bowel and bladder; -Had multiple falls; Observation during the survey showed staff did not initiate appropriate interventions and more frequent monitoring for the resident to keep the resident safe from sliding out of bed and falling. 16. Review of Residents #19, #18, #14, #11, #53, #435, and #436 showed the residents had pressure ulcers with physician ordered treatments. Further review showed staff did not consistently document application of the wound treatments as ordered by the residents’ physicians. 17. Observations and record review during the survey showed Resident #26 had abrasions on his/her left and right forearms, with physician ordered treatments. Observations showed the resident’s abrasions were not consistently covered, and record review showed staff did not document a treatment dressing change on 9/2/18. 18. During an interview on 8/31/18 at 9:45 A.M., LPN G said she/he is the wound nurse and provides all of the treatments during the week and weekly wound assessments but has been pulled from her/his position to perform charge nurse duties. LPN G said she/he was pulled from her/his wound treatments to perform charge nurse duties three times in the last seven days. 19. Review of Residents #23, #60, #77, #178, #278, #431, #433, #436’s 48 hour baseline care plans showed staff did not accurately complete the form and did not ensure the form was reviewed and signed by the resident or his/her representative. 20. Review of Residents #19, #23, and #278’s medical records, including MDS assessments, showed staff did not complete a significant change MDS assessment as directed by the Resident Assessment Instrument manual for the resident’s changes. 21. During an interview on 9/5/18 at 6:58 P.M., the Director of Nursing (DON) said the facility determines that they have enough staff by taking into account the acuity of the residents and the facility’s corporate has a ppd (allotted nursing hours per resident per day) set at the corporate level. The facility also has a staffing scheduler. | |
| F 0726 Level of harm – Minimal harm or potential for actual harm Residents Affected – Many | Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident’s well being. **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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0726 Level of harm – Minimal harm or potential for actual harm Residents Affected – Many | (continued… from page 59) staff had the appropriate competencies and skill sets to provide nursing and related services and that nurse aides are able to demonstrate competency in skills and techniques necessary to care for residents’ needs. Staff failed to demonstrate safe transfer techniques for two residents (Resident #4 and #278), failed to maintain the low air loss mattress setting for one resident (Resident #278), failed to prevent medication errors for three residents (Resident #19, # 228, and #433), failed to check placement prior to administering medications for one resident (Resident #19), failed to provide appropriate incontinent care for four residents (Resident #3, #19, #77, and #278) and did not reposition or provide toileting assistance for two residents (Resident #13 and #23). Additionally, facility staff failed to provide competent nursing staff when caring for five residents (Resident #3, #4, #9,#23 and #429) and one anonymous resident in a dignified manner. The facility census was 80. 1. During observations on [DATE] and [DATE], showed the following: -[DATE] at 4:00 P.M., Certified Nurse Aide (CNA) D applied the gait belt around Resident #4’s upper chest. CNA D and CNA E then grasped the gait belt and lifted the resident from the bed to the wheelchair. The resident’s knees were bent during the transfer and he/she was unable to bear weight; -[DATE] at 2:06 P.M., CNA H and CNA I attached the sit to stand lift sling around Resident #278 and to the sit to stand lift. CNA I lifted the resident with the lift. The resident remained in a sitting position with his/her knees bent and arms extended above his/her head. The sling around the resident was bunched up under his/her arms. The resident was unable to bear weight. CNA H turned the lift toward the wheelchair, while CNA I pushed on the resident’s bottom, then lowered to the wheelchair. The CNA’s said the resident needs to be a hoyer lift (mechanical lift) transfer; -[DATE] at 2:38 P.M., CNA H and certified occupational therapy assistant (COTA) transfer Resident #278 back to bed with the sit to stand lift. The CNA and COTA applied a sling and gait belt around the resident. The resident remained in a sitting position during the transfer with his/her knees bent, arms above his/her head, the sling bunched up under the resident’s arms, and the resident was unable to bear weight. During an interview on [DATE] at 10:07 A.M., the Director of Nursing (DON) said they already started educating staff on the sit to stand lift transfer yesterday. If a CNA notices a change in the residents transfer status or a decline, they need to report it to the nurse. The nurse should assess the resident to see if the transfer status changed. 2. Observations from [DATE] at 1:00 P.M. to [DATE] at 2:06 P.M. showed Resident #278’s low air loss mattress setting at a level 3 firmness. Further observations from [DATE] at 2:38 P.M. to [DATE] at 5:25 A.M., showed the resident lay on a low air loss mattress, fully inflated to a level 5 firmness. The resident had a fall during the change of shift for evenings and nights on [DATE] and at 3:28 A.M. on [DATE]. Interviews with CNA’s, Licensed Practical Nurses (LPN’s), Registered Nurses (RN’s), and the DON showed staff did not know what the setting of the resident’s low air loss mattresses was supposed to be set on or who was responsible for monitoring the settings. 3. Observations and record review showed staff did not administer the following medications in a manner to prevent medication errors. Observations, record review, and interviews showed the following: -Resident #433 reported the nurse on the evening of [DATE] tried to administer the resident’s [MEDICATION NAME] (blood thinner) when the medication was on hold related to the resident’s International Normalized Ration (INR) of 4.1 (High); -Resident #19’s [MEDICATION NAME] (anticonvulsant) order showed do not crush. Registered nurse (RN) R crushed the medication and administered through the [DEVICE] ([DEVICE]) and |
| 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0726 Level of harm – Minimal harm or potential for actual harm Residents Affected – Many | (continued… from page 60) did not check placement of the [DEVICE] prior to administration of medications; -LPN D attempted to administer [MEDICATION NAME] (treats high blood pressure) 50 milligram (mg) and [MEDICATION NAME] (acid reducer) 40 mg to Resident #228. The resident questioned the medications and when the LPN looked at the Medication Administration Record, [REDACTED]. During an interview on [DATE] at 6:45 A.M., LPN D said staff are expected to check the five rights (right resident, medication, dose, time and right route) before administering medications to a resident. 4. Observations from [DATE] to [DATE], showed staff did not provide thorough and proper pericare to Resident #3, #19, #77, and #278 during incontinent care. Staff did not ensure that they cleansed all areas covered with urine or stool. Additionally, the staff did not cleanse from front to back while providing care. During an interview on [DATE] at 6:40 P.M., CNA L said staff are expected to remove their gloves and wash their hands after providing incontinent care. 5. Observations showed staff did not provide repositioning or incontinent assistance for the following: -Resident #13 remained reclined in his/her geri-chair from 1:00 P. M. to 6:00 P.M. without staff repositioning or providing incontinent assistance; and -Resident #23 remained in his/her wheelchair without repositioning or incontinent assistance from 8:45 A.M. to 1:00 P.M. and 2:00 P.M. to 4:07 P.M. The resident reported he/she had not been changed all day. 6. Observations from [DATE] to [DATE], showed staff speaking to residents in an undignified manner. Observations showed the following: -Resident #23 crying and hollering out frequently without staff acknowledging or addressing the resident’s needs. On [DATE], observation showed CNA H say to the resident, You are really going to have to quit that crying. There is nothing wrong with you. The resident began to crying louder and harder; -CNA H told Resident #3 in an abrupt manner to lift his/her legs and after his/her pants and brief were around the resident’s ankles the CNA pushed down on the resident’s legs while abruptly saying put your legs down; -Resident #4 repetitively asked the CNA to not to hurt him/her as he/she has been through a lot. The CNA said in a harsh tone, What have you been through?; -Resident #29 reached out for a salt shaker in the dining room and the activity director said harshly, Don’t you get into that! I will get you!; -An alert and orient anonymous resident said he/she would like to go back to his/her room but staff take it out on him/her when he/she asks. The staff are hateful, mean. During an interview on [DATE] at 2:55 P.M., Resident #429 said over the weekend he/she had been up in his/her geri-chair since early morning and was not put to bed until 12:00 A.M. The resident said he/she asked the staff to please put him/her to bed as his/her leg and bottom were hurting. He/she said staff never got the nurse to assess for pain medication. He/she said the two staff took him/her to his/her room and said they were going to put others to bed and be back to help him/her. The resident said staff just left me in the room and I was hurting so bad. When staff returned to assist the resident to bed they wouldn’t listen to him/her before trying to transfer him/her. The resident said he/she told the staff to get his/her chair closer to the bed. The staff picked him/her up without using a gait belt, one staff grasped his/her arms and the other staff grasped his/her legs. The resident said one staff complained about his/her back hurting. The resident said staff never notified the nurse of his/her pain and he/she did not receive any pain medication. |
| 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0726 Level of harm – Minimal harm or potential for actual harm Residents Affected – Many | (continued… from page 61) 7. Review of the Facility Assessment, dated [DATE], showed the following information for staff training, education and competencies: -We have a full-time staff development coordinator who is responsible for orientation, nursing education, and CNA certification hours, We hold all staff meetings and nursing meetings monthly to go over education and topics about the facility. We provide CPR (cardiopulmonary resuscitation) classes. We also have safety fairs and Life Care University topics to complete for new processes and procedures; -Staff are expected to provide the care to meet the resident’s needs. Further review showed the Facility Assessment did not include specific training needs with competencies to assess the knowledge of the staff to include transfers, infection control, medication administration and dignity. During an interview on [DATE] at 6:58 P.M., the DON said they determine if staff are competent in their jobs by completing random observations of staff interactions with residents, observing pericare and medication administration, by completing rounds on different shifts. The facility also just hired a new staff development coordinator that will be doing all of the mandatory inservices, completing staff training, making observations, and providing education when he/she observes care not being completed correctly and staff will be held accountable. | |
| F 0759 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | Ensure medication error rates are not 5 percent or greater. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** |
| 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0759 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 62) the purpose of the medications were and instructed the resident these were the medications the physician ordered. The resident remained very concerned why she/he was receiving them and insisted on the nurse checking the order. LPN D then explained to the resident she/he would go back to the medication orders and check. LPN D looked at the Medication Administration Record (MAR), but did not realize she/he was looking at the wrong resident until the surveyor pointed it out to him/her on the MAR. LPN D did not ask the resident his/her name, or medication, dose and time of medications that she/he takes everyday. During an interview on 8/30/18 at 6:45 A.M., LPN D said she/he usually works night shift and did get the residents mixed up. Further, LPN D said staff are expected to check the five rights (right resident, medication, dose, time and right route) before administering medications to a resident. 3. Review of Resident #433’s medical record showed the resident admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Review of telephone physician orders [REDACTED]. Give [MEDICATION NAME] 5 mg 8/29, 8/30, 9/1 and 9/2/18. [MEDICATION NAME] 10 mg on 8/31/18. PT/INR (blood test that checks bleeding time) at [MEDICATION NAME] Clinic 8/31/18. During an interview on 8/29/18 at 8:19 A.M., the resident said he/she goes to a [MEDICATION NAME] clinic. He/She said they checked his/her INR and it was over 4.1. The resident said the nurse on the evening shift on 8/27/18 tried to administer his/her [MEDICATION NAME], but the resident caught it and told the nurse that his/her [MEDICATION NAME] was on hold for two days. 4. Review of Resident #19’s quarterly Minimum Data Set (MDS), a federally mandated assessment instrument, dated 6/18/18, showed staff assessed the resident as: -Severe cognitive impairment; -Minimal depression; -No behaviors or rejection of care; -Received 51% or more of daily nutrition and 501 cubic centimeters (cc) or more of daily fluids through tube feeding. Review of the resident’s care plan, dated 6/19/18, showed staff assessed the resident as at risk for his/her needs not being met related to memory impairment and relying on staff for most decision-making. Staff are directed to anticipate and provide daily care as indicated, administer fluids per [DEVICE] ([DEVICE]) as ordered, administer tube feeding formula and flushes as ordered, check the [DEVICE] placement by draw back aspiration and auscultation prior to administering any bolus enteral feeding, keep head of bed up at least 30 degrees, observe for [MEDICAL CONDITION] activity and report to the resident’s physician, observe for side effects of anticonvulsant medications, observe lab values for therapeutic level, observe status after [MEDICAL CONDITION], and report any changes in cognition or behavior to resident’s physician. Review of the resident’s physician orders, dated (MONTH) (YEAR), showed the physician ordered the following: -Check and verify placement of the [DEVICE] prior to enteral feedings, water flushes, and medication administrations; -Flush [DEVICE] with 10 milliners (ml) of water between each medication during administration; -[MEDICATION NAME] ([MEDICAL CONDITION] medication) 500 mg table by mouth two times daily *administer by mouth*; and -[MEDICATION NAME] ([MEDICAL CONDITION]) 5 mg tablet by mouth daily *administer by mouth* Review of the resident’s pharmacy consultation, dated 6/1-26/18, showed the pharmacist recommended 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0759 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 63) -[MEDICATION NAME], please administer by mouth-can be hazardous to employee crushing medication; -Levetiracetam ([MEDICATION NAME]), please administer by mouth. Further review showed the physician accepted the recommendations on 7/2/18. Review of the resident’s telephone order sheet (TOS), dated 7/2/18, showed staff documented an order from the physician for the [MEDICATION NAME] and [MEDICATION NAME] to be administered by mouth and do not crush. Observation on 8/29/18 at 8:36 A.M., showed Registered Nurse (RN) R placed the resident’s [MEDICATION NAME] 500 mg 1 tab and [MEDICATION NAME] sprinkle 125 mg 3 caps into a medicine cup after crushing the [MEDICATION NAME]. The RN popped the resident’s Losartan 100 mg, [MEDICATION NAME] 50 mg, [MEDICATION NAME] 10 mg, and [MEDICATION NAME] 25 mg, crushed the medication and placed in a medication cup, then crushed [MEDICATION NAME] 5 mg and [MEDICATION NAME] 10 mg and placed them into a third medication cup. The RN added about 10 cc water to each cup and and mixed the medication into the water. The RN entered the resident’s room, placed the syringe into the resident’s [DEVICE]. Observation showed the RN poured 30 cc water into the syringe without checking placement with auscultation and/or aspiration. The RN poured the resident’s blood pressure medications into the syringe, followed by the crushed [MEDICATION NAME] and [MEDICATION NAME] and last the crushed [MEDICATION NAME] and [MEDICATION NAME] sprinkles. The RN did not flush with any water between the medications. The RN flushed with 30 cc of water and reconnected the resident. During an interview on 9/5/18 at 6:58 P.M., the director of nursing (DON) said the nurse is expected to make sure medications match the orders on the MAR, ensure the correct dose by comparing the card to the MAR and sanitize hands prior to administration and between residents. The nurse needs to tell the resident what the medications are. If the nurse is unaware of what the medication is for, he/she should not give the medication until he/she looks it up. If a medication is put on hold, the nurse that takes the order needs to document hold on the MAR or TAR for the days that it is on hold. If a resident has a [DEVICE] he/she prefers that the pharmacy sends liquid medications, but if they have a pill and it is not supposed to be crushed, the nurse should administer the medication by mouth unless the resident is not able. If the resident can not take the oral form, the nurse needs to notify the physician. | |
| F 0838 Level of harm – Minimal harm or potential for actual harm Residents Affected – Many | Conduct and document a facility-wide assessment to determine what resources are necessary to care for residents competently during both day-to-day operations and emergencies. **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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0838 Level of harm – Minimal harm or potential for actual harm Residents Affected – Many | (continued… from page 64) documented staffing plan as follows: -Licensed nurses providing direct care: 11; -Nurse Aides: 18; -Other nursing personnel (e.g., those with administrative duties): 5; -Other staff needed for behavioral healthcare and services: 0; -Licensed dietician or other clinically qualified nutrition professional: 2; -Food and nutrition service staff: 7; -Respiratory care services staff: 0. Additional review showed staff did not specify staffing per shift, or based on any variances in acuity or specific, individualized care needs. Documentation showed facility staff stated they have a full time nursing staff coordinator who does nursing scheduling day to day. The resident preferred rise times, bath days, preferred nap/bed times, activities, meal times, total care patients, [MEDICAL TREATMENT], wound treatments, and therapy are taken into account with staffing and resources needs. Staff training/education and competencies that are necessary are provided by a full time staff development coordinator who is responsible for orientation, nursing education and CNA certification hours. They hold all staff meetings and nursing meetings monthly to go over education and topics about the facility. The facility provides CPR (cardiopulmonary resuscitation) classes and also has safety fairs, and Life Care University topics to complete for new processes and procedures. Additional review showed staff documented: the facility has a mix of white and African American residents. The majority are Catholic and Christian with a few Protestant and Lutheran religions. Further review of the facility assessment showed staff documented they have contracts with all 3rd party vendors, but did not list who their contracts are with, memorandums of understanding, or other agreements with third parties to provide services or equipment to the facility. Staff did not document their pharmacy, rehabilitation therapy provider, or other contracted staff. Staff did not list or provide a source for inventory of physical resources needed, such as numbers and types of medical supplies and equipment needed to provide care for the facility’s residents according to the facility assessment. During an interview on [DATE] at 2:40 P.M., the administrator said he/she did not have further information for the facility assessment. He/She was unaware that the facility assessment needed to be more detailed. | |
| F 0849 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services. **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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0849 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 65) toileting and personal hygiene; -Frequently incontinent of urine; -Always incontinent of bowel; -At risk for the development of a pressure ulcer; -Received hospice services. Further review of the medical record showed the resident’s hospice plan of care was not accessible to staff until requested from the Director of Nurses (DON). Review of the Hospice Interdisciplinary Comprehensive Care Plan dated 10/31/17 directed hospice services on the following interventions: -Nursing to evaluate systems; -Nursing to assist with pain management; -Nursing to teach medication management; -Provide emotional support; -Evaluate socialfinancial needs; -Aide assisted with personal care and Activities of Daily Living; -Bereavement risk; -Hospice will teach medication and treatment, safety issues, advanced directives, symptom control, patients rights, hospice notification of changes and hospice philosophy. Review of the resident’s comprehensive care plan, dated 5/30/18, directed staff on the following interventions for Hospice care: -Administer pain medication per physician’s orders [REDACTED].>-Put interventions in place to keep the resident comfortable; -Will choose hospice and notify changes in condition; -Encourage time with family and friends. -Further review showed the resident’s coordinated plan of care with hospice services, dated 5/30/18, did not include the following information: – Diagnoses; – A common problem list; – Palliative interventions; – Palliative goals/objectives; – Responsible discipline(s); – Responsible provider(s); and – Resident/designated representative choices regarding care and goals. 2. Review of Resident #21’s admission MDS, dated [DATE], showed the facility staff assessed the resident as follows: -Short and long term memory; -Required extensive assistance with bed mobility, transfers, dressing, eating, toileting and personal hygiene; -Frequently incontinent of urine; -Always incontinent of bowel; -[DIAGNOSES REDACTED]. -At risk for the development of pressure ulcer; -Stage IV pressure ulcer; -Application of dressing other than to feet; -Application of ointments other than to feet; -Hospice is not marked. Review of the resident’s comprehensive care plan, dated 4/20/18, directed staff on the following interventions for hospice services: -Arrange for clergy of choice to visit; |
| 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0849 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 66) -Assist in learning stress management/relaxation; -Assure resident that symptoms of grieving are normal and will improve with time; -Determine resident’s expectations; -Discuss coping strategies; -Discuss the resident concerns of being unwanted or feeling useless; -Discuss with resident feelings, reminiscence, issues; -Encourage family/friends to remain involved; -Give positive reinforcement as involvement improves to solve conflicts; -Invite and encourage to activities; -Observe need for psychological services; -Provide resident or responsible party with education as needed in the following areas. Review of the resident’s closed medical record showed only one Hospice Coordinated Task Plan of Care note, dated 4/11/18. Further review showed the Hospice Coordinated Plan of Care showed the schedule for nurse visits and aide visits, social worker frequency and Chaplin frequency. Further review showed the resident’s coordinated plan of care with hospice services, dated 4/20/18, did not include the following information: – Diagnoses; – A common problem list; – Palliative interventions; – Palliative goals/objectives; – Responsible discipline(s); – Responsible provider(s); and – Resident/designated representative choices regarding care and goals During an interview on 9/5/18 at 7:10 P.M., Licensed Practical Nurse (LPN) V said for residents receiving Hospice, a verbal report is given to the charge nurse after the clinic visit. LPN V said a hospice note is in the hospice book for each company, but there is not a care plan from hospice included and is unsure where the hospice care plan is located. Further, LPN V does not know who or what the hospice liaison is for the facility. During an interview on 9/5/18 at 2:40 P.M., the Director of Nurses (DON) said the hospice liaison is the social worker, who communicates between the hospice and the facility. At this time, the DON said she will have to find the location of the hospice care plans in the facility. | |
| F 0867 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action. Based on record review and interview, the facility failed to implement an effective |
| 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 0867 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 67) – To monitor and evaluate the appropriateness and quality of care provided within the framework of the Performance Improvement Plan; – To provide a means whereby negative outcomes relative to resident care are identified and resolved through an interdisciplinary approach, and positive outcomes can be reinforced through education and monitoring; -Committee Authority: The Performance Improvement Committee functions as an advisory committee to the Executive Director to implement the Performance Improvement Program, including, but not limited to, the following tasks: – Identify negative and positive outcomes on direct or indirect resident care; – Establish criteria and standards of practice of professional organizations, health care regulations, and federal and state requirements, as applicable to the facility; – Meeting with the regional or divisional team to discuss any problem areas encountered if necessary; – Set thresholds on areas not already set by corporate. Review of the facility’s annual statement of deficiencies (SOD) for the past three years, showed the facility was cited for F281, a citation for failing to provide services that meet professional standards; and for the past two years, showed the facility was cited for F441, a citation for failing to care for residents utilizing acceptable infection control procedures to prevent the spread of infection. The current SOD, dated 9/6/18, cited a deficiency at F658, failure to provide services that meet professional standards, and F880, failure to provide care in accordance with acceptable infection control procedures. Based on multiple deficiencies cited in resident rights, admission, transfer, and discharge practices, resident assessment and care plans, quality of care, nursing services, pharmacy services, administration, and infection control procedures, the facility does not have an effective quality assessment and assurance program to ensure staff identify issues and develop and implement appropriate plans of action to correct identified quality deficiencies that affect the residents’ health, safety and quality of life. During an interview on 9/5/18 at 08:14 PM, the administrator said the QA meetings consist of the medical director, all clinical management, social services, the wound nurse, therapy, and dietary manager. We try to include all levels of staff in the building in our QAPI. The QAPI binder is discussed monthly. This is used to help set policies, protocols, and see what needs to be fixed. We will complete and review audits, look at reductions, and investigations. The top area trends that we review in our QA includes wounds, infection control, bounce backs, dietary, falls, and weight loss. If the QA team notices issues are still occurring, they look to see if it is a specific person that is not implementing the interventions and if it is not a person then they go back and look at how we are going to resolve the issue. | |
| F 0880 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 – Some | (continued… from page 68) census was 80. Review of the facility Hand Hygiene policy, dated 4/01/15, showed the following: -Purpose: To decrease risk of transmission of infection by appropriate hand hygiene; -Handwashing: When hands are visibly dirty, contaminated, or soiled, wash with non-anti-microbial or anti-microbial soap and water; -Note: Because alcohol based hand rubs do not kill spore-forming organisms, they should not be used by staff when caring for residents with infections caused by spore-forming organisms. Examples are [MEDICAL CONDITION] and bacillus anthracis. Staff will use antimicrobial soap and water or non-antimicrobial soap and water for hand washing when caring for residents with infections caused by spore-forming organisms; -If hands are not visibly soiled, use an alcohol based hand rub for routinely decontaminating hands in all clinical situations other than those listed under Handwashing above. 1. Observation on 8/28/18 at 10:00 A.M., showed Certified Nursing Aide (CNA) J cleaned liquid stool off of Resident #3’s wheelchair with Clorox wipes in the resident’s room. CNA J removed his/her gloves, without washing or sanitizing his/her hands, put on a new pair of gloves. CNA J placed wash cloths directly into the sink basin with water running over them. Observation showed CNA H in the resident’s bathroom while the resident sat on the toilet. The CNA removed the resident’s liquid stool covered pull-up from the resident’s ankles. Observation showed CNA H assisted the resident off the toilet with the same soiled gloves. CNA J handed CNA H two wash cloths from the sink basin and CNA H cleansed the resident’s buttocks and perineal folds with the same wash cloth, then with the same gloves used a dry towel to dry off the resident. Without washing their hands or changing gloves, CNA H and CNA J assisted the resident to his/her wheelchair directly on the wheelchair cushion. CNA H placed the resident’s brief, pants, socks and shoes on his/her lower extremities, told the resident to stand up and pulled up the resident’s pull-up and pants, with the same soiled gloves. CNA J removed his/her gloves, grabbed the Clorox wipe container and left the resident’s room. CNA H placed the soiled linens in a plastic bag and left the resident’s room with the same soiled gloves on. Observation showed CNA H and CNA J did not wash their hands prior to leaving the resident’s room. 2. Observation on 9/04/18 at 6:25 P.M., showed Registered Nurse (RN) M and CNA L entered Resident #4’s room and applied gloves without washing their hands. The RN and CNA removed the resident’s sweater and t-shirt and placed a gown on the resident. The RN assisted turning the resident to his/her right side and pulled down the resident’s pants and removed the resident’s pull-up. Observation showed a strong urine odor and the resident’s pull-up very wet. CNA cleansed the resident’s buttock, removed his/her gloves, without washing his/her hands, opened the drawer on the bedside table, grabbed the resident’s barrier cream and handed it to the RN. The RN applied the barrier cream to the resident’s buttocks then removed his/her gloves. The CNA and RN positioned a brief under the resident and placed a pillow under his/her right arm and legs. Further observation showed the CNA and RN did not wash their hands upon entering the resident’s room and between dirty to clean tasks. Additionally, the CNA touched the resident’s personal care items without washing his/her hands after performing pericare. 3. Observation on 8/30/18 at 3:01 A.M., showed CNA K enter resident #9’s room to provide incontinent care. He/she placed towels in the sink and turned and on the water. CNA K removed a wet towel from the sink and began to provide pericare on the resident. He/she changed gloves without washing his/her hands, rolled the resident to his/her right side, placed soiled items in a plastic bag and placed the bag in a chair with a bedspread. The CNA changed his/her gloves without washing his/her hands and elevated the resident’s feet |
| 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 – Some | (continued… from page 69) on two pillows. He/she removed gloves and carried the bag of soiled towels into the hallway. He she re-entered the room and put on gloves without washing his/her hands, then emptied the resident’s catheter and disposed of the urine in toilet. He/she removed his/her gloves and washed his/her hands then exited the room. Further observation showed a brown bean shaped object left in sink. 4. Observation on 8/30/18 at 2:45 A.M., showed CNA A entered Resident #11’s room and applied gloves without washing his/her hands. Observation showed the resident’s pants pulled down to his/her ankles under the covers. The CNA cleansed the resident’s abdominal fold and front perineal area with a wipe. The CNA removed his/her gloves and without washing his/her her hands, applied gloves. Observation showed the CNA turned the resident to his/her right side, removed the saturated brief from the back side and cleansed the resident’s buttocks. Observation showed the resident’s brief leaked through to the incontinence cloth pad under the resident. The CNA changed his/her gloves, without washing his/her hands, positioned a dry pad and brief under the resident, and applied barrier cream to the resident’s buttocks. The CNA removed his/her gloves and without washing his/her hands, applied gloves and turned the resident to his/her left side and positioned the brief, pulled down the resident’s shirt, positioned his/her feet on a pillow, placed soiled linens in bag on bedside table, handed the resident his/her call light and left the room with gloves on and bagged linens. Observation showed the CNA left the resident’s room with soiled gloves and did not wash his/her hands with glove changes. Further observation showed the soiled linens leaked through the plastic bag and left a wet spot on the bedside table, which CNA A did not clean. 5. Observation on 8/29/18 at 3:07 P.M., showed Licensed Practical Nurse (LPN) G removed Resident #18’s soiled dressing from the resident’s coccyx, changed gloves without washing his/her hands, cleansed the wound with normal saline, and changed his/her gloves without washing his/her hands. The LPN applied the ordered treatment to the wound bed, and covered it with an abdominal pad and adhesive tape. Observation showed the LPN did not wash his/her hands after removing gloves and going from dirty to clean tasks. 6. Observation 8/30/18 at 3:56 A.M., showed CNA C entered Resident #19’s room, placed washcloths in the sink basin with water running over them, and put on a pair of gloves. The CNA pulled down the resident’s blanket and removed his/her brief from the front, then cleansed the resident’s front perineal and turned the resident his/her left side. Observation showed the resident had a small stool. The CNA cleansed the resident’s gluteal crease, tucked a brief under the resident, turned the resident to his/her other side, and fastened the resident brief. The CNA pulled up the resident’s sheet and used his/her controller to raise the head of the bed. Observation showed the CNA did not wash his/her hands when he/she entered the resident’s room, changed gloves, or wash his/her hands when going from dirty to clean tasks, and before touching the resident’s personal care items. The CNA removed his/her gloves and left the resident’s room with the bagged soil linens without washing his/her hands. 7. Observation on 8/29/18 at 4:45 P.M., showed CNA T entered Resident #23’s room to provide incontinent care. CNA T applied clean gloves then assisted the resident into bed and removed his/her pants and soiled brief. CNA T assisted the resident onto his/her side then cleansed the buttocks, groin and back area. CNA T then continued to wear the same soiled gloves while she/he touched the resident, the bedside table and the clean brief. Staff did not remove soiled gloves and wash hands after providing incontinent care. 8. Observation on 8/29/18 at 11:04 A.M., showed Resident #53 up in his/her wheelchair with his/her feet directly on the foot pedal and heel lift boot boots on the floor. Observation showed LPN G washed his/her hands, cut the resident’s soiled dressing off of 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 – Some | (continued… from page 70) resident’s left foot/ankle. LPN G removed his/her gloves and without washing or sanitizing his/her hands, put on a new pair of gloves. The LPN cleansed the wound, removed his/her gloves, without washing or sanitizing his/her hands, put on clean gloves. Observation showed the LPN applied the resident’s ordered treatment to his/her wound, put on the resident’s socks and heel lift boots. Further observation showed the LPN did not wash or sanitize his/her hands between dirty to clean tasks and with glove changes. 9. Observation 8/30/18 at 3:13 A.M., showed CNA K put on gloves without washing his/her hands and placed two disposable incontinence pads under Resident #77. The CNA wet a towel in the sink and started providing incontinence care to the resident. CNA K told the resident he/she had a small bowel movement. The CNA cleaned the resident’s bottom with cleansing wipes then changed gloves without washing his/her hands. The CNA applied barrier cream to the resident’s bottom. He/she changed gloves without washing his her hands and rolled the resident to his/her left side. The CNA placed the soiled items in a plastic bag, removed his/her gloves, and wrapped the resident’s leg stumps with a disposable incontinence pad. The CNA disposed the bag of soiled items in a container located in the hall. He/she removed the gloves and walked toward the nurses’ station without washing his/her hands. Observation on 8/30/18 at 10:00 A.M., showed LPN G and CNA Z entered the room to provide a treatment for [REDACTED]. The resident lay in bed with a brief on and was incontinent of urine and stool. CNA Z applied gloves and removed the resident’s soiled brief. CNA Z and LPN G assisted the resident to his/her side, and CNA Z applied gloves and cleansed the resident’s back, buttocks and groin areas. CNA Z then, with the same soiled gloves, turned the resident back over onto his/her back and placed the clean brief up through the resident’s legs and fastened the brief. Staff did not remove soiled gloves and wash hands after providing incontinent care. 10. Observation on 8/30/18 at 5:47 A.M., showed CNA C applied gloves without first washing his/her hands, and unfastened Resident #278’s brief. Observation showed dried brown stool to the resident’s buttocks and groin. The CNA cleansed the crease of the buttocks, applied a clean brief while turning the resident side to side. Further observation showed the CNA did not change gloves or wash hands when going from dirty to clean tasks during the provision of care. 11. Observation on 9/4/18 at 3:20 P.M., showed CNA BB entered Resident #429’s room to provide incontinent care. The resident lay in bed incontinent of urine. CNA BB applied gloves and assisted the resident onto his/her side then removed the soiled brief. CNA BB then cleansed the resident’s front peri area and buttocks, groin and folds. CNA BB continued to wear the same soiled gloves and touch the resident, clean linen and bedside drawer. CNA BB then applied a cream to the resident’s skin as she/he continued to wear the same soiled gloves. Staff did not remove soiled gloves and wash hands after providing incontinent care. 12. Observation on 8/29/18 at 4:57 P.M., showed CNA W and LPN G wore gowns and gloves and entered Resident #435’s room. The resident had liquid feces on his/her buttocks. LPN G cleansed the resident’s buttock and changed his/her gloves, without washing his/her hands, applied gloves and removed the resident’s old dressing from his/her coccyx. Observation showed a large amount of blood tinged drainage on the old dressing. LPN G cleansed the wound, remove his/her gloves, and without washing his/her hands, applied new gloves. Observation showed the resident continued to have liquid stool. LPN G cleansed the stool and changed gloves without washing his/her hands, and applied the resident’s ordered treatment to the wound. The LPN cleansed liquid stool from the resident’s bottom, removed gloves, did not wash his/her hands, and applied the dry dressing over the wound. |
| 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: 265345 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER LIFE CARE CENTER OF BRIDGETON | STREET ADDRESS, CITY, STATE, ZIP 12145 BRIDGETON SQUARE DR | |||||||||
| 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 – Some | (continued… from page 71) Observation showed the LPN applied barrier cream to the buttocks and groin without changing gloves or washing his/her hands. Further observation showed the LPN changed his/her gloves without washing his/her hands, removed the resident’s right heel lift boot, and cut off the dressing to the right foot. Observation showed scant (small) amount of serosangineous drainage on the soiled dressing and a moon shaped black eschar wound to the resident’s outer heel and a dime size circle black eschar area to the lateral right foot. The LPN cleansed both areas, changed gloves without washing hands or sanitizing, applied the ordered treatment and wrapped the foot with kerlix gauze. 13. During an interview on 9/05/18 at 6:40 P.M., CNA L said staff are expected to wash hands after pericare, after changing gloves and when providing any care. During an interview on 9/05/18 at 7:10 P.M., LPN V said staff are expected to wash hands after providing any care, and are expected to remove gloves after incontinent care and wash hands. During an interview on 9/5/18 at 6:58 P.M., the Director of Nursing (DON) said staff are expected to wash their hands before putting on gloves, after removing soiled items, before putting on on clean gloves, after the care is completed, and before they exit the room. Staff can use sanitizer if their hands/gloves are not visibly soiled. Staff should wet wash cloths by holding them in their hands or using a wash basin. Staff should not place wash cloths directly into the sink basin. When staff are doing wound care, staff are expected to wash their hands prior to putting on gloves, take off dirty dressings and place them in a plastic bag on bed, wash their hands, reglove, apply the treatment as order, take gloves off, wash hands, and tie the bag with soiled items. Staff are expected to sanitize or wash their hands any time that they remove gloves. | |
