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: 265366 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER MAPLE WOOD HEALTHCARE CENTER | STREET ADDRESS, CITY, STATE, ZIP 724 NORTHEAST 79TH TERRACE | |||||||||
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 – Minimal harm or potential for actual harm Residents Affected – Some | Honor the resident’s right to a dignified existence, self-determination, communication, and to exercise his or her rights. Based on observation and interview staff failed to provide for resident dignity and | |
F 0606 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | Not hire anyone with a finding of abuse, neglect, exploitation, or theft. Based on interview and record review, the facility failed to check the Nursing Assistant |
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: 265366 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER MAPLE WOOD HEALTHCARE CENTER | STREET ADDRESS, CITY, STATE, ZIP 724 NORTHEAST 79TH TERRACE | |||||||||
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 0607 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | Develop and implement policies and procedures to prevent abuse, neglect, and theft. Based on interviews and record reviews, the facility failed to follow their policy to | |
F 0636 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months. **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: 265366 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER MAPLE WOOD HEALTHCARE CENTER | STREET ADDRESS, CITY, STATE, ZIP 724 NORTHEAST 79TH TERRACE | |||||||||
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 0636 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 2) Should Have Been completed on 10/31/18. The Social Service Director had answered the questions in sections C, D, E and Q. Other sections were not completed. 3. Review on 11/8/18, of Resident #14’s quarterly MDS, dated , 10/24/18, had red alerts which stated In Progress and Should Have Been completed on 1/24/18. The Social Services Director had answered the questions in section C, D, E and Q. The other sections were not completed. During an interview on 11/9/18 at 3:32 P.M., the Director of Nurses, said: – The facility currently did not have an MDS coordinator and utilized a part time MDS Coordinator from a sister facility: – The previous MDS Coordinator left sometime in September. | |
F 0656 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | Develop and implement a complete care plan that meets all the resident’s needs, with timetables and actions that can be measured. **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: 265366 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER MAPLE WOOD HEALTHCARE CENTER | STREET ADDRESS, CITY, STATE, ZIP 724 NORTHEAST 79TH TERRACE | |||||||||
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 0656 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 3) and had never had one prior to being at facility. He/She liked a tub bath. Observation and interview on 11/8/18 at 3:20 P.M., showed the resident by the nurses station with a bottle of body wash in his/her hands, He/she said he/she was looking for a bath. Licensed Practical Nurse (LPN) B told the resident he/she would get staff to take him/her to get a shower. The resident immediately refused to take a shower. LPN B said: – Staff had a hard time getting the resident to take a shower; – When the resident refused showers, hair care and incontinent care, he/she tried to re-educate the resident to the benefits of being compliant with care. During an interview on 11/8/18 at 3:50 P.M., Certified Nurse Aide (CNA) E said: – Sometimes the resident refused cares, he/she told the charge nurse when that happened; – He/she could not comb the resident’s hair, the resident just needed a good shower; – The resident was afraid of the shower and often refused using it, he/she had only gotten the resident to use the shower twice since the resident came to the facility. During an interview on 11/9/18 at 3:32 P.M., the Director of Nurses, said: – He expected the nursing staff to find a care plan for a resident with a catheter; – If the goal for a problem had not been met and had not been updated, possibly the goal should change and the approaches should be changed to try and get the residents table to reach their goals; – The facility currently did not have an MDS coordinator and utilized a part ime MDS Coordinator from a sister facility. 3. Review of Resident #14’s admission MDS, dated , 7/24/18, showed: – Cognitive skills intact; – Had a Foley catheter (sterile tube inserted into the bladder to drain urine); – Always continent of bowel; – [DIAGNOSES REDACTED]. Review of the resident’s care plan, revised, 7/27/18, showed: – The resident had a potential for an ADL self care performance deficit related to diabetes mellitus; – The resident had a Foley catheter for bladder elimination. – The care plan had not been updated to show the Foley catheter had been discontinued. Review of the resident’s physician order [REDACTED]. – An order to discontinue the Foley catheter. During an interview on 11/9/18, at 3:32 P.M., the DON said: – The care plan should be updated to show the catheter had been discontinued. | |
F 0658 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | 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: 265366 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER MAPLE WOOD HEALTHCARE CENTER | STREET ADDRESS, CITY, STATE, ZIP 724 NORTHEAST 79TH TERRACE | |||||||||
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 – Few | (continued… from page 4) -A nurse or respiratory therapist will verify the oxygen order for the route and liters per minute (lpm) flow rate and deliver as prescribed. 2. Review of Resident #25’s annual Minimum Data Set (MDS), a federally mandated assessment instrument completed by facility staff, dated 8/1/18, showed: -A brief interview for mental status (BIMS) score of 15 out of 15; -Received oxygen therapy. Review of the resident’s care plan related to oxygen therapy, initiated on 9/21/18 and last updated on 8/14/18, showed: -On oxygen therapy due to [MEDICAL CONDITION] and [MEDICAL CONDITION] (chronically obstructed airways causing decreased oxygen in the blood); -Used oxygen through a nasal cannula at 4 liters continuously. Review of the resident’s current physician orders showed no order for oxygen. Observations on 11/6/18 through 11/8/18 at various times showed the resident received oxygen per a nasal cannula. 3. Review of Resident #38’s MDS dated [DATE], showed: – Some difficulty in making decisions; – Dependent on staff for toilet use; – Always incontinent of bowel and bladder; (indwelling catheter not coded) Review of the resident’s care plan, last revised 11/7/18, showed: – No care plan related to the resident’s indwelling catheter. Review of the resident’s 11/18 physician order sheet (POS), showed there was no order for the resident’s indwelling catheter. Observation and interview on 11/8/18 at 8:00 A.M., showed staff lay in bed with a catheter drainage bag attached to the bed. The resident said he/she returned to the hospital, without an indwelling catheter, when hospital staff called about some blood work results had come in, he/she returned to the facility with an indwelling catheter. During an interview on 11/9/18 at 3:32 P.M., the Director of Nurses (DON) said: – Staff should have clarified with the resident’s physician and gotten an order for [REDACTED].>4. Review of Resident #16’s MDS, dated [DATE], showed: – Able to make daily decisions: – Used oxygen therapy; [DIAGNOSES REDACTED]. Review of the resident’s care plan, revised on 10/19/18, showed: – Give oxygen therapy as ordered by the physician; – Uses oxygen continuously. Review of the resident’s 11/18 physician order sheet, showed the physician ordered: – Oxygen therapy at two liters per minute by nasal cannula continuously every shift for shortness of air. Observation and interview on 11/6/18 at 11:03 A.M., showed the resident used a portable tank of oxygen and had a oxygen concentrator beside his/her bed. The resident sat on the edge of his/her bed and said when he/she was up walking around the oxygen flow rate should be on at least four liters per minute and when he/she was not up and about the flow rate should be on two. He/she reached up and turned the knob on the portable oxygen tank from four liters down to three liters. Observation on 11/8/18 at 7:44 A.M., showed the resident lay in his/her bed with his/her eyes closed his/her nasal cannula was in place and attached to the oxygen concentrator. The flow rate on the oxygen concentrator was set on five liters per minute. During an interview on 11/8/18 at 2:45 P.M., Licensed Practical Nurse (LPN) B said: – Any staff CNA, CMT or Nurse could switch the residents oxygen from concentrator 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: 265366 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER MAPLE WOOD HEALTHCARE CENTER | STREET ADDRESS, CITY, STATE, ZIP 724 NORTHEAST 79TH TERRACE | |||||||||
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 – Few | (continued… from page 5) portable tank; – Staff looked at the flow rate on the concentrator and then set the portable oxygen tank flow rate to the same number as the concentrator; – If staff ever questioned the flow rate a resident’s oxygen should be set on, they should ask the charge nurse; – Residents should not set their own flow rate. During an interview on 11/8/18 at 2:50 P.M., CNA E said he/she looked on the oxygen concentrator to check the flow rate. He/she set the portable tank’s flow rate to match the concentrator, 5. Review of Resident #196’s care plan, revised on 4/9/18, showed: – Oxygen therapy as ordered by the physician. Review of the resident’s MDS, dated [DATE], showed: – Able to make decisions; – Oxygen therapy; – [DIAGNOSES REDACTED]. Review of the resident’s 11/18 physician’s order did not show an order for [REDACTED].>Observation on 11/6/18 at 10:31 A.M., showed the resident lay in bed using an undated nasal cannula attached to an oxygen concentrator. The flow meter of the concentrator was set on five liters per nasal cannula. Observation on 11/7/18 at 9:46 A.M., showed the resident used his/her nasal cannula attached to the oxygen concentrator that was set at five liters. 6. Review of Resident #13’s annual MDS, dated , 7/18/18, showed: – Cognitive skills intact; – [DIAGNOSES REDACTED]. Review of the resident’s care plan, revised 8/14/18, showed: – The resident had oxygen therapy related to [MEDICAL CONDITION] and [MEDICAL CONDITIONS], buildup of fluid in the lungs and surrounding body tissue; – The resident had oxygen at 4 liters/nasal cannula continuously. Observation on 11/7/18, at 8:36 A.M., showed: – The resident laid in bed with oxygen on at 4 liters (L)/ per nasal cannula. Review of the resident’s POS, dated 11/8/18, showed: – The resident did not have an order for [REDACTED].>7. Review of Resident #93’s care plan, revised, 8/24/18, showed: – The care plan did not address the use of oxygen. Review of the resident’s 14 day assessment MDS, dated , 10/24/18, showed: – Cognitive skills intact; – [DIAGNOSES REDACTED]. Review of the resident’s POS, dated, 11/8/18, showed: – The resident did not have an order for [REDACTED].>8. During an interview on 11/9/18 at 3:32 P.M., the Director of Nurses said: – Residents should not adjust the oxygen flow rate themselves; – If a CNA was changing a resident from a concentrator to a portable tank, he/she should verify with the charge nurse what the flow rate should be; – A resident that used continuous oxygen should have a physician’s order for oxygen 9. Review of Resident #196’s care plan showed staff had not assessed the resident for self administration of medications. Review of the resident’s quarterly MDS, dated [DATE], showed: – Cognitively intact; – Totally dependent upon staff for transfers; |
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: 265366 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER MAPLE WOOD HEALTHCARE CENTER | STREET ADDRESS, CITY, STATE, ZIP 724 NORTHEAST 79TH TERRACE | |||||||||
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 – Few | (continued… from page 6) – Required extensive staff assistance for toileting and hygiene; – [DIAGNOSES REDACTED]. Observation on 11/7/18 at 9:45 A.M. showed the resident in bed with a cup containing 12 pills. Observation on 11/7/18 at 11:33 A.M. showed: – The resident with a Sprivia (used to treat lung disease) inhaler at his/her bedside. – The resident taking one puff from his/her Sprivia inhaler. During an interview on 11/7/18 at 2:14 P.M. LPN H said: – He/she left the pills at the resident’s bedside because she had to leave to get something for the resident. – He/she should have not left the pills at the bedside. – He/she should not leave the resident’s inhaler at the bedside. During an interview on 11/9/18 3:00 P.M. the DON said: – Staff should not leave a resident’s pills at the bedside. – Staff should watch a resident take his/her pills. – Staff should not leave a resident’s inhaler at the bedside. | |
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: 265366 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER MAPLE WOOD HEALTHCARE CENTER | STREET ADDRESS, CITY, STATE, ZIP 724 NORTHEAST 79TH TERRACE | |||||||||
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 7) includes combing, brushing shampoo, trimming and simple haircuts. Routine care also includes nail hygiene services including routine trimming and cleansing and filing; – Can be completed in conjunction with bathing or performed separately; – Routine nail care and hair care is provided as part of the bath or shower; Hair shampooing will be completed on an as needed basis no less than weekly Review of the facility policies for Bathing and Showers, revised 4/25/18. showed: – It is the policy of this facility to provide resident centered care that meets the psychosocial, physical and emotional needs and concerns of the residents. – Residents have the right to choose their schedules, consistent with their interests, assessments and care plans including choice for personal hygiene; – This includes, but is not limited to , choices about the schedules and type of activities for bathing that may include a shower, a bed-bath or a tub bath, or a combination and on different days; Bathing preferences should be care planned including type and schedule; – In the event a resident refuses a bath because he/she prefers a shower or a different bathing method, such as in bed bathing, prefers to bathe at a different time of day or on a different day, does not feel well that day, is uneasy about the aide assigned to help or is worried about falling, the resident’s preference must be accommodated,; 2. Review of Resident #40’s care plan, revised 8/14/18, showed: – Check every two hours and as needed for incontinence; – Wash, rinse and dry perineum; – Change clothing as needed after incontinence episodes. Review of the resident’s Minimum Data Set (MDS), a federally mandated assessment instrument, completed by facility staff, dated 8/15/18, showed: – Unable to make daily decisions; – Required extensive assistance of staff for toilet use and personal hygiene; – Always incontinent of bowel and bladder; – [DIAGNOSES REDACTED]. Observation on 11/8/19 at 2:00 P.M., showed staff transferred the resident to his/her bed and provided incontinent care. Certified Nurse Aides (CNA) E and H provided perineal care. CNA E removed the soiled incontinent brief and said it was wet. CNA E wiped one time down the right groin with a pre-moistened wipe and one time down the left groin. CNA E rolled the resident onto his/her right side. When CNA H started to wipe the resident’s left buttock, the resident started to urinate in the bed. CNA H wiped one hand width of the resident’s left buttock, rolled the resident to his/her right side on the soiled incontinent pad and wiped one hand width on the left buttock and up the center crease of the buttocks. Staff rolled the incontinent pad under the resident and placed a brief under the resident. CNA H washed once down the left groin and one wipe down the right groin then fastened the brief on the resident. Staff did not re-wash the resident’s hips and buttocks after they rolled him/her on the wet incontinent pad. Staff did nor thoroughly manipulate the perineal folds or wash the inner thighs. 3. Review of Resident 196’s care plan, reised 4/9/18, showed: – Check throughout the day/night for incontinence; – Wash, rinse and dry perineum; – Change cthing as needed after incontinence episode; – Provide consistency in care to promote comfort with activities of daily living; – Maintain consistency in timing of activities of daily living, caregivers and routine, as much as poossible. Review of the resident’s MDS, dated 92218. showed: |
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: 265366 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER MAPLE WOOD HEALTHCARE CENTER | STREET ADDRESS, CITY, STATE, ZIP 724 NORTHEAST 79TH TERRACE | |||||||||
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 8) – Able to make daily decisions; – Required extensive assistance of staff for toilet use ad personal hygiene; – Frequently incontinent of bowel and bladder; – Weight 437 pounds; – [DIAGNOSES REDACTED]. Observation and interview on 11/7/18 at 9:45 A.M., showed the resident lay in bed incontinent of urine. The resident said he/she night shift only changed him/her once the night before, staff didn’t change him/her until 4:30 A.M., they always wanted to wake him/her up then. He/she thought staff should check and change him/her through the night, not just wake him/her at 4:30 in the moring to change him/her. The resident lay on an incontinent brief with two additional liners on top of two paper chux(pads) that stretched from mid way up the resident’s back to his/her knees. CNA G used one wipe per swipe and cleaned one time under the resident’s large panis(skin fold), once down the left groin, once down the right groin and once down the center. Staff assisted the resident to roll to his/her side, the brief, liners and paper chux are stained brown with urine. The paper chux were wet to up halfway up the resident’s back. CNA G used separate pre-moistened wipes and wiped back and forth on the back side of each of the resident’s legs from his/her knee to the gluteal fold and cleansed the buttocks. CNA G did not wash up the resident’s back that lay on the urine soiled paper chux, did not wash the entire buttocks, hip areas, the pubic area or inside each roll on the resident’s legs and did not thoroughly manipulate and cleanse the front perineal folds. Observation and on 11/8/18 at 2:20 P.M., CNA E and CNA H provided peri care for the resident. The resident lay in bed incontinent of urine through his/her brief, two liners, paper chux and the fitted sheet underneath the resident. The resident lay in urine up to his/her shoulder blades. CNA H used pre-moistened wipes and wiped once under the abdominal skin fold, twice down each groin and one down the front side middle, rolled the resident over and wiped both inner legs from knee to gluteal fold and cleaned one hand width on each buttock and from the rectum up towards the resident’s waste. CNA H did not manipulate and cleanse the front perineal folds or wash the resident’s back that lay in urine. 4 Review of Resident #25’s annual MDS, dated [DATE], showed: -Required extensive assistance of two staff for bed mobility and personal hygiene; -Always incontinent of bowel and bladder; -Had a stage II pressure ulcer (localized skin damage that may present as a blister or a small crater in the dermis that does not extend into the fatty tissue). Review of the resident’s care plan, last revised on 8/14/18, showed: -Had functional bowel/bladder incontinence related to overactive bladder; -Check every two hours and as needed for incontinence; -Wash, rinse and dry perineum; -Had moisture-associated abrasions of the right and left buttocks identified on 10/12/18; -Not toileted, per resident’s choice, and refuses use of a bed pan. Observation on 11/18/18, at 6:14 A.M., showed CNA’s A and B provided incontinent care for the resident in the following manner: -Both staff washed their hands and put on gloves; -CNA A used two wet wipes to cleanse the resident’s lower abdomen and both groin areas, folded each wipe multiple times, used the same two wipes on multiple areas, wiped in a back and forth motion, and did not separate and cleanse between all genital skin folds; -Fecal material remained on the last wipe used to cleanse the front genital areas; -CNA changed his/her gloves but did not wash or sanitized his/her hands; -Staff turned the resident onto his/her right side and cleansed the resident’s backside 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: 265366 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER MAPLE WOOD HEALTHCARE CENTER | STREET ADDRESS, CITY, STATE, ZIP 724 NORTHEAST 79TH TERRACE | |||||||||
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 9) the same manner-wiped back and forth, and folded and wiped with the same wet wipes multiple times; -The resident had several superficial, long thin open areas on the buttocks; -Staff turned the resident onto his/her back and cleansed his/her inner thighs with fecal material still present on the last wipe used; -Both staff replaced the soiled bed pad with a clean pad and continued the resident’s care. During an interview on 11/8/18 at 6:43 A.M., CNA A said: -Should cleanse any place urine may have touched; -Should not use the same wipe to cleanse different body areas; -Should use one wipe per swipe; -Should not wipe back and forth. 5. Review of Resident #56’s admission MDS, dated [DATE], showed: -Required extensive assistance for personal hygiene and toileting; -Occasionally incontinent of bladder and frequently incontinent of bowel. Review of the resident’s care plan, dated 9/13/18, showed: -Had bowel and bladder incontinence; -Provide perineal care after each incontinent episode. Observation on 11/6/18 at 11:48 A.M., showed CNA D provided care in the following manner: -Washed his/her hands and put on gloves; -Cleansed the front genital area; -Turned the resident onto his/her side and cleansed the rectal area, but did not cleanse the buttocks; -Replaced the wet brief with a clean one; -Removed his/her gloves and washed his/her hands. . Review of Resident #396’s admission MDS, dated , 10/7/18, showed: – Cognitive skills severely impaired; – Dependent on the assistance of two staff for bed mobility, transfers, and toilet use; – Frequently incontinent of bladder; – Always incontinent of bowel; – [DIAGNOSES REDACTED]. Review of the resident’s care plan, revised, 11/7/18, showed: – The resident was incontinent of bowel and bladder related to impaired mobility; – Prefers disposable briefs; – Change every two hours and as needed. Observation on 11/8/18, at 5:59 A.M., showed: – CNA A unfastened the resident’s wet incontinent brief; – CNA A used the same wipe and wiped back and forth across the resident’s pubic area, then down each side of the resident’s groin and did not separate and clean all the perineal folds; – CNA A pumped DermaKleen lotion soap (skin protectant) on the resident’s pubic area and used the same wipe and wiped back and forth across the pubic area, and down the perineal folds; – CNA A did not separate and thoroughly cleanse all the perineal folds; – CNA A turned the resident on his/her side and removed the wet incontinent brief; – CNA B used a new wipe and used the same area and wiped from back to front with a smear of fecal material multiple times; – CNA B used a new wipe and with the same area of the wipe, wiped back to front three times without any fecal material; |
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: 265366 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER MAPLE WOOD HEALTHCARE CENTER | STREET ADDRESS, CITY, STATE, ZIP 724 NORTHEAST 79TH TERRACE | |||||||||
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 10) – CNA B wiped in the wrong direction and did not clean all areas of the skin where urine had touched. – CNA A and CNA B placed a clean incontinent brief on the resident. During an interview on 11/8/18, at 6:39 A.M., CNA B said: – He/she should have wiped from front to back; – He/she should have cleaned all areas of the skin where urine had touched. During an interview on 11/8/18, at 6:44 A.M., CNA A said: – Should not use the same area of the wipe to clean different areas of the skin; – It should be one wipe, one swipe, should not wipe back and forth; – Should clean all areas of the skin where urine had touched. During an interview on 11/8/18 at 1:17 P.M., CNA D said staff should clean everywhere the brief touched. 6. During an interview on 11/8/18 at 2:40 P.M., CNA H, said: – He/She used one swipe per wipe and should not clean more than one area with the same wipe; – He/She should always wipe front to back, start on the outer side and clean towards the middle: – He/She should wash all areas of skin that urine touched. During an interview on 11/8/18 at 2:50 P.M. CNA E said: – He/she used wipes to clean only one area at a time and only swiped once with each wipe; – He/she should wipe front to back; – He/She tried to clean one side and then the other, then tried to wipe down the center. Sometimes the residents tightened their legs which made it difficult to get them clean, but he/she did the best he/she could; – He/she should have washed up the resident’s back where urine touched. During an interview on 11/9/18 at 2:00 P.M., CNA G, said: – After he/she removed an incontinent brief, he/she always wiped under the abdominal fold; – He/she used one wipe per swipe; – He/she used a clean wipe for each groin and used one more wipe to clean the center of the perineal fold; – After he/she rolled the resident to his/her side, he/she cleaned each buttock and then up the center of the buttocks from the rectum up to the coccyx; – He/she should also clean the resident’s thighs, inner thigh and anywhere urine or feces touched the resident’s skin. During an interview on 11/9/18 at 3:32 P.M., the Director of Nurses (DON) said: – Staff use the disposable wipes, one wipe per swipe; – Staff should not clean more that one area with each wipe; – Staff should clean inner to outer on the resident’s peri area and wipe front to back; – Staff should never wipe back and forth, – Staff should thoroughly separate and clean all areas of the skin where urine or feces had touched (hips back, abdomen etc). 7. Review of Resident 52’s care plan, revised 6/5/18, showed – Resident requires with his/her bathing; – Supervise the resident’s personal hygiene. Review of the resident’s MDS, dated [DATE], showed: – Unable to make daily decisions; – Required assistance with personal hygiene and bathing; – [DIAGNOSES REDACTED]. Observation on each day of the survey, 11/6, 11/7, 11/8 and 11/9/18, at various times |
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: 265366 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER MAPLE WOOD HEALTHCARE CENTER | STREET ADDRESS, CITY, STATE, ZIP 724 NORTHEAST 79TH TERRACE | |||||||||
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 11) throughout the days, showed the resident had numerous white chin and neck whiskers, some up to at least an inch in length. During an interview on 117/18 at 9:12 A.M., the resident said he/she did not like when the whiskers on his/her face got long like they are now. He/She used to take care of them his/herself and did not know that staff at the facility would help him/her with the whiskers. He/she had looked for a beauty shop but had not one found one and he/she thought the facility needed one. During an interview on 11/9/18 at 3:32 P.M., the DON said: – Removal facial hair depended whether the resident did or did not want it. If not, then staff should remove facial hair during the resident’s shower; – Staff should remove the facial hair when needed. 8. Review of Resident #91’s facility records showed: – A care plan revised 6/26/18, included the resident was dependent on staff assistance for all ADL’s due to [DIAGNOSES REDACTED]. – The residents MDS, dated [DATE], included he/she had severely impaired cognitive skills for daily decision making. He/she did not reject care. He/she required two-person physical assistance with personal hygiene. He/she had limited upper-extremity range of motion. Review of Resident #88’s facility records showed: – A care plan revised 8/10/18, included the resident had ADL self-care performance deficit due to spastic [MEDICAL CONDITION] (a neuromuscular condition of [DIAGNOSES REDACTED] that results in the muscles on one side of the body being in a constant state of contraction), poor balance and contracture of left hand requiring staff participation in personal hygiene. – The residents MDS, dated [DATE], included he/she was mentally-cognitively intact. Did not reject care. Required one-person physical assistance with personal hygiene. He/she had [DIAGNOSES REDACTED]. Observations on 11/7/18 at 3:00 P.M., showed Resident # 88 and Resident # 91’s fingernails were long, uneven and dirty. Licensed Practical Nurse (LPN) F said both residents needed their fingernails cleaned and trimmed. In an interview on 11/8/18 at 12:02 P.M., CNA J said a week ago he/she noticed Residents #88’s and Resident #91’s nails were too long and reported it to a charge nurse. During an interview on 11/7/18 at 3:20 P.M., LPN F said both Resident #88 and Resident #91 nails were too long. Staff should have told nursing who could trim their nails. Two days ago he/she noticed Resident #91’s finger nails needed trimming but did not trim them. In an interview on 11/09/18 at 3:32 P.M., the DON said staff should trim resident fingernails weekly. | |
F 0689 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | 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** |
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: 265366 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER MAPLE WOOD HEALTHCARE CENTER | STREET ADDRESS, CITY, STATE, ZIP 724 NORTHEAST 79TH TERRACE | |||||||||
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 – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 12) 1. Review of the manufacturer’s undated guideline for mechanical lift use, showed: – With the legs of the lift open use the steering handle to push the lift underneath the bed; – NOTE: Do not engage the rear locking casters when the patient is in the lift. Review of the facility policy for Mechanical Lift and Transfer, revised 5/23/18, showed: – Follow the manufacturer’s recommendations for specific mechanical lift equipment: – When transporting a resident from one location to another using a total lift, the legs of the lift must remain in the maximum open position for optimum stability and safety while lifting and safety while the lift is moving; – Transfer preparation, the rear casters are unlocked; – Legs of the lift are in the optimum open position. 2. Review of Resident #40’s care plan, revised 8/14/18, showed: -Resident requires total assistance of staff with transfers using the mechanical lift. Review of the resident’s Minimum Data Set, a federally mandated assessment instrument, completed by facility staff, dated 8/15/18, showed: – Unable to make daily decisions; – Dependent on staff for transfers; – [DIAGNOSES REDACTED]. Observation on 11/8/18 at 2:00 P.M., showed the resident sat in a Broda type wheelchair. Certified Nurse Aide (CNA)s E and H transferred the resident with a mechanical lift to his/her bed. – CNA H placed the closed lift legs through the wheels of the wheelchair and locked the casters; – After staff attached the sling to the lift, CNA H unlocked the caster, backed the lift, turned the lift toward the bed and pushed the lift at least six feet to the resident’s bed with the legs of the lift closed; – CNA H left the legs of the lift closed as he/she lowered the resident to his/her bed. 3. Review of Resident #38’s Minimum Data Set, (MDS), a federally mandated assessment instrument completed by facility staff, dated 8/13/18, showed: – Some difficulty in making decisions; – Dependent on staff for transfers; – [DIAGNOSES REDACTED]. Review of the resident’s care plan, last revised 11/7/18, showed: – Resident requires sliding board or mechanical lift for transfers, assist of two staff. Observation on 11/8/18 at 8:00 A.M., showed the resident lay in his/her bed. CNA E and CNA H placed a lift sling under the resident and transferred the resident with a mechanical lift in the following way: – CNA H placed the mechanical lift under the resident’s bed and left the legs in the closed position; – Attached the sling to the mechanical lift, lifted the resident from the bed and backed the lift from under the bed, turned the lift towards the resident’s wheelchair and opened the legs of the lift; – Locked the castors of the mechanical lift and lowered the resident into his/her wheelchair 4. During an interview on 11/8/18 at 2:40 P.M., CNA H said: – He/she should open the legs of the lift while hooking up the sling to the lift and close the legs of the lift when lifting, lowering and moving the resident; – He/she locked the casters before he/she lowered the resident; – The facility said he/she should follow manufacturer’s guidelines when he/she used 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: 265366 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER MAPLE WOOD HEALTHCARE CENTER | STREET ADDRESS, CITY, STATE, ZIP 724 NORTHEAST 79TH TERRACE | |||||||||
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 – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 13) mechanical lift. During an interview on 11/9/18 at 3:32 P.M., the Director of Nurses said: – Staff should follow the manufacturer’s guidelines when they use the mechanical lift; – The legs of the lift should be in the open position when staff raise, lower or move the resident; – Staff should only lock the casters when raising or lowering the resident. 5. Review of Resident #56’s admission MDS, dated [DATE], showed: -Severe cognitive impairment related to decision-making; -Required extensive assistance of one staff for transfers. Review of the resident’s care plan, dated 9/13/18, showed: -At risk for falls related to decreased balance; -Self care deficit related to generalized weakness compounded by dementia; -Required extensive assistance for transfers. Observation on 11/6/18 at 11:48 A.M., showed Certified Nurse Aide (CNA) D transferred the resident from the bed to a wheelchair in the following manner: -Provided incontinent care, washed his/her hands and put on gloves; -Dressed the resident, then placed a gait belt around the resident’s waist; -The resident stated, You’ve never used that before. -CNA A stated that the resident must be used to staff grabbing his/her pants to transfer him/her. -CNA A placed the wheelchair near the bed and locked the wheels, grasped the back of the resident’s gait belt and lifted the resident to a standing position; -The gait belt slid up the resident’s back, pulling the resident’s clothing up his/her back; -CNA A held onto the gait belt with one hand and used his/her other hand to grasp the back of the resident’s pants and pulled on the pants to moved the resident from the bed to the wheelchair. During an interview on 11/18/18 at 1:17 P.M., CNA D said: -Place the gait belt around the area where the tummy starts; -Grab the back of the gait belt and lift with the belt; -Was taught that it was alright to lift the resident by holding onto their pants, but he/she would rather lift with the gait belt. _. During an interview on 11/9/18 at 3:00 P.M., the DON said: -Place the gait belt tightly just above the resident’s hips. -Grasp the gait belt to lift, not clothing. -If the gait belt slides up, if possible, staff should lower the resident and adjust the gait belt. 6. Review of the facility’s resident smoking policy, showed, in part: – Smoking materials: smoking materials include but are not limited to cigarettes, cigars, electronic cigarettes, lighters and matches; – Independent smoker: a resident that is able to demonstrate safe smoking habits including smoking materials management, lighting, controlling cigarette ash and extinguishing smoking materials; – IDT: an interdisciplinary team is composed of professionals from a variety of disciplines (nursing, therapy, social services, dietary, pharmacy and other) working together to solve or address an issue using a holistic perspective; – It is the policy of this facility to promote resident centered care by providing a safe smoking area for residents that request to smoke and are capable of safe smoking behaviors; |
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: 265366 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER MAPLE WOOD HEALTHCARE CENTER | STREET ADDRESS, CITY, STATE, ZIP 724 NORTHEAST 79TH TERRACE | |||||||||
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 – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 14) – Smokers will be permitted to smoke only in designated smoking areas; – Obtaining smoking materials is the responsibility of the resident/family/guardian; – Facility staff will secure smoking materials in a locked area when not in use by the resident for both independent and supervised smokers. 7. Review of Resident # 64’s quarterly MDS dated [DATE], showed: – Makes self understood. – Understand others. – Moderately impaired cognitive status. Review of the residents care plan dated 10/3/18, showed the resident was non-compliant with the smoking policy as being a dependent smoker. The resident falls asleep when smoking and required staff supervision. The resident burned him/herself several time since admission. The Social Services Director (SSD) has educated the resident. Review of the resident Smoking assessment dated [DATE], showed: – The resident could not light his/her own cigarette. – The resident falls asleep or drops cigarette. The resident has numerous burns. Observation on 11/8/18 at 8:56 P.M., showed the resident in his/her room with smoke all around and the odor of cigarette smoke in the air. In an interview on 11/8/18 at 8:58 P.M., Certified Nurse Aide (CNA) L said another resident smelled smoke, informed staff and the resident was found in his/her room smoking. Review of Resident # 64’s care plan showed on 11/8/18, staff re-educated the resident of 8. Review of Resident #79’s care plan, revised, 6/8/18, showed: |
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: 265366 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER MAPLE WOOD HEALTHCARE CENTER | STREET ADDRESS, CITY, STATE, ZIP 724 NORTHEAST 79TH TERRACE | |||||||||
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 – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 15) – The residents are not allowed to have their cigarettes and lighters in their rooms; – When staff see them, they should lock them up in captivities or in the cigarette box which is kept in the east nurse’s station. During an interview on 11/9/18, at 8:38 A.M., the Social Services Director said: – It is against the facility’s policy for the resident’s to have their cigarettes or lighters in their rooms; – Staff should also notify him/her so he/she could document and re-educate the resident on the smoking policy. During an interview on 11/9/18, at 3:32 P.M., the DON said: – The residents should not smoke in their rooms; – The policy at Communicare is the residents cannot have a lighter on their person or in their rooms – Resident#64 was found smoking in his/her room and will be placed on one to one monitoring. – Residents were not allowed to have lighters. – Staff was to report to administration when residents had lighters in their rooms. – He was not aware that resident #79 stored lighters in his/her room. – No residents were allowed to store lighters in their room. | |
F 0690 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/31/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265366 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER MAPLE WOOD HEALTHCARE CENTER | STREET ADDRESS, CITY, STATE, ZIP 724 NORTHEAST 79TH TERRACE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
---|---|---|
F 0690 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 16) 4/2017, showed: – Tubing is maintained in a dependent position below the bladder, with the flow of urine downward and preventing backflow; – Drainage bags will be covered when the resident is out of the room for dignity and infection prevention purposes; – Drainage bags will not be placed on the floor; – Drainage bags will be emptied each shift. Use alcohol or other antiseptic wipe for disinfection of the port before and after draining urine. 2. Review of Resident #38’s Minimum Data Set, (MDS), a federally mandated assessment instrument completed by facility staff, dated 8/13/18, showed: – Some difficulty in making decisions; – Dependent on staff for toilet use; – Required extensive assistance with personal hygiene; – Always incontinent of bowel and bladder; (indwelling catheter not coded) – [DIAGNOSES REDACTED]. Review of the resident’s care plan, last revised 11/7/18, showed: – Resident on antibiotic therapy for a UTI; – No care plan related to the resident’s indwelling catheter. Observation on 11/8/18 at 8:00 A.M., showed staff lay in bed with a catheter drainage bag attached to the bed. Certified Nurse Aides (CNA)s E and H provided peri care and catheter care before getting the resident up for breakfast. Both staff put on gloves without washing their hands. – CNA E set a graduate (plastic measuring cup) on the floor without a barrier on the floor; – After CNA E drained urine from the drainage bag, he/she tapped the drainage port onto the side of the graduate; – CNA E did not clean the drainage spout with an alcohol pad but replaced the drainage port into the holder on the drainage bag; – CNA H returned to the resident’s room after he/she removed a soiled bag of linen from the room and retrieved more pre-moistened wipes. He/she did not wash his/her hands, put on gloves and without securely grasping the catheter tubing wiped down the tubing with three clean pre-moistened wipes; – CNA E held the catheter drainage bag above the bed as he/she threaded the bag through the leg of the resident’s shorts; – When staff transferred the resident to his/her wheelchair with a mechanical lift, CNA E placed the urinary drainage bag into a dignity bag hooked under the resident’s wheelchair, the tubing dragged the floor; – Without adjusting the tubing, CNA H pushed the resident’s wheelchair down the hallway to the dining room, the tubing dragged the floor up the hallway. During an interview on 11/8/18 at 2:40 P.M., CNA H said: – He/she should hold the catheter tubing by the entry site when wiping down the catheter tubing, that would help support the tubing so it didn’t get pulled; – The drainage tubing should never touch the floor. During an interview on 11/6/18 at 2:50 P.M., CNA E said: – He/she was suppose to have a clean field, towel or something, on the floor under the graduate; – He/she should have cleaned the drainage port with an alcohol wipe, but he/she did not have any; – The tubing and urinary drainage bag should always be kept below the level of the bladder |
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: 265366 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER MAPLE WOOD HEALTHCARE CENTER | STREET ADDRESS, CITY, STATE, ZIP 724 NORTHEAST 79TH TERRACE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
---|---|---|
F 0690 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 17) but not touch the floor. 3. Review of Resident #7’s annual MDS, dated , 10/12/18, showed: – Cognitive skills moderately impaired; – Required extensive assistance of one staff for bed mobility, transfers, and toilet use; – Had a Foley catheter; – Always incontinent of bowel; – [DIAGNOSES REDACTED]. Review of the resident’s care plan, revised, 11/6/18, showed: – The resident had an indwelling catheter: suprapubic: [DIAGNOSES REDACTED]. – Catheter care every shift; – Catheter strap in place at all times for securement of catheter; – Position catheter bag and tubing below the level of the bladder and away from entrance of the door; – Change drainage bag and tubing every two weeks on Sunday and as needed; – Monitor, record and report to physician for signs and symptoms of UTI. Review of the resident’s active POS, showed: – An order to change the drainage bag and tubing every night shift every 14 days; – Change Foley catheter as needed for leakage; – Foley catheter care as needed for hygiene; – Foley catheter care every day and night shift for hygiene. Observation on 11/8/18, at 6:27 A.M., showed: – The resident propelled him/herself down the hallway and the dignity bag dragged on the floor from the resident’s room to the dining room. Observation on 11/9/18, at 9:49 A.M., showed: – CNA C entered the resident’s room, did not wash his/her hands and applied gloves; – CNA C placed a paper towel on the floor, placed the graduate on the paper towel and placed the package of wipes directly on the floor; – CNA C unclamped the drainage spout and emptied the urine into the graduate; – CNA C used a wipe and and cleaned the drainage spout and replaced it in the sleeve. During an interview on 11/8/18, at 10:00 A.M., CNA C said: – He/she normally used a wipe to clean the drainage spout; – He/she should not have placed the package of wipes directly on the floor. Observation on 11/9/18, at 10:05 A.M., showed LPN A provided suprapubic catheter care in the following manner: – CNA C and CNA D transferred the resident from his/her wheelchair into his/her bed; – LPN A did not wash his/her hands and applied gloves; – LPN A used the same area of the wash cloth to clean the area around the insertion site; – LPN A used a new wash cloth and wiped approximately an inch down the catheter tubing; – LPN A applied a new dressing around the insertion site; – LPN A placed the drainage bag directly on the resident’s floor and attempted to get the urine out of the tubing. During an interview on 11/9/18, at 10:21 A.M., LPN A said: – He/she should not use the same area of the cloth to clean different areas of the skin; – He/she should have wiped four inches down the catheter tubing; – He/she should have anchored the tubing when he/she cleaned it. – He/she should not have placed the drainage bag directly on the resident’s floor. 4. Review of Resident #68’s care plan, dated 6/8/18, showed: – The resident had a suprapubic catheter. – Staff must keep the drainage bad below the level of the bladder. |
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: 265366 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER MAPLE WOOD HEALTHCARE CENTER | STREET ADDRESS, CITY, STATE, ZIP 724 NORTHEAST 79TH TERRACE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
---|---|---|
F 0690 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 18) – Staff must provide catheter care every shift and as needed. – Did not discuss the use of a leg strap. Review of the resident’s quarterly MDS dated [DATE], showed: – Cognitively intact; – Total dependence upon staff for transfers; – Required extensive staff assistance for dressing, toileting, and hygiene; – Had a catheter; – Frequently incontinent of bowel; – [DIAGNOSES REDACTED]. Observation on 11/6/18 at 10:54 A.M. showed the resident’s bulging (overfilled) catheter bag on the floor. Observation on 11/7/18 at 10:55 A.M. of Licensed Practical Nurse (LPN) G providing suprapubic care for the resident showed: – He/she emptied the resident’s drainage bag of 3000 milliliters (ml) of cloudy urine. – He/she then uncovered the resident and found the resident did not have a leg strap to anchor his/her suprapubic catheter. During an interview on 11/7/187 ay 10:55 A.M. LPN G said: – The resident’s drainage bag was overflowing. – Staff should empty it when ever the bag looks full. – The resident should have a leg strap to anchor the suprapubic catheter. During an interview on 11/7/18 at 11:55 A.M. the resident said: – Staff infrequently emptied his/her drainage bag. – Staff did not put on a leg strap. During an interview on 11/9/18 at 8:00 A.M. the DON said: – Staff should empty a resident’s drainage bag at the end of their shift and anytime the bag looked full. – Staff should anchor a resident’s suprapubic catheter with a leg strap. – The resident refused a leg strap sometimes. – Staff should care plan interventions if the resident refused a leg strap. 5. During an interview on 11/9/18 at 3:32 P.M., the Director of Nurses (DON), said: – Staff should place the graduate on a clean barrier; – If staff tapped the drainage spout on the graduate, it was contaminated and staff should clean it with an alcohol pad before replacing it in the holder on the drainage bag; – Staff should stabilize the catheter tubing before they wiped down the tubing; – Staff should keep the drainage bag inside a dignity bag. The tubing, urinary drainage bag and the dignity bag should never touch the floor unless there was a clear barrier; – Staff should make sure the residents wore a leg strap; – Staff should never place the drainage bag above the resident’s bladder. | |
F 0695 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | Provide safe and appropriate respiratory care for a resident when needed. **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: 265366 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER MAPLE WOOD HEALTHCARE CENTER | STREET ADDRESS, CITY, STATE, ZIP 724 NORTHEAST 79TH TERRACE | |||||||||
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 0695 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 19) facility census was 96. 1. Review of the undated facility policy on oxygen therapy showed: – Staff should remove and clean oxygen concentrator filters once a week. – Did not address person responsible for cleaning or when to clean the filter. Review of the facility policy, dated 3/20/18, on supplemental oxygen using a nasal cannula showed: – Staff must label the cannula tubing when opened. – Staff must change each resident’s nasal cannula weekly and as needed. – Licensed nurse only to adjust the oxygen liter flow. – Did not address the person responsible for changing the oxygen tubing and what day of the week. – Did not address changing the humidifier. 2. Review of Resident #19’s annual MDS, dated [DATE], showed: – Mild cognitive impairment; – Required supervision for dressing, toileting, and hygiene; – Occasionally incontinent of bladder and bowel; – [DIAGNOSES REDACTED]. – Did not indicate the resident received oxygen therapy. Review of the resident’s treatment administration record (TAR) dated (MONTH) (YEAR) showed: – Staff must change and date oxygen tubing every Sunday. – Did not discuss dating the oxygen humidifier. – Staff to ensure the resident received oxygen at two liters (l) per nasal cannula continuously. Observation on 11/6/18 at 10:45 A.M. of the resident showed: – The resident sitting in his/her wheelchair connected to a portable oxygen tank on the back of the wheelchair. – The portable oxygen tank was on empty. – The resident’s oxygen tubing was not labeled when staff opened the tubing. Observation on 11/7/18 at 9:21 A.M. showed: – The resident’s oxygen tubing connected to an oxygen concentrator. – The resident’s oxygen tubing not labeled when staff opened the tubing. – The resident’s oxygen tubing connected to humidifier not labeled when staff opened the tubing. During an interview on 11/7/18 at 10:11 A.M. the Director of Nursing (DON) said: – Staff should change each resident’s oxygen tubing once a week. – Did not know which staff or which day of the week staff were supposed to change and label the resident’s tubing and humidifiers. – Staff should frequently check each resident’s oxygen tank and promptly change when empty. 3. Review of the facility’s policy related to use of supplemental oxygen, dated 3/20/18, showed: -Oxygen is considered a medication and will be treated as such, including the need for a physician order and placement on the Medication Administration Record [REDACTED] -A nurse or respiratory therapist will verify the oxygen order for the route and liters per minute (lpm) flow rate and deliver as prescribed. 4. Review of Resident #16’s MDS, dated [DATE], showed: – Able to make daily decisions: – Used oxygen therapy; |
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: 265366 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER MAPLE WOOD HEALTHCARE CENTER | STREET ADDRESS, CITY, STATE, ZIP 724 NORTHEAST 79TH TERRACE | |||||||||
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 0695 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 20) – [DIAGNOSES REDACTED]. Review of the resident’s care plan, revised on 10/19/18, showed: – Give oxygen therapy as ordered by the physician; – Uses oxygen continuously. Review of the resident’s 11/18 physician order sheet, showed: – Oxygen therapy at two liters per minute by nasal cannula continuously every shift for shortness of air; – Change out oxygen tubing with date and initials once per week every night shift every Sunday for infection control. Observation and interview on 11/6/18 at 11:03 A.M., showed the resident used a portable tank of oxygen and had a oxygen concentrator beside his/her bed. The oxygen concentrator did not have a foam filter in place. Where the foam filter should have been was a space covered with light gray dust that removed with a wipe of the finger. Neither nasal cannula tubing on the concentrator nor the portable oxygen tank were dated. The resident sat on the edge of his/her bed and said when he/she was up walking around the oxygen flow rate should be on at least four liters per minute and when he/she was not up and about the flow rate should be on two. He/she reached up and turned the knob on the portable oxygen tank from four liters down to three liters. Observation on 11/8/18 at 7:44 A.M., showed the resident lay in his/her bed with his/her eyes closed and the undated nasal cannula attached to the oxygen concentrator beside his/her bed. The flow rate on the oxygen concentrator was set on five liters per minute. The tubing on the portable oxygen tank was also undated. 5. Review of Resident #196’s care plan, revised on 4/9/18, showed: – Oxygen therapy as ordered by the physician. Review of the resident’s MDS, dated [DATE], showed: – Able to make decisions; – Oxygen therapy; – [DIAGNOSES REDACTED]. Review of the resident’s 11/18 physician’s order did not show an order for [REDACTED].>Observation on 11/6/18 at 10:31 A.M., showed the resident lay in bed using an undated nasal cannula attached to an oxygen concentrator. The top of the concentrator was dirty with food crumbs and other debris, the foam filter of the concentrator was covered with a whitish gray dust. The flow meter of the concentrator was set on five liters per nasal cannula. Observation on 11/7/18 at 9:46 A.M., showed the resident used an undated nasal cannula attached to the oxygen concentrator that was set at five liters per nasal cannula. During an interview on 11/8/18 at 2:45 P.M., Licensed Practical Nurse (LPN) B said: – Any staff CNA, CMT or Nurse could switch the residents oxygen from concentrator to portable tank; – Staff looked at the flow rate on the concentrator and then set the portable oxygen tank flow rate to the same number as the concentrator; – If staff ever questioned the flow rate a resident’s oxygen should be set on, they should ask the charge nurse; – Sunday night charge nurses set up the oxygen tubing and supplies and the CNAs changed it out: – The CNAs should date the tubing when placed on the concentrators; – He/she thought the night charge nurses were suppose to wash the filters; – Residents should not set their own flow rate. 6. Review of Resident #13’s annual MDS, dated , 7/18/18, showed: |
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: 265366 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER MAPLE WOOD HEALTHCARE CENTER | STREET ADDRESS, CITY, STATE, ZIP 724 NORTHEAST 79TH TERRACE | |||||||||
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 0695 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 21) – Cognitive skills intact; – [DIAGNOSES REDACTED]. Review of the resident’s care plan, revised 8/14/18, showed: – The resident had oxygen therapy related to [MEDICAL CONDITION] and [MEDICAL CONDITIONS], buildup of fluid in the lungs and surrounding body tissue; – The resident had oxygen at 4 liters/nasal cannula continuously. Observation on 11/17/18, at 8:36 A.M., showed: – The filter on the oxygen concentrator covered with gray dust; – The oxygen tubing did not have a date when it was changed. Review of the resident’s POS, dated 11/8/18, showed: – The resident did not have an order for [REDACTED].>7. Review of Resident #93’s care plan, revised, 8/24/18, showed: – The care plan did not address the use of oxygen. Review of the resident’s 14 day assessment MDS, dated , 10/24/18, showed: – Cognitive skills intact; – [DIAGNOSES REDACTED]. Observation on 11/6/18, at 10:08 A.M., showed: – The oxygen tubing for the O2 concentrator did not have a date when it was changed; – The portable oxygen tank tubing did not have a date when the oxygen tubing was changed. Review of the resident’s POS, dated, 11/8/18, showed: – The resident did not have an order for [REDACTED].>8. During an interview on 11/9/18 at 3:32 P.M., the Director of Nurses said: – The orders for changing oxygen and nebulizer tubing is placed on the electronic treatment sheets that the nurse and CMT signs off; – Tubing should be changed and dated every Sunday night; – The concentrator filters should be cleaned every Sunday night and who should clean the filters depended on who changed the tubing; – Residents should not adjust the oxygen flow rate themselves; – If a CNA was changing a resident from a concentrator to a portable tank, he/she should verify with the charge nurse what the flow rate should be; – A resident that used continuous oxygen should have a physician’s order for oxygen | |
F 0761 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/31/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265366 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER MAPLE WOOD HEALTHCARE CENTER | STREET ADDRESS, CITY, STATE, ZIP 724 NORTHEAST 79TH TERRACE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
---|---|---|
F 0761 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 22) 2. Observation on 11/8/18 at 8:26 A.M. of the west medication cart showed: – A vial of Humalog insulin pen dated opened 10/8/18 (31 days after opening); – An opened mixed vial of cefatriaxone (an antibiotic) labeled single use only and dated 10/8/18. During an interview Registered Nurse (RN) D said: – All insulins should be discarded 30 days after opening; – Staff should discard single use only medications after use. 3. Observation of the East Medication Room and interview with Graduate Nurse (GN) A on 11/8/18 at 6:33 A.M., showed: – A bottle of 82 [MEDICATION NAME] (nonsteroidal anti-[MEDICAL CONDITION]) 800 mg tablets, that belonged to a resident who GN A said discharged from the facility on 10/30/18 to another facility, in a drawer where other miscellaneous items were stored; – Also in that drawer was an opened bottle of 58 [MEDICATION NAME] (sleep aid) 1 mg tablets with an unreadable smeared date on it. GN A said the [MEDICATION NAME] was house stock, he/she could not read the smeared date on the lid, did not know who had used medication out of it and could not find an expiration date on the bottle; – The upper cabinet held more house stock medication that included a bottle of [MEDICATION NAME] (fiber supplement for digestive health) expired 10/18 and an opened jar of Vaseline that the lid was not on correctly and that expired 6/18. 4. Observation and interview on 11/8/18, at 6:57 A.M., of the West medication room, showed: – One 1000 ml. bag of [MEDICATION NAME] HN ( used for individuals with increased calorie needs and/or limited fluid tolerance), expired (MONTH) 6, (YEAR); – One container of [MEDICATION NAME] 1.5 calorie, expired (MONTH) 8, (YEAR); – One opened vial of Apisol ([MEDICATION NAME] Purified Protein Derivative) did not have a date when it was opened; – One can of 2 Cal HN, ( nutritionally complete high-calorie liquid food) 8 ounces, expired (MONTH) 1, (YEAR); – Five, 8 fluid ounce containers of nepro therapeutic nutrition, expired (MONTH) 1, (YEAR); – Registered Nurse (RN) A said all medications should have a date when they are opened. Staff should not use medications if they are expired, the medications should be destroyed. All charge nurses check for expired medications and make sure they have a date when they were opened. If the medication does not have a date when it was opened, it should be discarded. During an interview on 11/9/18, at 3:32 P.M., the Director or Nursing (DON) said: – The medications should be dated when opened; – The Certified Medication Technicians (CMT’s) and the nurses check the medication rooms for expired medications and central supply checks the medication room when he/she puts the stock medications in it. | |
F 0809 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | Ensure meals and snacks are served at times in accordance with resident’s needs, preferences, and requests. Suitable and nourishing alternative meals and snacks must be provided for residents who want to eat at non-traditional times or outside of scheduled meal times. |
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: 265366 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER MAPLE WOOD HEALTHCARE CENTER | STREET ADDRESS, CITY, STATE, ZIP 724 NORTHEAST 79TH TERRACE | |||||||||
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 0809 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 23) Based on observations and interviews, the facility failed to ensure staff offered each resident a bedtime snack. This had the potential to affect all facility residents. The facility census was 96. 1. During an interview on 11/6/18, at 10:08 A.M., Resident #72 said staff do not serve a snack at bedtime. During an interview on 11/6/18, at 10:19 A.M., Resident #18 said sometimes staff put snacks out in the hall but not always. Staff do not pass the bedtime snacks. During an interview on 11/6/18, at 10:54 A.M., Resident #68 said staff never bring him/her a bedtime snack. During an interview on 11/6/18, at 11:49 A.M., Resident #95 said: – He/she does not get offered a snack at bedtime; – He/she would take a snack at bedtime if it was offered. During an interview on 11/7/18, at 8:27 A.M., Resident #34 said if you want a snack you have to go and get it for yourself. Staff do not bring it to your room and offer it. He/she would take a snack if it was brought to him/her and offered. During the resident council meeting on 11/7/18, at 10:31 A.M., 10 residents said: – Staff do not bring the snack carts to their rooms and offer them a snack; – The residents said they would take a snack if it was offered to them; – If they cannot get to the snack cart, they do not get a snack. During an interview on 11/7/18, at 2:43 P.M., Resident #79 said: – Staff do not come to his/her room at bedtime and offer him/her a snack; – He/she would take a snack if it was offered at bedtime. Observation on 11/8/18, of the 100 hall from 8:34 P.M. to 9:23 P.M., showed: – At 8:45 P.M., dietary staff positioned a snack cart in front of the nurses’ station. – A few residents went to the cart and obtained a snack. – The cart remained in front of the nurses’ station. Staff did not pass bedtime snacks to the residents. During an interview on 11/8/18, at 9:08 P.M., Certified Nurse Aide (CNA) K said residents who wanted a bedtime snack came and got one off of the bedtime snack cart. He/she did not know that there was a time to serve snacks. If a resident request a snack, they are given one. During an interview on 11/8/18, at 9:15 P.M., CNA L said usually residents came to the bedtime snack cart and got their own snack. During an interview on 11/8/18, at 9:23 P.M. the Director of Nursing said staff served snacks to residents with physician orders. The snack cart was available for any resident who requested a snack. During an interview on 11/9/18, at 10:19 A.M., Resident #70 said: – Staff do not offer him/her a snack at bedtime; – He/she would take a snack if it was offered at bedtime. During an interview on 11/9/18, at 4:30 P.M., the Administrator said the facility did not monitor to track if residents were offered snacks. Staff were trained to pass bedtime snacks. She expected staff to offer bedtime snacks to each resident. | |
F 0812 Level of harm – Minimal harm or potential for actual harm Residents Affected – Many | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. |
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: 265366 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER MAPLE WOOD HEALTHCARE CENTER | STREET ADDRESS, CITY, STATE, ZIP 724 NORTHEAST 79TH TERRACE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
---|---|---|
F 0812 Level of harm – Minimal harm or potential for actual harm Residents Affected – Many | Based on observations, interview and record review, the facility failed to properly store foods and provide a sanitary environment in the kitchen. The facility census was 96. Review of the facility’s policy which discussed the environment, revised (MONTH) (YEAR), showed all food preparation areas will be maintained in a clean and sanitary condition. 1. Observation and interview on 11/6/18, at 10:15 A.M., showed: – Rust on the shelves of the refrigerator near the food preparation areas; – Three outdated 5-pound containers of yogurt; – A container of applesauce split open and seeping out; – Ricotta cheese uncovered and exposed; – The Regional Dietary Director (RDD) said the rust in the refrigerator could cause cross contamination. The Dietary manager was to monitor food to assure it did not pass expiration dates. Food should be covered and sealed. 2. Observation on 11/6/18, at 11:57 A.M., showed the steam table in the main dining room had food floating in the steam water when staff brought fresh food from the kitchen and set it in the steam table. Observation and interview on 11/8/18, at 8:17 A.M., showed the steam table water had pieces of food in it as staff were putting fresh food trays in the table. The Cook and the RDD said it was unsanitary. The RDD said staff were to clean the steam table every other day but should clean it every shift. | |
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: 265366 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER MAPLE WOOD HEALTHCARE CENTER | STREET ADDRESS, CITY, STATE, ZIP 724 NORTHEAST 79TH TERRACE | |||||||||
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 25) – Perform hand hygiene before feeding or assisting in the dining room for tray pass, before and after direct contact with a resident’s intact skin, after contact with blood, body fluids or excretions, mucous membranes non intact skin or wound dressings, after contact with inanimate medical equipment; – Perform hand hygiene when hands move from a contaminated body site to a clean body site during patient care, care between residents and after glove removal. Review of the facility’s policy for Standard Precautions and Transmission Based Precautions, reviewed 10/31/18, showed: – Change gloves between clean and dirty tasks and procedures on the same resident after contact with material that may contain a high concentration of microorganisms; – Remove gloves promptly after use, before touching non-contaminated items and environmental surfaces. 1. Review of Resident #25’s annual Minimum Data Set (MDS), a federally mandated assessment instrument completed by facility staff, dated 8/1/18, showed: – Extensive assistance of two staff for personal hygiene; – Always incontinent of bowel and bladder. Review of the resident’s care plan, last revised on 8/14/18, showed: – Had functional bowel and bladder incontinence; – Check and provide incontinence care every two hours and as needed. Observation on 11/8/18, at 6:14 A.M., showed Certified Nurse Aides (CNAs) A and B provided care for the resident in the following manner: – Both staff washed their hands and put on gloves. – CNA A used only two wet wipes, wiped back and forth, and folded and re-used the same wipe multiple times in more than one area as he/she cleansed the resident’s front genital area. – Fecal material was present on the wipes. – CNA A changed gloves, but did not wash or sanitize his/her hands between glove changes. – Staff turned the resident to his/her right side. – CNA A wiped back and forth and folded and re-used the same wet wipe multiple times as he/she cleansed the resident’s buttocks and rectal areas. – Staff turned the resident onto his/her back and CNA A cleansed fecal material from the resident’s inner thighs. – Without removing his/her gloves and washing his/her hands, CNA A removed the soiled bed pad and placed a clean one beneath the resident. – CNA A, with the same soiled gloves on, gathered the bagged soiled items, placed the bags on an empty bed, obtained a pillow and placed it behind the resident’s back, removed his/her gloves, but did not wash or sanitize his/her hands before he/she left the room. – CNA B gave the resident his/her call light, positioned the resident’s neck pillow and positioned the over bed table within the resident’s reach, removed his/her gloves and washed hands before he/she left the room. During an interview on 11/8/18, at 6:35 A.M., CNA A said: – Staff should wash their hands when they enter a room, each time they remove their gloves, if the gloves become soiled with fecal material, and before they leave a resident room. – Staff should remove their gloves after they complete peri care, before they touch other items in the room. During an interview on 11/9/18, at 3:00 P.M., the Director of Nurses (DON) said: – Staff should wash their hands before and after resident care, when hands are visibly soiled, after glove removal and before they leave a resident room. |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/31/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265366 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER MAPLE WOOD HEALTHCARE CENTER | STREET ADDRESS, CITY, STATE, ZIP 724 NORTHEAST 79TH TERRACE | |||||||||
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 26) – Staff should not touch other items or surfaces with soiled gloves. 2. Review of Resident #40’s care plan, revised 8/14/18, showed: – Check every two hours and as needed for incontinence; – Wash, rinse and dry perineum; – Change clothing as needed after incontinence episodes. Review of the resident’s MDS, dated [DATE], showed: – Unable to make daily decisions; – Required extensive assistance of staff for toilet use and personal hygiene; – Always incontinent of bowel and bladder; – [DIAGNOSES REDACTED]. Observation on 11/8/19, at 2:00 P.M., showed CNA E and H provided perineal care. Neither staff washed their hands before they put on gloves. CNA E removed the soiled incontinent brief and said it was wet. When CNA H started to wipe the resident’s left buttock, the resident started to urinate in the bed. CNA H wiped one hand width of the resident’s left buttock, rolled the resident to his/her right side on the soiled incontinent pad and wiped one hand width on the right buttock and up the center crease of the buttocks. CNA H washed once down the left groin and one wipe down the right groin then fastened the brief on the resident. CNA H changed his/her gloves but did not wash or sanitize hands. CNA H assisted to cover the resident, touched the remote control to lower the bed, pulled the string to turn down the light and moved the resident’s Broda type wheelchair. 3. Review of Resident #38’s MDS, dated [DATE], showed: – Some difficulty in making decisions; – Required staff assistance for bed mobility, transfers, dressing, toilet use, personal hygiene and bathing; – Limited range of motion on one side; – Two unstageable pressure ulcers; – [DIAGNOSES REDACTED]. Review of the resident’s care plan, last revised 11/7/18, showed: – Resident has an amputation below the left knee; – Resident has skin breakdown to the right heel and a surgical wound to let leg; – Administer treatments as ordered and monitor for effectiveness. Review of the resident’s November, (YEAR), physician order [REDACTED]. Apply Santyl (debridement agent) to be nickel thick, apply calcium alginate (absorbent dressing) and cover with border gauze and wrap with [MEDICATION NAME] (four inch gauze strip) and secure with tape. Observation and interview on 11/9/18, at 8:59 A.M., showed the resident lay in bed with a border gauze covering his/her right heel. Registered Nurse (RN) B washed his/her hands and gloved before and after he/she removed the old dressing on the right heel. RN B used wound cleanser and gauze pads to clean the wound. RN B said the wound had no depth and was 3.4 centimeters (cm) by 4.7 cm. The wound bed was 50 % yellow slough (mass of dead skin), 20 % eschar (black scab, falling away of dead tissue) and 30 % granulation (healthy skin), the wound had a small amount of drainage. After cleaning the wound, without changing gloves or washing his/her hands, RN B placed santyl on the wound with a Q-tip, picked up calcium alginate with his/her soiled glove and place it on the wound, then covered the alginate with a border gauze dressing. After he/she picked up the trash from his/her clean field and threw it away, he/she washed his/her hands and changed gloves. RN B said he/she washed his/her hands after he/she removed the soiled dressing. He/she should have washed hands and changed gloves after he/she cleaned the wound. During an interview on 11/9/18, at 3:21 P.M., the Director of Nurses (DON) said: |
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: 265366 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER MAPLE WOOD HEALTHCARE CENTER | STREET ADDRESS, CITY, STATE, ZIP 724 NORTHEAST 79TH TERRACE | |||||||||
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 27) – The nurse should have washed his/her hands and changed gloves after he/she cleaned the wound. 4. Review of Resident #70’s admission MDS, dated [DATE], showed: – Cognitive skills intact; – Required extensive assistance of one staff for bed mobility, transfers and dressing; – Lower extremity impaired on one side; – [DIAGNOSES REDACTED]. Review of the resident’s care plan, revised 10/4/18, showed: – The resident had an actual impairment to skin integrity related to fragile skin and diabetes; – Provide treatment as ordered. Observation on 11/8/18, at 1:59 P.M., showed RN A did the following: – Sanitized his/her hands; – Placed the wound supplies in a plastic basin and placed it on the resident’s over the bed table; – Did not wash his/her hands and applied gloves; – Used his/her gloved hands and picked the trash can up and placed it within his/her reach by the table; – Removed his/her gloves, did not wash his/her hands and applied gloves; – Removed the resident’s incontinent brief, removed his/her gloves, washed his/her hands and applied gloves; – The resident’s spouse assisted in putting a clean incontinent brief on him/her; – Measured the resident’s wound on his/her left buttock; – Removed gloves, ran water over his/her hands and applied new gloves; – Completed the wound treatment, removed one glove and dated the dressing, did not wash his/her hand and applied a new glove; – Pulled the resident’s incontinent brief and pants up; – Removed his/her gloves, ran water over his/her hands and took supplies out of the resident’s room. During an interview on 11/8/18, at 2:15 P.M., RN A said: – He/she should wash his/her hands between clean and dirty surfaces and between glove changes. 5. Review of Resident #396’s admission MDS, dated [DATE], showed: – Cognitive skills severely impaired; – Dependent on the assistance of two staff for bed mobility, transfers, and toilet use; – Frequently incontinent of bladder; – Always incontinent of bowel; – [DIAGNOSES REDACTED]. Review of the resident’s care plan, revised 11/7/18, showed: – The resident was incontinent of bowel and bladder related to impaired mobility; – Prefers disposable briefs; – Change every two hours and as needed. Observation on 11/8/18, at 5:59 A.M., showed: – CNA A and CNA B entered the resident’s room, did not wash their hands and applied gloves; – CNA A provided incontinent care to the front perineal folds; – CNA B provided incontinent care to the rectal area with a smear of fecal material noted; – Without removing their gloves or washing their hands, they placed a clean incontinent brief on 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: 265366 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER MAPLE WOOD HEALTHCARE CENTER | STREET ADDRESS, CITY, STATE, ZIP 724 NORTHEAST 79TH TERRACE | |||||||||
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 28) – CNA B removed his/her gloves, did not wash his/her hands and left the room to get a clean gown; – CNA A removed his/her gloves and washed his/her hands and applied new gloves; – CNA B entered the room and CNA A and CNA B placed a clean gown on the resident; – CNA A and CNA B washed their hands before they left the room. During an interview on 11/8/18, at 6:39 A.M., CNA B said: – He/she should wash his/her hands when he/she enters the room, between glove changes and before leaving the room. 6. Review of Resident #68’s care plan, dated 6/19/18, showed: – He/she had wounds requiring wound care; – Staff must provide wound treatments as ordered. Review of the resident’s quarterly MDS, dated [DATE], showed: – Cognitively intact; – Total dependence upon staff for transfers; – Required extensive staff assistance for dressing, toileting, and hygiene; – [DIAGNOSES REDACTED]. – Had one or more Stage II pressure ulcers (partial thickness loss of skin). Observation on 11/8/18, at 2:31 P.M., of RN A providing wound care for the resident showed: – He/she took scissors from his/her pants pocket. – Without disinfecting the scissors, he/she used the scissors to cut a wound treatment. – With gloved hands, he/she cleaned the resident’s rectal area which was soiled with fecal material. – Without washing his/her hands and changing gloves, he/she cleaned all three open areas on the resident’s rectal area. – Without washing his/her hands and changing gloves, he/she applied a large dressing over a draining wound and a non-draining wound. – Without washing his/her hands and changing gloves, he/she dressed the resident’s other wound. During an interview on 11/8/18, at 2:31 P.M., RN A said: – He/she should have disinfected the scissors with a bleach wipe and allowed the scissors to dry before using them. – He/she should have washed his/her hands and changed gloves after cleaning the resident’s rectal area. – He/she should have cleaned each wound separately and washed his/her hands in between cleaning each wound. – He/she should have placed a separate dressing over each wound. During an interview on 11/9/18, at 8:00 A.M., the DON said: – Staff must disinfect scissors with a bleach wipe and allow them to dry before using the scissors for wound care. – Staff must wash their hands and change gloves after cleaning a resident’s rectal area. – Staff must clean each wound seperately and wash their hands and change gloves. – Staff must dress each wound seperately. 7. Review of Resident #88’s care plan, dated 10/2/18, showed: – Staff must isolation precautions due to an infection with [MEDICAL CONDITION] (an infection causing diarrhea). – Staff must wear gowns and masks when changing contaminated linens. – Staff must place soiled linens and trash in bags marked biohazard. – Staff must disinfest all equipment before removing the equipment from the room. |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 7/31/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265366 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER MAPLE WOOD HEALTHCARE CENTER | STREET ADDRESS, CITY, STATE, ZIP 724 NORTHEAST 79TH TERRACE | |||||||||
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 29) Review of the resident’s significant change in condition MDS, dated [DATE], showed: – Mild cognitive impairment; – Required extensive staff assistance for transfers, dressing, toileting and hygiene; – Frequently incontinent of bowel; – [DIAGNOSES REDACTED]. Observation on 11/8/18, at 1:57 P.M., of CNA F providing care for the resident showed: – On the resident’s bathroom floor, an open overflowing red biohazard full of trash and another full of linens; – CNA F put on a gown and gloves; – CNA F removed his/her gait belt from under his/her gown and applied the gait belt around the resident’s waist. – After transferring the resident, CNA F started to put the gait belt back around his/her waist, touching his/her clothes, but stopped and placed the gait belt in the laundry; – CNA F went into the resident’s bathroom, removed his/her gloves and gown. – CNA F’s pants brushed the linen in the open bag while he/she washed his/her hands. During an interview on 11/8/18, at 1:57 P.M., CNA F said: – The resident’s trash and soiled linens should be in bins and not on the floor. – Staff should disinfest all equipment after using it in an isolation room. Observation on 11/9/18, at 1:02 P.M., of Certified Medication Technician (CMT) B administering medications to the resident showed: – He/she removed a blood pressure (BP) cuff from the medication cart. – Without wearing a gown and gloves, he/she entered the resident’s room, checked the resident’s BP and administered the resident’s BP medication. – After washing his/her hands, he/she placed the used BP cuff back in the medication cart. During an interview on 11/9/18, at 1:02 P.M., CMT B said he/she did not realize that he/she should have disinfected the used BP cuff before returning the BP cuff to the medication cart. During an interview on 11/9/18, at 3:00 P.M., the DON said: – Staff should not put any linen or trash on the floor. – Trash and linens from an isolation room should be placed in a bag holder. – Staff should provide dedicated equipment to be kept and used only in an isolation room. – If staff must remove any equipment from an isolation room, staff must disinfect the equipment. | |