DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0550 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 1) part of his/her pants pulled down, exposing his/her pubic hair; -The resident wore neither underwear or incontinent briefs; -The resident’s buttocks and peri-area were visible to any onlooker. -The administrator delivered a breakfast tray to the resident’s three table mates separately. The administrator did not assist the resident with proper positioning of his/her clothing or cover the resident’s exposed body; -Medical Records staff U delivered silverware to the residents at Resident #12’s table. Medical Records staff U did not assist the resident with proper positioning of his/her clothing or cover the resident’s exposed body; -Certified Nurse Aide (CNA) V delivered Resident #12 his/her breakfast tray. CNA V did not assist the resident with proper positioning of his/her clothing or cover the resident’s exposed body. Observation on 03/19/19 at 12:00 P.M. showed the following: -The resident self-propelling in his/her wheelchair in the facility hallway; -The waistband of the resident’s pants was below the resident’s buttocks and the front part of his/her pants pulled down, exposing his/her pubic hair; -The resident wore neither underwear or incontinent briefs; -The resident’s buttocks and peri-area were visible to any onlooker. -CNA J walked past the resident and spoke to him/her. CNA J did not assist the resident with proper positioning of his/her clothing or cover the resident’s exposed body. During an interview on 03/18/19 at 3:25 P.M., Resident #101 said the following: -He/she had seen Resident #12 with his/her pants down, exposing his/her parts; -Seeing this made his/her stomach roll, but he/she had gotten used to it. During an interview on 03/18/19 at 3:26 P.M., Resident #43 said the following: -He/she had seen Resident #12 with his/her pants down, exposing his/herself; -He/she doesn’t like seeing this and it bothers him/her that Resident #12 is not covered up or staff doesn’t help him/her. During interview on 03/18/19 at 3:27 P.M., Resident #14 said the following: -He/she has seen Resident #12 with his/her pants down, exposing his/herself; -He/she loses his/her appetite when he/she sees it and wishes staff would address it instead of ignoring it; -Other residents call Resident #12 duck pants, because you can see his/her quack. During an interview on 03/18/19 at 3:28 P.M., Resident #69 said the following: -He/she had seen Resident #12 with his/her pants down in public areas of the facility; -He/she thinks it’s inappropriate and doesn’t want to see it. During an interview on 03/22/19 at 3:53 P.M., the Director of Nursing (DON) said resident clothing should be adjusted to prevent exposure. 3. Observation on 3/17/19 at 1:15 P.M., showed dietary cook/aide CC portioning salad for supper meal service in individual Styrofoam bowls. Observation of the assisted dining room on 03/17/19 at 6:00 P.M. showed the following: -Twenty-one residents with three staff assisting the residents with their evening meal; -Staff served the residents’ evening meal consisting of pasta and red sauce, salad, bread and yogurt on Styrofoam plates and bowls with plastic utensils. Staff served beverages in Styrofoam cups. Observation of the main dining room on 03/17/19 at 6:16 P.M. showed the following: -Thirty-three residents present for the meal and four staff in and out of the dining room; -Staff served the residents’ evening meal consisting of pasta and red sauce, salad, bread and yogurt on Styrofoam plates and bowls with plastic utensils. Staff served beverages in Styrofoam cups. |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0550 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 2) 3. Review of Resident #1’s admission Minimum Data Set (MDS), a federally mandated assessment instrument completed by facility staff, dated 3/16/19 showed the following: -Cognition moderately impaired; -Independent with eating. Observation on 3/17/19 at 6:10 P.M. showed the following: -The resident sat in his/her room eating supper; -The resident had plastic utensils to use to eat; -Staff served the resident’s meal including fruit and lettuce salad served in a Styrofoam bowl; -Staff served the main entrée, pasta with sauce and garlic on a paper plate; -Staff served the resident’s drinks in Styrofoam cups. Observation on 3/21/19 at 10:55 A.M. showed the resident had a plastic spoon to eat his/her cereal. During an interview on 3/21/19 at 10:55 A.M., the resident said the following: -He/she said he/she did not like lunch or dinner served on paper plates and did not like plastic knives and forks; -He/she said at different times staff provided plastic and paper products to eat with and he/she did not know why; -He/she had a plastic spoon for his/her cereal today. 4. Review of Resident #12’s MDS, dated [DATE], showed the following: -BIMS of 15 indicating intact cognition; -[DIAGNOSES REDACTED]. -Independent with eating, set up help only. During an interview on 03/17/19 at 6:08 P.M. the resident said it was harder to eat the meal from the Styrofoam and to use plastic silverware. 5. Review of Resident #14’s MDS, dated [DATE], showed the following: -BIMS of 15; -[DIAGNOSES REDACTED]. -Supervision with eating, set up help only. During an interview on 3/18/19 at 2:50 P.M. the resident said he/she would rather eat from real plates, using real silverware, instead of the Styrofoam and plastic. 6. Review of Resident #22’s MDS, dated [DATE], showed the following: -BIMS of 14 (cognition intact); -[DIAGNOSES REDACTED]. -Independent with eating, set up help only. During an interview on 3/19/19 at 10:00 A.M., the resident said he/she did not like being served his/her meals on Styrofoam and having to use plastic silverware; this made it harder to eat the meal. 7. Review of Resident #25’s MDS, dated [DATE], showed the following: -BIMS of 15; -[DIAGNOSES REDACTED]. -Independent with eating, set up help only. During an interview on 3/18/19 at 2:50 P.M. the resident said he/she does not like meals being served on Styrofoam or having to use plastic utensils; this makes it harder to eat the food. 8. Review of Resident #27’s annual MDS, dated [DATE], showed the following: -The resident was cognitively intact for daily decision making; -Independent with eating, set up help only. Observation on 3/17/19 at 6:01 P.M., showed the following: |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0550 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 3) -The resident sat on the edge of his/her bed eating supper; -Staff served the resident lettuce and fruit in Styrofoam bowls; -Staff served the main entrée, pasta with sauce, and garlic bread on a Styrofoam plate; -Staff provided plastic utensils for the resident to eat his/her meal; -Staff served the resident drinks in Styrofoam cups. During an interview on 3/17/19 at 6:01 P.M. the resident said the following: -He/she does not like eating from Styrofoam as it does not keep the food at a warm temperature; -The facility serves meals on Styrofoam regularly; -There will be times when he/she will get either just a plastic spoon or plastic fork and the entree may require a different utensil, such as staff may served soup and provide a plastic fork to eat the soup. 9. Review of Resident #29’s Admission MDS, dated [DATE], showed the following: -The resident was cognitively intact for daily decision making; -[DIAGNOSES REDACTED].>-Required limited assist of one staff for eating. Observation on 3/17/19 at 6:10 P.M., showed the following: -The resident sat in the assisted dining room; -Staff served the resident lettuce and fruit in Styrofoam bowls; -Staff served the main entrée, pasta with sauce, and garlic bread on a Styrofoam plate; -Staff provided plastic utensils for the resident to eat his/her meal; -Staff served the resident drinks in Styrofoam cups. During an interview on 3/18/19 at 10:18 A.M., the resident’s family member said the following: -He/she did not like the resident being served his/her meal on Styrofoam; -Styrofoam appears cheap and the plastic silverware breaks easily. 10. Review of Resident #39’s quarterly MDS, dated [DATE], showed the following: -The resident was cognitively intact for daily decision making; -[DIAGNOSES REDACTED].>-Required set up assistance of staff for eating. Observation on 3/17/19 at 6:15 P.M., showed the following: -The resident sat in the main dining room; -Staff served the resident lettuce and fruit in Styrofoam bowls; -Staff served the main entrée, pasta with sauce, and garlic bread on a Styrofoam plate; -Staff provided plastic utensils for the resident to eat his/her meal; -Staff served the resident drinks in Styrofoam cups. During an interview on 3/17/19 at 6:18 P.M., the resident said the following: -The facility did not have enough staff to do dishes and this is the reason they have to eat on and Styrofoam plates and use plastic utensils; -He/she did not like eating off of Styrofoam or using plastic utensils; -The facility served on Styrofoam and used plastic utensils on a regular basis. Observation on 3/18/19 at 10:49 A.M. showed the following: -The resident’s hair was disheveled; -The resident’s bed was soiled and unmade; -A hamper full of clothes sat in the middle of the resident’s room behind his/her chair. During an interview on 3/18/19 at 10:50 A.M. the resident said the following: -Staff were supposed to give him/her a shower this morning; -He/she liked to be showered early so he/she could be in clean clothes for the day; -Staff were supposed to make and his/her bed as soon as he/she got out of bed but they still had not changed the sheets and/or made the bed; Observation and interview on 3/18/19 at 10:50 A.M. showed the following: |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0550 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 4) -The resident turned on his/her call light; -CNA A entered the resident’s room; -The resident told CNA A that he/she still had not been given a bath, staff had not picked up his/her laundry for days, and staff still had not made his/her bed; -CNA A told the resident that he/she was spoiled and that the CNA working his/her hall would help him/her as soon as he/she could. He/she knew the resident liked things a certain way and was spoiled, but all CNAs did things differently and that did not make them wrong. During an interview on 3/18/19 at 10:55 A.M. CNA A said he/she did not think there was anything wrong with calling the resident spoiled. During an interview on 3/18/19 at 10:56 A.M. the resident said he/she didn’t like the staff calling him/her spoiled. During an interview on 3/22/19 the DON said the following: -She would not expect staff to call the resident spoiled; -Staff should spoil all the residents. During an interview on 4/4/19 at 12:50 P.M. the administrator if a resident was asking for help and voicing concerns, it would not be appropriate for the staff member to call the resident spoiled. 11. Review of Resident #59’s MDS, dated [DATE], showed the following: -[DIAGNOSES REDACTED]. -Independent with eating, set up help only. Observation and interview on 03/20/19 at 8:30 A.M. showed the following: -Resident #59 sat in the main dining room eating Rice Krispie cereal with a plastic fork; -The resident said staff told him/her there were no spoons available; -Two other unidentified residents were eating oatmeal and cream of wheat cereal with a plastic fork. During an interview on 03/17/19 at 6:05 P.M. the resident said he/she would never have served meals on Styrofoam or used plastic silverware and he/she thought it was disrespectful to the elderly. 12. Review of Resident #72’s quarterly MDS, dated [DATE], showed the following: -Cognitively intact for daily decision making; -Independent with eating, set up help only. Observation on 3/17/19 at 6:05 P.M., showed the following: -The resident sat on the edge of his/her bed; -Staff served the resident lettuce and fruit in Styrofoam bowls; -Staff served the main entrée, pasta with sauce, and garlic bread on a Styrofoam plate; -Staff provided plastic utensils for the resident to eat his/her meal; -Staff served the resident drinks in Styrofoam cups. During an interview on 3/17/19 at 6:05 P.M. the resident said the following: -He/she did not like eating from Styrofoam. It felt cheap and did not keep the foods very warm; -Staff served meals on Styrofoam regularly with plastic silverware. Sometimes the plastic silverware would break when trying to cut food. 13. Review of Resident #95’s admission MDS, a federally mandated assessment instrument completed by facility staff, dated 3/4/19 showed the following: -Cognition intact; -Independent with eating. Observation on 3/17/19 at 6:15 P.M. showed the following: -The resident sat in a chair in his/her room eating supper; |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0550 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 5) -Staff served the resident lettuce and fruit in Styrofoam bowls; -Staff served the main entrée, pasta with sauce, and garlic bread on a Styrofoam plate; -Staff provided plastic utensils for the resident to eat his/her meal; -Staff served the resident drinks in Styrofoam cups. Observation on 3/21/19 at 9:54 A.M. showed the resident had a plastic spoon to eat his/her breakfast. During an interview on 3/21/19 at 9:54 A.M., the resident said the following: -It bothers him/her to use plastic silverware; -He/she can’t do anything with plastic silverware; -It is usually the spoon that is plastic, but can be all plastic utensils at times; -He/she had a plastic spoon at breakfast today; -Have been served plastic utensils a lot lately. 14. Review of Resident #97’s quarterly MDS, dated [DATE], showed the following: -Cognitively intact for daily decision making; -Independent with eating, set up help only. Observation on 3/17/19 at 6:30 P.M., showed the following: -The resident sat in a straight back chair in the main dining room; -Staff served the resident lettuce and fruit in Styrofoam bowls; -Staff served the main entrée, pasta with sauce, and garlic bread on a Styrofoam plate; -Staff provided plastic utensils for the resident to eat his/her meal; -Staff served the resident drinks in Styrofoam cups. During an interview on 3/17/19 at 6:30 P.M. showed the following: -He/she did not like to eat off of Styrofoam, it did not feel homelike; -He/she said the facility served meals regularly on Styrofoam. 15. Review of Resident #111’s annual MDS, dated [DATE], showed the following: -The resident was cognitively intact for daily decision making; -[DIAGNOSES REDACTED]. -Required set up assistance of staff for eating. Observation on 3/17/19 at 6:15 P.M., showed the following: -The resident sat in the main dining room; -Staff served the resident lettuce and fruit in Styrofoam bowls; -Staff served the main entrée, pasta with sauce, and garlic bread on a Styrofoam plate; -Staff provided plastic utensils for the resident to eat his/her meal; -Staff served the resident drinks in Styrofoam cups. During an interview on 3/17/19 at 6:18 P.M., the resident said the following: -He/she did not like eating off of Styrofoam or using plastic utensils; -The facility served on Styrofoam and used plastic utensils on a regular basis. 16. Review of Resident #62’s MDS, dated [DATE], showed the following: -BIMS of 15; -Independent with eating. During an interview on 3/18/19 at 2:50 P.M. the resident said the plastic silverware was flimsy and broke easily. 17. Review of Resident #43’s MDS, dated [DATE], showed the following: -BIMS of 15; -[DIAGNOSES REDACTED]. -Independent with eating, set up help only. Resident #43 said plastic silverware frequently punctured through the Styrofoam plates. 18. Review of Resident #69’s MDS, dated [DATE], showed the following: -BIMS of 15; |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0550 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 6) -Independent with eating, set up help only. During an interview on 3/18/19 at 2:50 P.M. the resident said he/she can’t cut meat with plastic knives very well. 19. Review of Resident #92’s MDS, dated [DATE], showed the following: -BIMS of 15; -[DIAGNOSES REDACTED]. -Independent with eating. During an interview on 3/18/19 at 2:50 P.M. the resident said it bothered him/her to eat from Styrofoam all of the time. 20. Review of Resident #101’s quarterly MDS, dated [DATE], showed the following: -Cognitively intact for daily decision making; -[DIAGNOSES REDACTED]. -Independent with eating, set up help only. During an interview on 3/18/19 at 2:50 P.M. the resident said he/she would rather eat from real plates, using real silverware, instead of the Styrofoam and plastic. 21. Interviews during the resident council meeting on 03/18/19 at 2:50 P.M. showed residents said the following: -Meals were frequently served on Styrofoam/paper products; -Reasons given for the use of the Styrofoam/paper products vs. real dishes included the facility being short staffed, not enough time for staff to wash real dishes and/or the dishwasher was broken. 22. During interview on 3/18/19 at 12:40 P.M. dietary aide DD said sometimes he/she was the only one staff working in the kitchen and could not get everything completed. They had to serve off of Styrofoam plates and use disposable utensils and cups just to get the residents served. During an interview on 3/20/19 at 1:42 P.M. dietary aide CC said there wasn’t enough staff to get everything done including dishes. They had to serve the residents on disposable plates, silverware and cups because staff couldn’t get the dishes clean in time. During interview on 3/22/19 at 3:53 P.M. the Director of Nursing said the following: -Plastic and paper are appropriate to be served on if outside at a picnic; -Residents should not have to eat cereals with a fork; -Resident clothing should be adjusted to prevent exposure. During an interview on 4/4/19 at 12:50 P.M. the administrator said she would expect staff to adjust a resident’s clothing to cover the residents buttocks, hips, and perineal area. | |
F 0567 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | Honor the resident’s right to manage his or her financial affairs. U4413 |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0567 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 7) (Resident #1, #2, #3, #4, #5, #6, #7, #8, #9, #10, #11, #12 and #13). The facility census was 118. 1. Record review of the facility maintained Accounts Receivable A/R Aging Report for the period 03/01/18 through 03/20/19, showed the following residents with personal funds held in the facility operating account: Resident Amount Held in Operating Account #1 $ 23.00 #2 $ 2,363.12 #3 $ 11.00 #4 $ 2,691.76 #5 $ 1,002.51 #6 $ 84.11 #7 $ 1,312.60 #8 $ 3,276.16 #9 $ 2,565.86 #10 $ 1,648.02 #11 $ 2,481.20 #12 $ 2,527.60 #13 $ 5.60 Total $19,992.54 During an interview on 03/20/19 at 1:29 P.M., the Corporate Controller said he/she was working on cleaning up the operating account. | |
F 0582 Level of harm – Potential for minimal harm Residents Affected – Some | Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered. Based on interview and record review, the facility failed to provide the resident or |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0582 Level of harm – Potential for minimal harm Residents Affected – Some | (continued… from page 8) Providers must deliver the NOMNC: -To all beneficiaries eligible for the expedited determination process per Chapter 4, Section 260 of the Medicare Claims Processing Manual and Chapter 13, Sections 90.2-90.9 of the Medicare Managed Care Manual. A NOMNC must be delivered even if the beneficiary agrees with the termination of services. Medicare providers are responsible for the delivery of the NOMNC; -The provider must ensure that the beneficiary or representative signs and dates the NOMNC to demonstrate that the beneficiary or representative received the notice and understands that the termination decision can be disputed. 2. Review of a Department of Health and Human Services, Centers for Medicare and Medicaid Services form, dated 2/2017, titled Skilled Nursing Facility Beneficiary Protection Notification Review, Beneficiary Liability Protection Notice Scenarios showed residents having skilled benefit days remaining and are being discharged from Part A services and will continue living in the facility should be issued a NOMNC. 3. Review of the facility policy Medicare Advance Beneficiary Notice (ABN), dated 4/23/12, showed the following: -Residents receiving Medicare covered services shall have advanced notice of when those services will be ending and will be made aware of their appeal rights. Should residents wish to continue receiving said services knowing that we believe services would not be paid for by Medicare, they will be made aware of any charges or liability they would incur for said services; -Two days prior to Medicare A services or Medicare B services are expected to end, the resident or responsible party is to be informed and the form CMS Notice of Medicare Non Coverage shall be completed following form instructions. This form explains the notice and the resident’s appeal rights. Should an appeal be made, facility will be contacted by the CMS Quality Improvement Organization and complete form CMS -Detailed Explanation of Non Coverage following form instructions. These forms are to be used for all Medicare Part A and Medicare Part B; -When the resident or responsible party wishes to continue receiving services the facility believes will not be covered by Medicare, facility will issue the SNF-ABN liability notice explaining what the charges will be. The liability notice for Medicare Part A is the SNF-ABN form CMS- and the liability notice for Medicare Part B is form CMS-R-131 (03/2011); -Social Services designee shall present notices and complete applicable forms. Verbal notification is acceptable so long as Social Services then completes the written form, signs indicating notice given verbally and insert form in the patient record, then proceed to mail the form asking responsible party to sign and return to facility; -Note: The NOMNC informs one that services are ending AND they have rights to appeal; -When the Medicare Part A Skilled days are exhausted, the NOMNC form is not necessary because they have used up their benefit, nothing to appeal; -If the person is staying on at the nursing home after the Medicare covered stay, present the liability notice SNF-ABN which informs them of the charges they will incur. 4. Review of Resident #39’s SNF Beneficiary Protection Notification Review showed the resident’s last covered day of Medicare services was 12/24/18. Review of the resident’s SNFABN showed the resident signed the form on 12/24/18 the day services ended. Review of the resident’s NOMNC showed the resident signed the form on 12/24/18 the day services ended. Review showed no evidence staff documented the resident had been notified prior to |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0582 Level of harm – Potential for minimal harm Residents Affected – Some | (continued… from page 9) 12/24/18. 5. Review of Resident #101’s SNF Beneficiary Protections Notification Review showed the resident’s last covered day of Medicare services was blank. Review of the resident’s SNFABN showed the resident’s last covered day of Medicare services was 1/24/19. Review of the resident’s medical record showed no evidence the facility provided the resident with the NOMNC. 6. Review of Resident #61’s SNF Beneficiary Protection Notification Review showed the resident’s last covered day of Medicare services was 2/15/19. Review of the resident’s medical record showed no evidence the facility provided the resident with the NOMNC. 7. During interview on 3/22/19 at 5:10 P.M. the administrator said the following: -The Social Service Designee (SSD) was responsible for completing and issuing SNF beneficiary notices upon discharge from Medicare Part A services; -The facility did not currently have a SSD; -She would expect a NOMNC to be issued 48 hours prior to the ending of services to the resident or representative if services are ended, days are not exhausted and benefit days remain. | |
F 0584 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | Honor the resident’s right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0584 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 10) gets out of bed. Observation on 3/19/19 at 6:06 A.M. showed the following: -The resident lay in his/her bed; -The inner canthus of the resident’s right eyes had dried yellow matter in the corner; -CNA L assisted the resident with morning cares, dressed the resident and transferred him/her to his/her wheelchair; -CNA L took the resident out of the room and to the day area off of the nursing station; -CNA L did not wash the resident’s face or hands when getting the resident up for the day. 3. Record review of Resident #28’s updated care plan, dated 1/4/19, showed the following: -Resident is limited in ability for all ADL’s; he/she requires the assist of one staff for all of his/her ADL’s; -Requires extensive assistance with grooming; -Requires extensive assistance with hygiene. Observation on 3/19/19 at 5:52 A.M., showed the following: -The resident lay in his/her bed; -The corners of the resident’s mouth had dried white matter in the corners; -The inner canthus of the resident’s eyes had dried yellow matter in the corners; -CNA L assisted the resident with morning cares, dressed the resident and transferred him/her to his/her wheelchair; -CNA L took the resident to the day area off of the nursing station; -CNA L did not wash the resident’s face or hands when getting the resident up for the day. During an nterview on 3/19/19 at 6:10 A.M., CNA L said the following: -He/she did not wash Resident #28 or #5’s face or hands because the facility did not have washcloths available to complete this task; -He/she had to step out of the room while providing cares to Resident #5 to try and find him/her clean pants in the laundry; -Clean laundry was hit and miss at the facility and a lot of times staff did not have the clean laundry they needed unless they did it themselves; -He/she would do laundry as time allowed just so he/she would have available items he/she needed, but he/she had not been told it was his/her responsibility to do facility laundry; -When providing peri-care, he/she had to use the disposable wipes because washcloths were not available for use. 3. Review of Resident #12’s care plan revised 1/31/19, showed the following: -Requires minimal assistance due to fluctuating weakness for many ADL’s and/or requiring supervision for completion for ADL’s; -Does need extensive assistance with bathing needs; -Supervise to ensure personal hygiene is met; Record review of the resident’s quarterly MDS, dated [DATE], showed the following: -BIMS of 15 indicating no cognitive impairment; -Personal hygiene, including bathing, combing of hair and shaving, required limited assistance; one person physical assist. Observation on 3/17/19 at 12:58 P.M. showed the following: -The resident sat in his/her wheelchair in the main dining room; -The resident was wearing a red baseball shirt and gray sweat pants. Observation and interview on 3/18/19 at 9:25 A.M. showed the following: -The resident sat in his/her wheelchair in the main dining room; -The resident wore the same red baseball shirt and gray sweat pants that he/she was noted to be wearing on 3/17/19. Observation and interview on 3/19/19 at 8:10 A.M. showed the following: |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0584 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 11) -The resident lay in bed in his/her room; -The resident said he/she wanted to get up for breakfast but he/she did not have any clean pants; -He/she paid for the facility to do his/her laundry; -Laundry service was horrible and sometimes he/she didn’t change his/her clothes to make sure he/she had something to wear. 4. Review of Resident #14’s care plan revised 12/27/18, showed the following: -The resident has an ADL self-care deficit and requires assistance with dressing and hygiene; -Extensive assistance with bathing needs; -[DIAGNOSES REDACTED]. Review of the resident’s quarterly MDS, dated [DATE], showed the following: -Cognitively intact; -Requires extensive assistance of one staff for dressing; -Requires limited assistance of one staff for personnel hygiene. During interview on 3/18/19 at 4:00 P.M. the resident said the following: -He/she paid for the facility to do his/her laundry; -He/she had difficulty getting his/her laundry back after sending it to be cleaned; -He/she frequently was without socks and/or underwear and it sometimes took two weeks to get his/her laundry back. 5. Review of Resident #25’s care plan revised 12/24/18, showed the following: -Required extensive assistance with bathing; -Required limited assistance with dressing. Record review of the resident’s quarterly MDS, dated [DATE], showed the following: -BIMS of 15; -Requires extensive assistance of one staff for dressing; -Requires limited assistance of one staff for personnel hygiene. During interview on 3/18/19 at 4:00 P.M. the resident said the following: -He/she paid for the facility to do his/her laundry; -He/she sometimes did not have his/her laundry returned for a couple of weeks and he/she had to wear his/her clothes more than once, when they really needed to be cleaned. 7. Review of Resident #39’s quarterly MDS, dated [DATE], showed the following: -The resident was cognitively intact for daily decision making; -Required extensive assistance of staff for dressing; -Required limited assistance of one staff for transfers. Observation on 3/18/19 at 10:49 A.M. showed the following: -The resident’s bed was soiled and unmade; -A hamper full of clothes sat in the middle of the resident’s room behind his/her chair; -The resident turned on his/her call light; -CNA A entered the resident’s room; -The resident told CNA A that he/she still had not been given a bath, staff had not picked up his/her laundry for days, and staff still had not made his/her bed. During an interview on 3/18/19 at 10:55 A.M. CNA A said he/she always picked up his/her resident’s laundry and took it to the laundry room but not all CNAs did this. During interview on 3/18/19 at 10:50 A.M. and 3/21/19 at 10:40 A.M. the resident said staff were supposed to make his/her bed as soon as he/she got out of bed but they still had not changed the sheets and/or made the bed. He/she reported needing laundry done to staff and they still have not done it. He/she was on his/her last pair of pants to wear. Observation on 3/21/19 at 10:40 A.M. showed the resident’s full clothes hamper still sat |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0584 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 12) behind the resident’s chair. 8. Review of Resident #43’s care plan revised 1/15/19, showed the following: -Assist time one staff with daily care; -Required extensive assistance with dressing; -Required limited assistance with grooming, requiring staff set up help only. Record review of the resident’s quarterly MDS, dated [DATE], showed the following: -Cognitively intact; -Required limited assistance of one staff for dressing; -Was independent with set up assistance only for personal hygiene. Observation and interview on 3/18/19 at 4:00 P.M. showed the following: -The resident said he/she paid for the facility to do his/her laundry; -He/she mostly went without socks; -The resident was observed to be wearing black tennis shoes with no socks; -Staff did not always have washcloths available to give to him/her to wash his/her face. 10. Record review of Resident #53’s quarterly MDS, dated [DATE], showed he/she required limited assistance with personal hygiene. Review of the resident’s care plan, dated 2/27/19, showed the following: -Required limited assistance with ADL’s; -Avoid doing things for the resident that he/she can do; assist as needed; -Encourage to groom self with set up help (assistance required for completion); -Encourage participation in ADL’s to the extent possible; -Limited assistance with grooming (staff to provide set up at sink assist only when resident is unable to perform); -Give verbal reminders and cues while participating in ADL tasks. During an interview on 03/17/19 at 1:05 P.M., the resident’s family member said the following: -He/she took the resident’s laundry home to wash because the facility seemed to lose his/her items or it took the facility too long to do the resident’s laundry. He/she thought it was due to a staffing issue and staff just didn’t have time to do laundry regularly; -He/she usually helped the resident shave and wash his/her face, but staff often tell him/her they were out of washcloths. 11. Record review of Resident #62’s quarterly MDS, dated [DATE], showed the following: -Cognitively intact; -The resident was independent and required no staff assistance with dressing or personal hygiene. Review of the resident’s care plan revised 1/25/19, showed the following: -The resident was alert and oriented to person, place and time; -The resident completed his/her own ADL’s. During interview on 3/18/19 at 4:00 P.M. the resident said the following: -Laundry services could use some improvement; -He/she paid for the facility do to his/her laundry; -Getting laundry back that had been sent to be cleaned sometimes took two weeks; -He/she sometimes had to shower without washcloths because the facility did not have any clean washcloths. 12. Review of Resident #69’s care plan revised 2/7/19, showed the following: -Encourage the resident to groom self with staff set up help; -Limited assistance with dressing and grooming. Review of the resident’s quarterly MDS, dated [DATE], showed the following: |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0584 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 13) -Cognitively intact; -Extensive assistance of one staff with dressing; -Limited assistance of one staff for personal hygiene. During interview on 3/18/19 at 4:00 P.M. the resident said the following: -He/she paid for the facility do to his/her laundry; -Laundry was not always returned in a timely manner; it sometimes took two weeks to get items back; -Staff was often limited on the amount of washcloths they gave him/her to do his/her bathing cares. 13. Review of Resident #101’s care plan revised 3/1/19, showed the following: -Requires limited assistance for daily care; -Can make needs known; -Requires staff support for dressing and bathing. Record review of the resident’s quarterly MDS, dated [DATE], showed the following: -Cognitively intact; -Required total dependence on staff for dressing; -Extensive assistance of one staff for personal hygiene. During interview on 3/18/19 at 4:00 P.M. the resident said the following: -He/she paid for the facility do to his/her laundry; -He/she did not always have clean laundry available because it took the laundry staff weeks to get his/her clothes clean. 14. Record review of Resident #46’s quarterly MDS, dated [DATE], showed the following: -Cognitively intact for daily decision making; -Used wheelchair for mobility. Observation and interview on 3/17/19 at 1:20 P.M., showed the following: -The resident sat in his/her wheelchair, the armrest on the right of the wheelchair was cracked and peeling; -The resident said the armrest was rough and uncomfortable. 15. Record review of Resident #58’s quarterly MDS, dated [DATE], showed the following: -Moderate cognitive impairment for daily decision making; -Used wheelchair or walker for mobility. Observation on 3/17/19 at 1:59 P.M., showed the resident sat in his/her wheelchair, the armrests of the wheelchair were cracked and peeling and the handle from the left push bar in the back of the wheelchair was missing. During an interview on 3/19/19 at 10:40 A.M. CNA K said the following: -He/she verbally reports to maintenance when he/she had issues with a resident’s wheelchair; -Wheelchairs are to be cleaned at least once weekly and if issues noted then he/she would report. During interview on 03/22/19 at 3:53 P.M. the director of nursing (DON) said the following: -Laundry turn around should be on the same day; -There should be washcloths to wash resident faces; -Wheelchairs should be clean and repaired; -If a wheelchair needs repaired she would expect staff to report that to the maintenance personnel. During an interview on 4/1/19 at 2:23 P.M. and 4/4/19 at 12:50 P.M., the Administrator said the following: -CNAs are responsible for ensuring wheelchairs, including armrests are in good repair and |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0584 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 14) reporting issues with the wheelchairs as they arise. CNA staff can report wheelchair issues to the Unit Managers; -The facility does not have a policy for resident/facility laundry turn around or expectations. -Laundry staff is responsible for resident and facility laundry. Laundry staff is responsible for picking laundry up and returning it; -Residents should get their laundry items returned within 48 hours, a week is too long; -She would expect staff to have washcloths available to provide personal care to the residents; -She had no knowledge of laundry issues. | |
F 0645 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | PASARR screening for Mental disorders or Intellectual Disabilities **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0645 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 15) -[MEDICATION NAME] (antidepressant) 15 mg at bedtime for depression. Record review of the resident’s admission Minimum Data Set (MDS), a federally mandated assessment tool required to be completed by facility staff, dated 2/18/19 showed the following: -[DIAGNOSES REDACTED]. -The resident was admitted to the facility from the hospital; -The resident had received antipsychotic medications for the past seven days; -The resident received antipsychotic medications on a routine basis; -No documentation that a PASARR was completed for the resident. Record review of the resident’s care plan, dated 2/22/19 showed the following: -The resident was at risk for adverse reactions or complications from routine psychoactive medication usage; -Administer psychoactive medications as ordered by the physician; -Monitor/document/report as needed any adverse reactions to psychoactive medication usage: change in behavior/mood/cognition, hallucinations/delusions, social isolation, suicidal thoughts, withdrawal, and decline in activities of daily living (ADL) ability, etc. Review of the resident’s medical record showed no PASARR screening (Level I or II). 3. Review of Resident #95’s face sheet, showed: -admitted to the facility on [DATE], 1/30/19 and readmitted on [DATE]; -[DIAGNOSES REDACTED]. Record review of the resident’s admission MDS, dated [DATE], showed the following: -The resident was cognitively intact; -A PASARR was not completed for the resident; -admitted from an acute hospital. Record review of the resident’s care plan, dated 3/5/19, showed the following: -Administer psychoactive medications as ordered by physician; -Monitor/document/report as needed any adverse reactions to psychoactive medication usage: change in behavior/mood/cognition, hallucinations/delusions, social isolation, suicidal thoughts, withdrawal, and decline in activities of daily living (ADL) ability, etc. Record review of the resident’s medical record showed no PASARR screening (Level I or II). During interview on 3/22/19 at 3:53 P.M. the director of nursing (DON) said level one | |
F 0658 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | Ensure services provided by the nursing facility meet professional standards of quality. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0658 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 16) review of 24 sampled residents. Facility staff failed to follow physician’s orders [REDACTED].#29 and #71), and failed to assess one resident (Resident #97) who was undergoing both [MEDICAL CONDITION] and [MEDICAL CONDITION] treatments for possible side effects or complications. The facility census was 118. 1. During an interview on 4/4/19 at 12:50 P.M. the administrator said the following: -She would expect staff to follow physician orders; -She would expect the Director of Nursing (DON) set the expectations for documentation. 2. Review of Resident #29’s face sheet showed the resident was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Review of the resident’s physician’s orders [REDACTED].>Review of the resident’s Admission Minimum Data Set (MDS), a federally mandated assessment instrument required to be completed by facility staff, dated 1/7/19, showed the following: -Cognitively intact for daily decision making; -Had no rejection of care; -Required limited assistance of one staff for eating; -Weight was 163 pounds. Review of the resident’s care plan, dated 1/13/19 showed the following: -Problem: The resident requires extensive assist to full staff asssistance with ADL’s; -Interventions: Eating: The resident can feed his/her self although at times, does not complete meal therefore staff required. Limited assistance at meals. Eats in supervised dining room except at lunch in which he/she eats in room with family member per family member’s request; -Problem: The resident has [MEDICAL CONDITION]; -Interventions: Monitor/document/report as needed any signs/symptoms of [MEDICAL CONDITION]: weight gain unrelated to intake. Review of the resident’s Weight Record, showed no documentation/evidence staff weight the resident daily as ordered on [DATE], 1/23/19, 1/24/19, 2/3/19, and 2/22/19. Review of the resident’s Physician Orders, dated 2/6/19, showed an order for [REDACTED]. Further review of the resident’s care plan, dated as initiated 2/27/19, showed the following: -Problem: The resident has experienced weight fluctuations placing him/her at risk for nutritional deficit. The resident requires nutritional monitoring; -Interventions: Daily weights as ordered. The resident to use plate with plate guard or built up edges for all meals when available. Further review of the resident’s Weight Record, showed no documentation/evidence staff weight the resident daily as ordered on 3/2, 3/3, 3/4, 3/10, and 3/14/19. Observation 3/17/19 at 6:10 P.M., showed the resident in the supervised dining room. Staff served the resident’s meal on a Styrofoam plate with no plate guard and no built up edges as physician ordered. Observation on 3/18/19 at 9:31 A.M., showed the resident in the supervised dining room. He/She ate his/her meal from a glass plate with no plate guard and no built up edges as physician ordered. Observation on 3/21/19 at 8:49 A.M., showed the resident in the supervised dining room. He/She ate his/her meal off a glass plate with no plate guard and no built up edges as physician ordered. During an interview on 3/21/19 at 8:50 A.M., Certified Nurse Assistant (CNA) AA, said he/she had never seen the resident with a plate guard or built up edges on the plate. During an interview on 3/21/19 at 9:02 A.M., Unit Manager Licensed Practical Nurse (LPN) W, said he/she was unaware if the resident had an order for [REDACTED].>During an |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0658 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 17) interview on 3/21/19 at 9:03 A.M., Unit Manager LPN NN, said dietary should put a plate guard on or send a plate with built up edges if the physician ordered one. During an interview on 3/21/19 at 8:51 A.M., the Occupational Therapist said the resident should have a plate guard or built up edges on his/her plate if the physician ordered this. 3. Review of Resident #71’s updated care plan, dated 2/8/19 showed the following: -Dependent on staff for locomotion; -Transfer with two staff; -The resident will have his/her basic care needs met daily; -At risk for pressure ulcers due to the need for extensive assistance with repositioning and bed mobility; -History of healed pressure injury (right and left heels); -Administer treatments as ordered and monitor for effectiveness; -Elevate bilateral heels as much as the resident will allow; the resident does not want to wear any pressure boots; when applied, the resident will resist and kick off; -Extensive assistance with repositioning or bed mobility; needs pressure relief when in bed and wheelchair. Review of the resident’s quarterly MDS, dated [DATE], showed the following: -Extensive assistance of one staff for bed mobility; -Total dependence of two staff for transfers; -Extensive assistance of one staff for locomotion on and off the unit; -Used wheelchair for mobility device; -History of pressure ulcer/injury; -Risk of pressure ulcer/injury; -Pressure decreasing device for wheelchair and bed. Review of the resident’s (MONTH) 2019 physician order [REDACTED]. -[DIAGNOSES REDACTED]. -Bilateral heels open to air with heel protectors every shift related to [MEDICAL CONDITION] ([MEDICAL CONDITION] disorder of the central nervous system that affects movement, often including tremors). Observation on 03/17/19 at 2:45 P.M. showed the following: -The resident lay in his/her bed; -The resident did not have bilateral heel protectors on; there were none observed in the resident room; -The resident’s heels were not elevated off of the bed. Observation on 03/18/19 at 10:00 A.M. showed the following: -The resident lay in his/her bed; -The resident did not have bilateral heel protectors on; there were none seen in the resident room; -The resident’s heels were not elevated off of the bed. During interview on 03/18/19 at 10:00 A.M., LPN H said he/she did not know if the resident was to be wearing heel protectors or have his/her feet elevated. Observation on 03/19/19 at 10:26 A.M. showed the following: -The resident lay in his/her bed; -The resident did not have bilateral heel protectors on; there were none seen in the resident room; -The resident’s heels were not elevated off of the bed. During interview on 03/19/19 at 10:26 A.M., CNA J said the following: -He/she did not know where the resident’s heel protectors were; |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0658 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 18) -He/she had returned the resident to bed that morning and had not elevated his/her heels; he/she did not know they needed to be. 4. Review of Resident #97’s quarterly MDS dated [DATE], showed the resident was cognitvely intact for daily decision making; Review of the resident’s physician progress notes [REDACTED]. -Recent PET scan (positron emission tomography is an imaging test that helps reveal how your tissues and organs are functioning) showed a large mass in the superior segment of the right lower lobe lung, most likely represents a [MEDICATION NAME] ([MEDICAL CONDITION]). He/she was also noted to have a large soft tissue mass in the left proximal posterior thigh which was even more metabolically active with a second nodule in the right thigh. Possibly both could reflect metastatic (widespread) disease. The biospy showed metastatic disease and is receiving infusion therapy. Review of the resident’s physician progress notes [REDACTED]. His/her next scheduled infusion is 2/27/19. Review of the resident’s care plan, dated as reviewed 2/26/19, showed the following: -Problem: The resident is at risk for pain or discomfort due to [DIAGNOSES REDACTED].>-Interventions: Anticipate the resident’s need for pain relief and respond immediately to any complaints of pain. Identify and record previous pain history and management of that pain and impact on function. Monitor/document for side effects of pain medication. Monitor/record pain characteristics. Monitor/record/report to nurse any sign/symptoms of non-verbal pain; -No documentation regarding the resident’s [MEDICAL CONDITION] and [MEDICAL CONDITION] in the care plan or directions to monitor for potential complications from both. Review of the resident’s medical record showed the following: -No documentation/evidence the resident was going to [MEDICAL CONDITION] or [MEDICAL CONDITION] therapy appointments; -No documentation/evidence the resident was being assessed following the [MEDICAL CONDITION] or [MEDICAL CONDITION] appointments. During an interview on 3/17/19 at 2:00 P.M., the resident said he/she had been going out for [MEDICAL CONDITION] appointments and [MEDICAL CONDITION]. During an interview on 3/20/19 at 12:10 P.M., Licensed Practical Nurse (LPN) M, said the following: -The resident goes out daily for [MEDICAL CONDITION] therapy; -Staff should document in the medical record when the resident leaves and when he/she returns; -Staff should document in the medical record how the resident responded to [MEDICAL CONDITION] or [MEDICAL CONDITION] and if he/she was having any side effects of the either. Further review of the resident’s medical record, showed the following: |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0658 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | ||
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: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0677 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 20) cares and emptying of catheter drainage bag. Set up at sink for the resident to self perform own grooming needs. Review of the facility shower assignment showed the resident was to get a shower on Monday and Thursday day shift. Observation and interview on 03/17/19 at 4:20 P.M., showed the resident complained that he/she does not get showers. The resident’s hair was disheveled and greasy. The resident had an area of dried blood on his/her lower right leg. The resident wore yellow hospital gown. The resident had a brownish colored area to the foot of his/her bed on the sheets. Observation and interview on 3/18/19 at 10:10 A.M., showed the resident was wearing the same yellow gown as 3/17/19 and still the area of dried blood on his/her lower right leg remained. The resident said he/she had not had a shower and had not had his/her sheets changed. The resident’s hair was disheveled and greasy and he/she still had the brownish colored area to the foot of his/her bed on the sheets. Observation and interview on 3/19/19 at 10:49 A.M., showed the resident wore the same yellow gown as 3/17/19 and still had an area of dried blood on his/her lower right leg. The resident said he/she had not had a shower and had not had his/her sheets changed. The resident’s hair was disheveled and greasy and he/she still had the brownish colored area to the foot of his/her bed on the sheets. The resident resided in the room by him/herself and upon entering the room, the room had a foul odor. Observation and interview on 3/20/19 at 11:53 A.M., showed the resident wore the same yellow gown as 3/17/19 and still had an area of dried blood on his/her lower right leg. The resident said he/she had not had a shower and had not had his/her sheets changed. The resident’s hair was disheveled and greasy and he/she still had the brownish colored area to the foot of his/her bed on the sheets. The resident’s room had a foul odor. Observation and interview on 3/21/19 at 9:07 A.M., showed the resident wore the same yellow gown as on 3/17/19 and still had an area of dried blood on his/her lower right leg. The resident said he/she had not had a shower and had not had his/her sheets changed. The resident’s hair was disheveled and greasy and he/she still had the brownish colored area to the foot of his/her bed on the sheets. The resident’s room had a foul odor. 6. Review of Resident #5’s care plan, revised 12/31/18, showed the following: -The resident had dementia, gets confused and needs direction; -The resident will have all of his/her basic needs met by staff; -Assist times one supervision with care needs and bathing; allow him/her to do as much for him/herself with set up assistance as tolerated; -Encourage the resident to perform or participate in ADL’s to extent possible; -Staff may need to provide more ADL assistance in the mornings when the resident first gets out of bed. Review of the resident’s quarterly MDS dated [DATE], showed the following: -Brief interview for mental status (BIMS) of nine indicating some cognitive impairment (BIMS scores range from 0-15, the higher the score, the lower the impairment to the cognitive response); -Personal hygiene, including washing and drying of the face and hands, required limited assistance of one staff. Observation on 3/19/19 at 6:06 A.M. showed the following: -The resident lay in his/her bed; -The inner canthus of the resident’s right eyes had dried yellow matter in the corner; -Certified Nurse Aide (CNA) L assisted the resident with morning cares, dressed the resident and transferred him/her to his/her wheelchair; -CNA L took the resident out of the room and to the day area; |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0677 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 21) -CNA L did not wash the resident’s face or provide oral care before taking the resident out of the room. 7. Record review of Resident #9’s Admission MDS dated [DATE], showed the following: -Cognitively intact for daily decision making; -Had no rejection of care; -Required extensive assist of one staff for bed mobility, transfers, dressing, and toileting; -Required limited assist of one staff for personal hygiene; -Required physical help of one staff for bathing; -Was occasionally incontinent of urine; -Was always continent of bowel. Review of the resident’s care plan, dated as reviewed 3/11/19, showed the following: -Problem: The resident requires limited to extensive assist with ADL’s; -Interventions: The resident requires extensive assist from staff with showering two times weekly and as necessary. Review of the facility’s shower assignment sheet, showed the resident was to receive on Tuesday and Friday day shift. Review of the resident’s comprehensive CNA shower review documentation provided by the facility for 1/17/19 through 3/22/19, showed the following: -On 1/30/19 there was no hot water, so shower was not given; -Received a shower on 2/25/19, 3/2/19, and 3/8/19; -No documentation to show showers were given or refused on other days. Observation and interview on 3/18/19 at 4:12 P.M., showed the resident said he/she does not get showers. He/she had not received a shower for over ten days. He/she would prefer his/her family member be at the facility when he/she takes a shower and would prefer a bench over the shower chair. The resident was in bed with only a brief on and covered in a sheet. The resident’s hair was disheveled and greasy. The room had an unidentifiable odor. 8. Review of Resident #12’s updated care plan, dated 1/31/19, showed the following: |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0677 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 22) -The resident sat in his/her wheelchair in the main dining room; -The resident had unshaven facial hair resembling stubble; -The resident’s hair appeared greasy and unkempt. Observation on 3/18/19 at 9:25 A.M. showed the following: -The resident sat in his/her wheelchair in the main dining room; -The resident had unshaven facial hair resembling stubble; -The resident’s hair appeared greasy and unkempt. Observation on 3/19/19 at 8:10 A.M. showed the following: -The resident lay in bed in his/her room; -The resident had unshaven facial hair resembling stubble; -The resident’s hair appeared greasy and unkempt. Observation and interview on 3/22/19 at 10:05 A.M. showed the following: -The resident sat in his/her wheelchair in the facility hallway; -The resident had unshaven facial hair resembling stubble; -The resident’s hair appeared greasy and unkempt; -The resident said he/she needed help shaving his/her facial hair and staff never assisted him/her; -He/she sometimes asked for supplies to shave and assistance, but staff never brought them or offered to help; -He/she likes to be clean shaven; -Staff does not always help him/her with bathing; -He/she used to go to the shower room and linen room on his/her own because he/she got tired of waiting on staff to help, but he/she got in trouble with staff for doing that so he/she doesn’t do it anymore; -He/she does not even have a comb or wash clothes to clean up at the sink if he/she wanted to. 9. Review of Resident #22’s quarterly MDS, dated [DATE], showed the following: -Cognitively intact; -Required limited assistance with personal hygiene, including shaving; -Required physical help in part of bathing assistance. Review of the resident’s care plan, revised 2/21/19, showed the following: -Requires supervision to limited assistance at times with ADL’s; -The resident will be appropriately assisted with ADL’s as needed; -Allow the resident to do as much as possible for him/herself and offer assistance when needed; -Encourage the resident to allow staff to assist with hygiene and bathing; encourage staff assist and completion of these tasks; -Limited assistance with bathing; -Set up and supervision for grooming needs to assure the resident is completing task. Record review of the facility’s shower assignment sheet showed the resident was to have a shower on Monday and Thursday day shift. Review of the resident’s comprehensive CNA shower review documentation provided by the facility for (MONTH) 2019 through (MONTH) 2019, showed the following: -The resident’s last documented shower was on 2/21/19; -No documentation to show the resident had been shaved or that cares had been provided or refused on 02/25/19, 02/28/19, 03/04/19, 03/07/19, 03/11/19, 03/14/19, 03/18/19 and 03/21/19. Observation on 03/17/19 at 12:02 P.M. showed the following: -The resident sat in his/her wheelchair in the main dining room; |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0677 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 23) -The resident had unshaven facial hair resembling stubble. Observation on 3/18/19 at 9:25 A.M. showed the following: -The resident sat in his/her wheelchair in the main dining room; -The resident had unshaven facial hair resembling stubble. Observation on 3/19/19 at 8:10 A.M. showed the following: -The resident sat in a wheelchair in his/her room; -The resident had unshaven facial hair resembling stubble. Observation and interview on 3/22/19 at 10:15 A.M. showed the following: -The resident sat in his/her wheelchair in his/her room; -The resident had unshaven facial hair resembling stubble; – He/she needed help shaving his/her facial hair and staff never assisted him/her; -He/she sometimes asked for supplies to shave and assistance, but they never brought them or offered to help; -He/she likes to be clean shaven; -Staff does not always help him/her with bathing because they are short staffed; -It had been a long time since he/she had a shower and he/she felt dirty. 10. Record review of Resident #28’s annual MDS, dated [DATE], showed the following: -BIMS of seven indicating severely impaired cognition; -Personal hygiene, including washing and drying of the face and hands, required extensive assistance. Review of the resident’s care plan revised 1/4/19, showed the following: -Resident is limited in ability for all ADL’s; he/she requires the assist of one staff for all of his/her ADL’s; -Requires extensive assistance with grooming; -Requires extensive assistance with hygiene. Observation on 3/19/19 at 5:52 A.M., showed the following: -The resident lay in his/her bed; -Dried white matter was present in the corners of the resident’s mouth; -Dried yellow matter was present in the corners of the resident’s eyes; -CNA L assisted the resident with morning cares, dressed the resident and transferred him/her to his/her wheelchair; -CNA L took the resident to the day area; -CNA L did not wash the resident’s face or hands or provide oral care when getting the resident up for the day. 11. Record review of Resident #29’s Admission MDS, dated [DATE], showed the following: -Cognitively intact for daily decision making; -No rejection of care; -Was dependent on one staff for dressing, toileting, and bathing; -Required extensive assist of one staff for bed mobility, transfers, and personal hygiene; -Always incontinent of bladder; -Frequently incontinent of bowel. Review of the resident’s care plan, dated 1/13/19, showed the following: -Problem: The resident requires extensive to full staff assistance with ADL’s; -Interventions: The resident is totally dependent on one staff to provide showers twice weekly and as necessary. Record review of the facility’s shower assignment sheet showed the resident was to have a shower on Monday and Thursday evening shift. Review of the resident’s comprehensive CNA shower review documentation provided by the facility for 1/17/19 through 3/22/19, showed the following: |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0677 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 24) -The resident received one shower on 3/7/19 (49 days); -No documentation to show the resident had refused or received a shower for the other days. Observation and interview on 03/17/19 at 3:05 P.M., showed the resident’s family member said the resident did not receive showers like he/she should. The resident had been at the facility since 12/31/18 and as far as he/she knew had only received three showers. The resident’s hair appeared greasy. During an interview on 3/19/19 at 8:30 A.M., the resident’s family member said that the resident did not receive his/her shower last night. Observation showed the resident’s hair appeared greasy. Observation on 3/22/19 at 10:53 A.M., showed a hand written sign on the resident’s door that said, Shower time! During an interview on 3/22/19 at 11:13 A.M., the resident’s family member said the following: He/she put the sign on the resident’s door to remind staff to do the resident’s shower. He/she was unsure if the resident received his/her shower the night before. 12. Review of Resident #38’s quarterly MDS, dated [DATE], showed the following: -BIMS of 14; -Personal hygiene, required extensive assistance of one staff; -Bathing, was totally dependent on two or more staff. Review of the resident’s care plan, revised 1/22/19, showed the following: -Requires extensive assist to full assist with daily cares; -Staff to assist to make sure basic care needs are met; -Is incontinent of bladder with occasional incontinence of bowel. Record review of the facility’s shower assignment sheet showed the resident was to have a shower on Monday and Thursday evening shift. Review of the resident’s comprehensive CNA shower review documentation provided by the facility for (MONTH) 2019 through (MONTH) 2019, showed the following: -The resident received a shower on 2/07/19; -No documentation the resident received a shower as scheduled on 02/11/19, 02/14/19, 02/18/19, 02/21/19, 02/25/19, 02/28/19, 03/04/19, 03/10/19, 03/11/19, 03/14/19 and 03/18/19. Observation and interview on 03/17/19 at 2:45 P.M. showed the following: -The resident lay in bed watching television; -The resident said he/she had not had a shower for six weeks; -The reason staff gives him/her for not getting his/her shower is that they are low on staff; this includes no hair washing; -His/her hair felt greasy; -The resident’s hair appeared greasy; -The resident ran his/her hands through his/her hair and it stood up on end. 13. Record review of Resident #53’s quarterly MDS, dated [DATE], showed the following: -BIMS of 10; -Personal hygiene, including shaving, required limited assistance. Review of the resident’s care plan, dated 2/27/19, showed the following: -Required limited assistance with ADL’s; -Avoid doing things for the resident that he/she can do; assist as needed; -Encourage to groom self with set up help (assistance required for completion); -Encourage participation in ADL’s to the extent possible; -Limited assistance with grooming (staff to provide set up at sink assist only when resident is unable to perform); |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0677 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 25) -Give verbal reminders and cues while participating in ADL tasks. Record review of the facility’s shower assignment sheet showed the resident was to receive his/her showers on Tuesday and Friday day shift. Review of the resident’s comprehensive CNA shower review documentation provided by the facility for (MONTH) 2019 through (MONTH) 2019, showed the resident had received showers as scheduled, but there was no documentation to support the resident had been shaved. Observation and interview on 03/17/19 at 1:05 P.M., showed the following: -The resident had a mustache and goatee; there was facial stubble on the resident’s cheeks; -The resident’s family member said staff frequently did not assist the resident with shaving; he/she thought it was due to a staffing issue and they just didn’t have time; he/she usually helped the resident shave as the resident would not want the facial stubble. 14. Review of Resident #57’s care plan, dated 7/25/18, showed the following: -Check frequently for wetness and change after incontinence occurs; -Continent of bowel and bladder with occasional incontinence requiring pads/briefs; -The resident often refuses showers. Does shave as needed. Staff is to encourage shower or at minimal washing body at sink to prevent odor or complications from poor hygiene. Review of the resident’s annual MDS, a federally mandated assessment instrument completed by facility staff, dated 1/31/19, showed the following: -Cognition moderately impaired; -Had no rejection of care; -Bathing somewhat important; -Required extensive assistance of one staff for bathing; -Frequently incontinent of urine. Review of the resident’s comprehensive CNA shower review documentation provided by the facility for 1/17/19 through 3/22/19, showed the following: -Refused a shower on 3/8/19; -The resident received a shower on 3/14/19; -There was no documentation the resident received a shower 1/17/19 through 3/13/19 (55 days). Observation on 3/20/19 at 1:35 P.M., showed the resident walking the halls of the facility. The resident’s hair was disheveled. 15. Record review of Resident #71’s care plan revised 1/16/19, showed the following: -Dependent on staff for bathing; -Extensive assistance with grooming needs; unable to complete tasks on own. Record review of the resident’s MDS, dated [DATE], showed the following: -BIMS of six indicating severely impaired cognition; -Personal hygiene, including shaving, required extensive assistance and was a one person physical assist; -Total dependence on staff for bathing. Record review of the facility’s shower assignment sheet showed the resident was to have a shower on Monday and Thursday evening shift. Review of the resident’s comprehensive CNA shower review documentation provided by the facility for (MONTH) 2019 through (MONTH) 2019, showed the resident had received showers as scheduled, but there was no documentation to support the resident had been shaved. Observation on 03/17/19 at 3:22 P.M. showed the following: -The resident lay in bed on his/her left side; -The resident had unshaven facial hair resembling stubble. |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0677 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 26) Observation on 3/18/19 at 9:15 A.M. showed the following: -The resident sat in his/her wheelchair in the assisted dining room; -The resident had unshaven facial hair resembling stubble. Observation on 3/19/19 at 11:02 A.M. showed the following: -The resident lay in bed on his/her left side; -The resident had unshaven facial hair resembling stubble. 16. Record review of Resident #72’s Admission MDS dated [DATE], showed the following: -Cognitively intact for daily decision making; -No rejection of care; -Required physical help in part of bathing activity of one staff; -Required limited assistance of one staff for bed mobility, transfers, dressing, and toileting; -Required supervision with set-up help for personal hygiene; -Was continent of bowel and bladder. Review of the resident’s care plan, dated 12/2/18, showed the following: -Problem: The resident requires limited to extensive assist with ADL’s due to recent hospitalization and increased weakness; -Interventions: Provide shower/bath two times a week and as needed (extensive assist). Limited assist with grooming. Record review of the facility’s shower assignment sheet showed the resident was to receive his/her showers on Monday and Thursday evening shift. Review of the resident’s comprehensive CNA shower review documentation provided by the facility for 1/17/19 through 3/22/19, showed the following: -The resident refused to shower on 2/11/19, 2/14/19, and 2/21/19; -The resident received one shower on 2/25/19 (40 days); -The resident refused to shower on 3/7/19 and 3/14/19; -No documentation the resident received a shower from 2/25/19 to 3/22/19 (25 days). Observation and interview on 03/17/19 at 2:21 P.M., showed resident said that he/she does not get showers like he/she would like. The resident was unshaven and hair appeared disheveled and greasy, he/she said that he/she would like to be shaved daily. Observation and interview on 3/19/19 at 7:24 A.M., showed the resident wearing the same clothes as he/she had on 3/18/19. He/she had slept in his/her clothes. The resident said that he/she did not receive a shower last night 3/18/19. The resident was still unshaven and his/her hair was disheveled and greasy. Observation and interview on 3/21/19 at 8:42 A.M., showed the resident in the same clothes he/she wore on 3/20/19. The resident said that he/she had still not received a shower. He/she was shaven, but his/her hair was disheveled and greasy. 17. Record review of Resident #97’s quarterly MDS dated [DATE], showed the following: -Cognitively intact for daily decision making; -No rejection of care; -Required limited assistance of one staff for toileting; -Required physical help of one staff for bathing; -Required supervision with no set up for personal hygiene; -Had an indwelling catheter; -Was continent of bowel. Review of the resident’s care plan, dated as reviewed 2/22/19, showed the following: -Problem: The resident requires supervision to limited assist at times with ADL’s; -Interventions: The resident needs encouragement to take showers or perform own grooming. When not performing staff will offer assistance although the resident refuses staff |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0677 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 27) assistance. The resident may be more compliant with showers when going on outings with family so staff may need to adjust shower days. Limited assist with bathing twice weekly and/or as needed, may need assist with lower body washing and drying. The resident is able to self perform grooming needs daily with supervision that he/she completes tasks on his/her own. Record review of the facility’s shower assignment sheet showed the resident was to receive a shower on Tuesday and Friday day shift. Review of the resident’s comprehensive CNA shower review documentation provided by the facility for 1/17/19 through 3/22/19, showed the following: -The resident had received four showers 2/17/19, 2/19/19, 3/1/19, and 3/5/19 in 64 days. Observation and interview on 03/17/19 at 2:00 PM., showed the resident said he/she had not received a shower in four or five days. Observation showed the resident with facial hair and his/her hair was disheveled and greasy. The resident said he/she would like to shave daily if he/she could, but the facility had no staff to help. Observation on 3/18/19 at 4:10 P.M., showed the resident wore in the same clothes as 3/17/19 and was unshaven. His/her hair was disheveled and greasy. 18. Review of Resident #99’s admission MDS, dated [DATE], showed the following: -Makes self understood and understands others sometimes; -Had no rejection of care; -Bathing somewhat important; -Required total assistance of one staff for bathing; -Always incontinent of bladder and bowel. Review of the resident’s care plan, dated 12/5/18, showed the following: -Requires extensive to full staff support with ADL’s due to [DIAGNOSES REDACTED]. -Dependent on staff for bathing needs. Both washing and drying of upper and lower body. Review of the resident’s comprehensive CNA shower review documentation provided by the facility for 1/17/19 through 3/22/19, showed the following: -The resident received showers on 1/18/19, 1/23/19, 1/26/19, 2/3/19, 2/5/19, 2/9/19, 2/13/19, 2/26/19, 3/3/19, 3/8/19 and 3/15/19; -The resident received no showers/baths from 1/27/19 through 2/2/19 (6 days); -The resident received no showers/baths from 2/14/19 through 2/25/19 (11 days); -The resident received no showers/baths from 3/9/19 through 3/14/19 (6 days); -The resident received no showers/baths from 3/16/19 through 3/22/19 (6 days). 19. Review of Resident #109’s care plan, dated 7/24/18, showed the following: -The resident needs extensive assistance with bathing needs especially washing and drying of lower body; -Incontinent of bladder and frequently incontinent of bowels requiring use of pad/brief and full staff support for incontinence. Review of the resident’s annual MDS dated [DATE], showed the following: -Short and long term memory problems; -Had no rejection of care; -Prefers a shower; -Required extensive assistance of one staff for bathing and personal hygiene; -Always incontinent of urine; -Frequently incontinent of bowel. Review of the resident’s comprehensive CNA shower review documentation provided by the facility for 1/17/19 through 3/22/19, showed the following: -The resident received showers/baths on 2/7/19, 2/18/19, 2/21/19, 2/25/19, and 2/28/19; -Refused a shower times three on 3/15/19; |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0677 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 28) -There was no documentation the resident received a shower 1/17/19 through 2/6/19 (20 days); -There was no documentation the resident received a shower 2/8/19 through 2/17/19 (9 days); -There was no documentation the resident received a shower 3/1/19 through 3/22/19 (22 days). 20. Review of Resident #110’s care plan, dated 2/8/19, showed the following: -Totally dependent on staff to provide bath/shower two times weekly and as necessary; -Totally dependent on staff for personal hygiene and oral care. Review of the resident’s 14 day Prospective Payment System (PPS) MDS dated [DATE], showed the following: -Cognitively intact; -Had no rejection of care; -Required total assistance of two or more staff for bathing; -Indwelling catheter for bladder and ostomy for bowel. Review of the resident’s comprehensive CNA shower review documentation provided by the facility for 1/17/19 through 3/22/19, showed the following: -The resident received no showers/baths from 1/28/19 through 2/2/19 (5 days); -The resident received a shower on 2/3/19, bed bath on 2/8/19, shower on 2/17/19, and a bed bath on 2/19/19; -Was in the hospital on [DATE] and 2/26/19; -There was no documentation the resident received a shower 3/1/19 through 3/22/19 (22 days). Observation on 3/17/19 at 1:45 P.M., showed the resident lay in bed with head of bed up watching television with long fingernails. During an interview on 3/17/19 at 1:45 P.M., the resident said he/she has told staff that he/she wants fingernails trimmed but they have never been trimmed. During an interview on 3/19/19 at 7:44 A.M., the resident said staff just come in and do a bed bath when they are ready. It can be a long period between baths and that he/she has went a couple of weeks without a shower before. He/She doesn’t know why he/she doesn’t get a bath/shower when scheduled. 21. Review of Resident #111’s care plan dated 3/5/19 showed the following: -Date initiated 3/14/16 and target date 6/11/19; -Required one staff assistance with all ADL’s due to the resident’s limited mobility related to the resident being weaker on the left side. Record review of the Resident’s annual MDS dated [DATE], showed the following: -Cognitively intact for daily decision making; -Had no rejection of care; -Required extensive assistance of one staff for bathing; -Was always continent of bowel and bladder. Review of the facility’s shower assignment sheet, showed the resident was to receive showers on Tuesdays and Fridays during the evening shift. Review of the resident’s comprehensive CNA shower review documentation provided by the facility for 1/17/19 through 3/22/19, showed the following: -Staff showered/bathed the resident three days in a (MONTH) 2019; -Staff showered/bathed the resident two days in 27 days from 2/1/19 to 2/28/19; -Staff showered and/or bathed the resident one time in 22 days from 3/1/19 to 3/22/19. Observation and interview on 3/19/19 at 7:35 A.M., showed the resident said he/she does not get showers as he/she would like or needed. Staff had not given him/her a shower for |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0677 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 29) two weeks. There wasn’t enough staff on evenings to give him/her a showers. He/she would like to get showers at least twice a week. He/she did not care if he/she got his/her shower on evenings or days, he/she just wanted a shower. The resident’s finger nails were long and had brown debris under them. The res (TRUNCATED) | |
F 0678 Level of harm – Minimal harm or potential for actual harm Residents Affected – Many | Provide basic life support, including CPR, prior to the arrival of emergency medical personnel , subject to physician orders and the resident’s advance directives. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0678 Level of harm – Minimal harm or potential for actual harm Residents Affected – Many | (continued… from page 30) 3. Review of Licensed Practical Nurse (LPN) II’s Community and Workplace certification cards showed the following: -LPN II successfully completed CPRToday! Inc. Training Course in BLS, Adult CPR and AED; -Certified on [DATE]. Expired ,[DATE]; -Certified on [DATE]. Expires on ,[DATE]. During interview on [DATE] at 4:00 P.M. LPN II said his/her CPR recertification in (YEAR) and [DATE] were online courses only. There was no hands-on component to the certification. 4. Review of Medical Records Staff U Lifeline Training Resources card showed the following: -Medical Records Staff U successfully completed all Lifeline Training curriculum coursework equivalent to (YEAR) EDD/ILCOR and AHA guidelines; -Certified on [DATE]. Expires [DATE]. During interview on [DATE] at 4:45 P.M. Medical Records Staff U said the following: -His/her CPR certification was online only; -He/she did not complete any hands-on skills component. 5. Review of the Director of Nurses (DON)’s CPR certification card showed the following: -Course date [DATE]; -Recommended renewal date: ,[DATE]. 6. Review of Certified Nurse Aide (CNA) KK’s American Health Care Academy CPR certification card showed the following: -He/she successfully completed the requirements in accordance with American Health Care Academy’s curriculum; -Issue date [DATE]. Renewal date [DATE]. 7. Review of LPN LL’s American Health Care Academy CPR certification card showed the following: -He/she successfully completed the requirements in accordance with American Health Care Academy’s curriculum; -Issue date [DATE]. Renewal date [DATE]. Review of www.cpraedcourse.com showed American Health Care Academy offers nationally accepted and easy-to-understand Adult, Child and Infant Online CPR certification and Online First Aid certification courses for the community, school, workplace and Healthcare Providers. 8. During interview on [DATE] at 2:35 P.M. Unit Manager/LPN W said the following: -He/she was the staffing coordinator from (MONTH) (YEAR) to [DATE]; -He/she was responsible for scheduling all nursing staff; -He/she scheduled staff based on fire code; -He/she did not know who was CPR certified; -He/she did not staff based on CPR certification and ensuring CPR certified staff were available on all shifts 24 hours a day/seven days a week; -It was the responsibility of the DON to make sure CPR certifications were current; -All licensed staff should be CPR certified. During interview on [DATE] at 2:45 P.M. LPN P/Staffing Coordinator said the following: -He/she has been the staffing coordinator for the last week or week and a half; -He/she was in charge of scheduling all nursing staff; -All licensed nurses should be CPR certified; -He/she had not verified all licensed nurses were CPR certified; -He/she wouldn’t know if a licensed nurse was CPR certified or not unless the facility receives a CPR card from the nurse; -He/she does not schedule staff based on ensuring CPR certified staff are in the facility |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0678 Level of harm – Minimal harm or potential for actual harm Residents Affected – Many | (continued… from page 31) on all shifts. During interview on [DATE] at 3:50 P.M. the DON said she thought all licensed staff were CPR certified. She did not follow up or review the schedule to assure there were CPR certified licensed staff on all shifts. During interview on [DATE] at 2:15 P.M. and [DATE] at 2:23 P.M. the administrator said the following: -The staffing coordinator was responsible for ensuring CPR certified staff are in the facility on all shifts; -The staffing coordinator was responsible for ensuring CPR certifications are current and CPR certification cards are present in the employee files; -She believed all her licensed staff were CPR certified; -The DON was responsible for tracking CPR certification and overseeing the staffing coordinator’s scheduling; -She thought her staffing coordinator was assuring all licensed staff had CPR certificates; -She felt the system needed improvement; -She would expect all licensed nurses to be CPR certified; -She had not identified some licensed staff who were not CPR certified; -She was not aware some of the facility’s licensed staff were CPR certified/recertified online only; -She was not aware online only certification was not sufficient; -She would expect staff to be CPR certified in both the cognitive and hands-on skills components of CPR. | |
F 0684 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | Provide appropriate treatment and care according to orders, resident’s preferences and goals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0684 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 32) other current medications and all active diagnoses; -The staff and physician will identify and address potential complications in individuals receiving anticoagulation; for example, someone with a fall risk, history of GI bleed or poorly controlled hydration; -The physician will order appropriate lab testing to monitor anticoagulation therapy and potential complications; for example, periodically checking hemoglobin/hematocrit, platelets, PT/INR ([MEDICATION NAME] time and international normalized ratio used to check coagulation of the blood), and stool for occult blood; -The staff should use a [MEDICATION NAME] flow sheet or comparable monitoring tool to follow trends in anticoagulation dosage and response; -The physician will help review the process of individuals who are being anticoagulated; for example, to see whether recent-onset [MEDICAL CONDITION] has resolved; -The physician will periodically identify individuals whose anticoagulation can be discontinued or reduced, and will document a rationale for continuing anticoagulation over time, including the medication and current dosage; -The staff and physician will monitor for possible complications in individuals who are being anticoagulated, and will manage related problems; -If an individual on anticoagulation therapy shows signs of excessive bruising, theatrical, empty, or other evidence of bleeding, the nurse will discuss the situation with the physician before giving the next scheduled dose of anticoagulant. 2. Review of Resident #463’s medical record dated 1/28/19 showed the following: -PT of 26.8 (normal limits were 9.5 to 11.8); -INR of 2.4 (normal limits were 0.9 to 1.1). Review of the resident’s face sheet, showed the following: -Readmitted to the facility on [DATE] from an acute care hospital; -[DIAGNOSES REDACTED]. pressure, and [MEDICAL CONDITION]. Review of the resident’s facility medical record showed the following: -Hospital discharge note, printed 3/18/19 at 11:42 A.M., that showed the resident was admitted to the hospital on [DATE]; -Discharge [DIAGNOSES REDACTED]. -Future appointments included anti-coagulation laboratory 3/25/19; -Continue taking the following medications which have changed; -[MEDICATION NAME] (blood thinner) 10 milligrams (mg); -What changed? These instructions start on 3/28/19; if you are uncertain what to do until then, ask your doctor or other care provider; -Notes to patient: to be held for ten days then resume on 3/28/19; -Take one and one half tablets as directed on Mondays and Fridays and one tablet the other days; start taking on 3/28/19. Review of the resident’s facility admit/readmit screener, dated 3/18/19 at 2:30 P.M., showed the following: -admitting [DIAGNOSES REDACTED]. -Skin integrity assessment showed the admission nurse documented the resident had healed wounds to foot from previous double toe amputation. Review of the resident’s physician order sheets (POS) dated (MONTH) 2019 showed the following: -[MEDICATION NAME] 10 mg in the evening (the order was not consistent with the hospital discharge order which was to hold [MEDICATION NAME] until 3/28/19); -Cleanse wound, pack loosely with plain packing strip and cover with dry dressing one time a day, every other day, related to complete traumatic amputation of two or more left |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0684 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 33) lesser toes. Review of the resident’s (MONTH) 2019 Medication Administration Record [REDACTED] -Cleanse wound, pack loosely with plain packing strip and cover with dry dressing one time a day, every other day, scheduled for 9:00 A.M. beginning 3/19/19; the box for 3/19/19 was blank, indicating the treatment had not been completed; -[MEDICATION NAME] 10 mg in the evening, scheduled for 5:00 P.M.; (order not consistent with the hospital discharge orders); -The administration boxes for the resident’s [MEDICATION NAME] on 3/19/19, 3/20/19 and 3/21/19 at 5:00 P.M. showed staff administered the medication (when the medication should have been on hold until 3/28/19). Observation on 3/19/19 at 9:05 A.M. showed the following: -The resident lay in his/her bed; -His/her feet were uncovered and his/her left foot had a folded gauze pad secured with tape to his/her foot. Observation and interview on 3/20/19 at 2:00 P.M. showed the following: -The resident said staff had not completed any treatment on his/her left foot or even looked at the area where his/her toes had been amputated in (MONTH) 2019; -His/her left foot had a folded gauze pad secured with tape to his/her foot. Review of the resident’s nursing notes, dated 3/21/19 at 1:37 P.M., showed LPN D obtained a clarification of the treatment order and documented the treatment order was from a prior admission, the area was healed, the physician was notified and the treatment discontinued. During interview on 3/21/19 at 4:03 P.M. LPN D said the following: -He/she did not actually complete the resident’s treatment as he/she had documented; -He/she had not assessed the resident’s foot; -He/she just knew the resident’s toes had been amputated back in (MONTH) and when he/she was discharged from the facility in January, the area was healed; -He/she had sought the discontinue order because he/she knew it was old. Observation on 3/21/19 at 4:50 P.M. of the resident’s left foot showed the following: -The resident wore tennis shoes with no socks; -After the resident removed his/her left shoe, the skin of the resident’s foot appeared to be dry, scaly and peeling a white and yellow slough; -There was no dressing on the resident’s foot; -His/her second and third toes were missing; -The area of the second and third toes showed an open circular area, approximately the base width of a toe, with depth and a white, moist wound bed and edges. During interview on 3/21/19 at 4:45 P.M. and 5:00 P.M., Unit Manger/LPN W said the following: -He/she had not observed the resident’s left foot; he/she thought the area was healed before the resident discharged from his/her previous stay; -He/she had not reviewed the resident’s hospital discharge orders; once reviewed, the orders appeared to read to hold the resident’s [MEDICATION NAME] until 3/28/19. He/she was not the resident’s admission nurse and he/she did not know what took place or why the facility POS and MAR indicated [REDACTED] Review of the resident’s nurses’ notes, dated 3/22/19 at 7:54 A.M., showed the following: -The resident’s physician was called regarding the resident’s left toe area draining due to the resident pulling a scab off the incision line from double toe amputation back in January; -Order received to apply triple antibiotic ointment and dry dressing for seven days and then re-evaluate |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0684 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 34) During interview on 3/22/19 at 8:00 A.M., LPN M said the following: -Unit Manager/LPN W had instructed him/her to call the resident’s physician and report his/her left toe area draining due to the resident pulling a scab off the incision line from his/her double toe amputation back in January; -He/she had not assessed the resident’s foot prior to calling the physician, he/she just reported what the Unit Manager/LPN W had told him/her; -A physician’s order was received to apply triple antibiotic ointment and dry dressing for seven days and then re-evaluate. During interview on 3/22/19 at 8:10 A.M. LPN I said the following: -He/she was the facility admitting nurse; -When the resident arrived to the facility for admission on 3/18/19, he/she came with no hospital discharge orders. He/she did not see the hospital discharge orders until 3/22/19; -On 3/18/19 he/she called the resident’s physician’s office for a current medication list (this was the medication list found in the chart); she had not called the hospital for discharge orders; -He/she did not know how the [MEDICATION NAME] order on the medication list did not get entered correctly on the resident’s facility POS and MAR, it must have populated from his/her previous stay; after reviewing the facility POS and MAR indicated [REDACTED] -On 3/18/19 he/she completed a skin assessment and found there to be a scabbed area on the resident’s right foot; he/she denied there was a dressing on the resident’s foot; he/she would not consider a scab as something that needed treatment; -He/she thought the treatment order to cleanse wound, pack loosely with plain packing strip and cover with dry dressing one time a day, every other day, related to complete traumatic amputation of two or more left lesser toes populated from the resident’s previous stay; -He/she knew LPN S had helped him/her with the admission but was not sure what, if any reports he/she had given her about the resident. During interview on 3/22/19 at 8:20 A.M. LPN S said the following: -He/she helped LPN I with the resident’s admission; -He/she had taken verbal report from the hospital and the written note in the resident’s medical record was the information he/she had taken from that verbal report; -He/she was aware the resident’s [MEDICATION NAME] was to be held for 10 days; -He/she thought he/she told LPN I the [MEDICATION NAME] was to be held; -He/she did not enter any of the resident’s medication orders in the computer . Observation on 3/22/19 at 10:40 A.M. showed the following: -The resident lay in his/her bed, gripper socks on both feet; -The resident removed the sock off his/her left foot; -The physician assessed the resident’s left foot; -The skin of the resident’s foot appeared to be dry, scaly and peeling a white and yellow slough; -There was no dressing on the resident’s foot; -His/her second and third toes were missing; -The area of the second and third toes showed an open circular area, approximately the base width of a toe, with depth and a white, moist wound bed and edges. During interview on 3/22/19 at 10:40 A.M., the resident’s physician said the following: -The area on the resident’s left foot was a vascular wound at the previous amputation cite and needed treatment; she did not believe there had been a scab over the area and observed the area to have been open, with drainage and depth for what she thought was a while; -She would expect the facility to follow physician orders; |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0684 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 35) -If a resident presents for admission from a hospital, she would expect the facility to confirm discharge medication orders and not physician office orders as the orders may have changed; -She said the resident’s [MEDICATION NAME] should have been held as ordered due to the resident’s [DIAGNOSES REDACTED]. During interview on 3/22/19 at 3:53 P.M. the director of nursing (DON) said the following: -Nurses should complete skin assessments and document daily; -Nurses should inspect resident’s skin themselves prior to calling a physician for an order; -All licensed nurses are qualified to assess resident’s skin and wounds; -Staff should follow physician orders; -When a resident is admitted to the facility, the admitting nurse should confirm the resident’s current orders from the sending facility; -Nursing staff should be reviewing resident’s medications and ensuring that any monitoring that needs done is ordered; -Residents on [MEDICATION NAME] are at risk for bleeding, especially if they have a history or [DIAGNOSES REDACTED]. | |
F 0686 Level of harm – Actual harm Residents Affected – Few | Provide appropriate pressure ulcer care and prevent new ulcers from developing. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0686 Level of harm – Actual harm Residents Affected – Few | (continued… from page 36) Resident refusal of some aspects of care and treatment; -Conduct structured pressure ulcer/injury risk assessment using a facility-approved tool; -Conduct a comprehensive skin assessment with every risk assessment. Once inspection of the skin is completed document the findings on a facility-approved skin assessment tool. If a new skin alteration is noted, initiate a (pressure or non-pressure) form related to the type of alteration in the skin; -Develop the resident centered care plan and interventions based on the risk factors identified in the assessments, the condition of the skin, the resident’s overall clinical condition, and the resident’s stated wishes and goals. The interventions must be based on current, recognized standards of care. The effects of the interventions must be evaluated. The care plan must be modified as the resident’s condition changes, or if current interventions are deemed inadequate; -The following information should be recorded in the resident’s medical record utilizing facility forms: The type of assessment(s) conducted. The date and time and type of skin care provided, if appropriate. The name and title (or initials) of the individual who conducted the assessment. Any change in the resident’s condition, if identified. The condition of the resident’s skin (i.e., the size, and location of any red or tender areas), if identified. How the resident tolerated the procedure or his/her ability to participate to the procedure. Any problems or complaints made by the resident related to the procedure. If the resident refused the treatment, the reason for refusal and the resident’s response to the explanation of the risks of refusing the procedure, the benefits of accepting and available alternatives. Document family and physician notification of refusal. Observation of anything unusual exhibited by the resident. The signature and title (or initials) of the person recording the data. Initiation of a (pressure or non-pressure) form related to the type of alteration in skin if new skin alterations is noted. Document in medical record addressing physician notification if new skin alteration noted with change of plan of care, if indicated. Documentation in medical record addressing family, guardian, or resident notification if new skin alteration noted with change of plan of care, if indicated; -Notify the supervisor if the resident refuses the procedure; -Report other information in accordance with facility policy and professional standards of practice; -Notify attending physician if new skin alteration noted; -Notify family, guardian, or resident update if new skin alterations noted. 2. Review of the RAI User’s Manual (Long-term Care Facility Resident Assessment Instrument User’s Manual) Chapter 3, Section M, defines the different stages of pressure ulcers (localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction) as follows: -Stage I: an observable, pressure related alteration of intact skin, whose indicators as compared to an adjacent or opposite area on the body may include changes in skin temperature, tissue consistency, sensation, and/or a defined area of persistent redness; -Stage II: Partial thickness loss of dermis (the inner layer that makes up skin) presenting as a shallow open ulcer with a red-pink wound bed, without slough (non-viable yellow, tan, gray, green or brown tissue). (MONTH) also present as an intact or open/ruptured blister; -Stage III: full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle is not exposed. Slough may be present but does not obscure the depth of tissue loss. (MONTH) include undermining (destruction of tissue or ulceration extending under the |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0686 Level of harm – Actual harm Residents Affected – Few | (continued… from page 37) skin edges) or tunneling (a passage way of tissue destruction under the skin surface that has an opening at the skin level from the edge of the wound); -Stage IV: Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar (dead or devitalized tissue that is hard or soft in texture; usually black, brown, or tan in color) may be present on some parts of the wound bed. Often includes undermining and tunneling; -Unstageable pressure ulcers related to suspected deep tissue injury. Purple or maroon area of discolored intact skin due to damage of underlying soft tissue. The area may be preceded by tissue that is painful, firm, mushy, boggy, warmer or cooler as compared to adjacent tissue. 3. Review of the facility policy from the Nursing Services Policy and Procedure Manual for Long-Term Care, Wound Care, revised (MONTH) (YEAR), showed the following: -The purpose of this procedure is to provide guidelines for the care of wounds to promote healing; -Dress wound. Mark tape with initials, time, and date and apply to dressing. -Documentation: The following information should be recorded in the resident’s medical record; -The type of wound care given; -The date and time the wound care was given; -The name and title of the individual performing the wound care; -All assessment data (i.e., wound bed color, size, drainage, ect.) obtained when inspecting the wound; -If the resident refused the treatment and the reason (s) why; -The signature and title of the person recording the data. 4. Record review of Resident #100’s Annual Minimum Data Set (MDS), a federally mandated assessment instrument completed by facility staff, dated 2/18/19, showed the following: -Resident cognitively intact for daily decision making; -Had no rejection of care (e.g., bloodwork, taking medications, ADL assistance); -Required extensive assist of one staff for bed mobility, transfers, dressing, and personal hygiene; -Was dependent on one staff for toileting and bathing; -Had impairment in functional limitation of range of motion on one side of lower extremity; -Used wheelchair as mobility device; -Was always incontinent of bladder and bowel; -Active [DIAGNOSES REDACTED]. -Was at risk for developing pressure ulcers; -Had no unhealed Stage I (intact skin with non-blanchable redness of a localized area usually over a bony prominence) or higher pressure ulcers; -Skin and Ulcer treatments included: pressure reducing device for bed, turning and repositioning program, surgical wound care, application of nonsurgical dressing (with or without topical medications) other than to feet, and applications of ointments/medications other than to feet. Review of the resident’s care plan, dated as last revised on 2/25/19, showed the following: -Problem: The resident is at risk for development of pressure ulcers related to incontinence and the need for assistance with bed mobility and repositioning. On 10/11/18 the resident had a scab located to left lower leg requiring treatment with previous venous ulcer that reopens and heals continuously. On 2/4/19 the resident was readmitted from the |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0686 Level of harm – Actual harm Residents Affected – Few | (continued… from page 38) hospital with a surgical graft right leg requiring treatment and observation. On 2/25/19 the resident has a pressure area to the right distal heel requiring treatment and observation; -Approaches: Float heels when in bed. Position to keep pressure off heel. Heel protectors on when in bed. Educate importance of keeping pressure off heel and encourage compliance when in bed. The resident has a pressure reducing mattress in place. Extensive assist to turn/reposition as need or requested, may attempt to self perform but staff must supervise to assure performance affective. Observe for signs and symptoms of infection when venous ulcers are present and report to physician changes in venous ulcers when occur. Provide incontinence care after each incontinent episode, apply moisture barrier cream as needed. Treatment as ordered to right heel. Observe the right heel for signs and symptoms of infection and report any declines to the resident’s physician. Weekly skin assessments to be obtained and documented per facility policy. Report any new areas of redness or concern. Review of the resident’s physician’s orders dated 2/25/19, showed heel protector and float right heel while in bed every shift. Review of the resident’s Treatment Administration Record (TAR), dated 2/1/19 through 2/28/19, showed the following: -Heel protector and float right heel while in bed every shift; -No documentation/evidence staff completed the treatment as ordered on night shift on 2/26 and on night shift 2/28. Review of the resident’s TAR, dated 3/1/19 through 3/31/19, showed the following: -Heel protector and float right heel while in bed every shift; -No documentation/evidence staff completed the ordered treatment on the evening on 3/1, 3/2, 3/3, 3/10, 3/15, 3/16, 3/17, and 3/21; -No documentation/evidence staff completed the ordered treatment on the night shift on 3/1, 3/2, 3/3, 3/6, 3/7, 3/8, 3/9, 3/10, 3/11, 3/12, 3/13, 3/15, 3/16, 3/17, 3/18, and 3/20. Review of the resident’s Wound Consultant’s weekly wound note, dated 3/12/19, showed the following: -Stage II pressure ulcer to right heel healed; -No documentation of any areas to the right lateral heel. Review of the resident’s skin observation tool, dated 3/14/19, showed skin warm and dry. Turgor fair. Open area noted to right thigh- see wound report for measurements. Review of the resident’s nurse’s notes dated 3/1/19 through 3/14/19 showed no documentation the resident refused to wear heel protector or free float his/her right heel. Observations on 3/18/19, showed the following: -At 9:33 A.M., the resident lay in his/her bed on his/her back with no heel protector on and right foot, the right heel was not free floating; -At 4:08 P.M., the resident lay in his/her bed on his/her back with no heel protector on and right foot/heel was not free floating. Observations on 3/19/19, showed the following: -At 5:40 A.M., the resident in his/her bed on his/her back with no heel protector on and right foot was not free floating; -At 7:40 A.M., the resident in his/her bed on his/her back with no heel protector on and right foot was not free floating; -At 10:40 A.M., the resident in his/her bed on his/her back with no heel protector on and right foot was not free floating. |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0686 Level of harm – Actual harm Residents Affected – Few | (continued… from page 39) Observation and interview on 3/20/19, showed the following: -At 11:50 A.M., the resident lay in his/her bed on his/her back with no heel protector on and right foot was not free floating. The resident’s right foot was kicked outside of the sheet with a blackened area noted to the right lateral heel; -At 12:13 P.M., the Unit Manager Licensed Practical Nurse (LPN) W said that he/she wasn’t sure if the resident had a pressure ulcer, but did not think the resident did. He/she observed the blackened area to the right lateral foot and would not say if he/she thought it was a pressure ulcer. He/she said the wound physician would be at the facility that day and would have him look at the area. He/she did not apply the heel protector or free float the resident’s right heel while in the room; -At 2:20 P.M., the Physician Wound Consultant was in to see the resident. He said he expected orders to be followed and that the area to the right lateral heel was a new area and might have been prevented if the facility applied the heel protectors. He said the area was an unstageable pressure ulcer. He applied the heel protector to the resident’s right foot. Review of the resident’s nurse’s notes 3/14/19 through 3/20/19 showed no documentation the resident refused to wear the heel protector or free float his/her right heel. Review of the resident’s Wound Consultant’s weekly wound note, dated 3/20/19, showed the following: -New right lateral heel unstageable pressure ulcer; -Location: Right lateral heel; -Eschar (black, brown, or tan tissue that adheres firmly to the wound bed or ulcer edges, may be softer or harder than surrounding skin); -Measurement: 2.0 centimeter (cm) by 1.0 cm; -Treatment ordered: Heel protector to right heel. Observation on 3/21/19 at 8:54 P.M., showed the resident in his/her bed on his/her back eating breakfast with no heel protector on and right foot was not free floating. 5. Review of Resident #110’s Admission record showed an original admitted [DATE]. Review of the resident’s Braden Scale for predicting pressure ulcer risk, dated 1/28/19, showed a score of 14 indicating moderate risk for pressure ulcers. Review of the resident’s hospital record, sacrum pressure ulcer, dated 2/22/19 at 2:00 P.M., showed the following: -Consulted for wound to sacrum present on admission. Patient with history of [MEDICAL CONDITION], and is bed bound. He/she has an unstageable wound to his/her sacrum with a moderate amount of serous (clear, thin, watery plasma) brown drainage. Wound presents as a pressure wound. Planning on use of Dakin’s (antiseptic used to cleanse wounds in order to prevent infection), wet to dry dressing to assist with debridement; -Wound bed assessment: Black; Deep purple; Deep pink; Yellow; Brown; -Exudate description: Moderate; Serous; -Length: 6 centimeters (cm); -Width: 10 cm; -Depth: 0.3 cm; -Staging: Unstageable; -Peri-wound skin assessment: [DIAGNOSES REDACTED]/Red; -Dressing/Treatment: Silicone dressing; -Dressing status: Clean, Dry, intact. Review of the resident’s progress note dated 3/1/19 at 6:48 P.M, showed the resident returned from hospital. Wound to the coccyx (tailbone), 11 cm in length (L) x 7.5 cm width (W). Upper portion of the wound bed has 8 cm L x 7.5 cm that is black. The lower portion |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0686 Level of harm – Actual harm Residents Affected – Few | (continued… from page 40) of the wound bed is pink with some yellow. Physician’s office notified of return and orders faxed to pharmacy. Review of the resident’s transfer orders for receiving facility from the hospital, dated 3/1/19, showed current discharge medication list included Santyl, (sterile enzymatic [MEDICATION NAME] ointment that works by helping to break up and remove dead skin and tissue) apply to open area on coccyx every day for wounds. Cleanse wound, apply skin prep to periwound, apply Santyl to necrotic tissue, and cover with a dry dressing. Change daily and as needed (PRN). Review of the resident’s care plan, last revised 3/1/19, showed the following: -Readmitted to the facility on [DATE]; -readmitted with Stage III pressure ulcer (3/1/19 increase from Stage II prior to hospitalization ) to coccyx requiring treatment and observation and has potential for pressure ulcer development related to impaired mobility and incontinence; -Administer treatments as ordered and monitor for effectiveness; -Assess/record/monitor wound healing weekly. Measure length, width and depth where possible. Assess and document status of wound perimeter, wound bed and healing progress. Report improvements and declines to the physician; -Follow facility policies/protocols for the prevention/treatment of [REDACTED].>-Currently using pressure reducing mattress; -Needs full staff assistance to turn/reposition at least every two hours, more often as needed or requested; -Totally dependent on staff to provide bath/shower two times weekly and as necessary; -Totally dependent on staff for personal hygiene. Review of the resident’s Skin Observation Tool, dated 3/1/19, showed the following: -Stage III pressure ulcer to coccyx at 11 cm x 7.5 cm x 0.2 cm; -Notes – coccyx wound 11 cm length x 7.5 cm width, upper portion of the wound bed has 8 cm in length x 7.5 cm width that is black, the lower portion of the wound bed is pink with some yellow. Review of the resident’s Skin Observation Tool, dated 3/8/19, showed skin warm and dry to touch, turgor fair, pressure wound to coccyx. Review of the resident’s treatment administration record (TAR) dated 3/1/19 to 3/31/19 showed the following: -Dakin’s Solution, apply to coccyx wound topically every 12 hours for coccyx wound. Start date 3/1/19 at 9:00 P.M.; -Scheduled for 9:00 A.M. and 9:00 P.M.; -On 3/1/19 at 9:00 P.M., treatment blank; -On 3/2/19 at 9:00 A.M. and 9:00 P.M., treatment blank; -On 3/3/19 at 9:00 P.M., treatment blank; -On 3/6/19 at 9:00 P.M., treatment blank; -On 3/7/19 at 9:00 P.M., treatment blank; -On 3/11/19 at 9:00 A.M. and 9:00 P.M., treatment blank; -On 3/12/19 at 9:00 P.M., treatment blank. Review of the weekly pressure ulcer QI (quality improvement) log, dated 3/13/19, showed the following: -Stage IV; -Coccyx – 5.4 cm x 9.2, medium drainage; -No treatment listed. Review of the resident’s Skin Observation Tool, dated 3/15/19, showed the following: -Stage IV pressure ulcer to coccyx at 5.4 cm x 9.2 cm x 0.3 cm; |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0686 Level of harm – Actual harm Residents Affected – Few | (continued… from page 41) -Notes – skin warm and dry to touch, turgor fair, pressure wound to coccyx 5.4 cm x 9.2 cm. Review of the resident’s 14 day Prospective Payment System (PPS) MDS, dated [DATE], showed the following: -Cognitively intact; -Had no rejection of care; -Required total assistance of two or more staff for bed mobility, transfer and bathing; -Required total assistance of one staff for dressing, eating, toileting and personal hygiene; -One unstageable pressure ulcer. Review of the resident’s TAR dated 3/1/19 to 3/31/19 showed the following: -Dakin’s Solution, apply to coccyx wound topically every 12 hours for coccyx wound. Start date 3/1/19 at 9:00 P.M.; -Scheduled for 9:00 A.M. and 9:00 P.M.; -On 3/15/19 at 9:00 A.M. and 9:00 P.M., treatment blank; -On 3/16/19 at 9:00 P.M., treatment blank; -On 3/17/19 at 9:00 P.M., treatment blank; -On 3/18/19 at 9:00 A.M., treatment blank. Observation and interview on 3/18/19 at 10:00 A.M., showed Registered Nurse (RN)R and Certified Nurse Aide (CNA) MM repositioned the resident in bed. The resident had a dressing on his/her coccyx dated 3/17/19 and timed 11:00 A.M. RN R said he/she didn’t know anything about it, as he/she doesn’t normally work on this hall. CNA MM said the resident had a wound. RN R did not change the dressing. Review of the resident’s physician order sheet (POS) dated 3/18/19 at 3:12 P.M., showed the following: -Discontinue Dakin’s solution; -Santyl Ointment 250 UNIT/gram (GM), apply to coccyx topically every day shift for pressure ulcer. Cleanse open area (OA) to coccyx with normal saline (NS), apply Santyl and [MEDICATION NAME] (antibiotic ointment), to wound bed cover with dry dressing daily and as needed (PRN) until healed; -[MEDICATION NAME] ointment 2%, apply to coccyx topically every day shift for pressure ulcer. Cleanse open area (OA) to coccyx with normal saline (NS), apply Santyl and [MEDICATION NAME] to wound bed, cover with dry dressing daily and as needed (PRN) until healed. Observation and interview on 3/19/19 at 1:52 P.M., showed the following: -RN R and CNA MM transferred the resident to bed with the Hoyer lift; -RN R removed a dressing dated 3/17/19 at 11:00 A.M. from the resident’s coccyx; -The wound measured approximately 10 cm x 6 cm, with the edges pink and beefy red about 1-2 cm around the outside edge and in the center the area was tan edges and a black center; -RN R cleansed the wound with normal saline (NS), applied Santyl and covered with adhesive dressing; -RN R said the [MEDICATION NAME] was not in from the pharmacy yet and that he/she did not get the dressing change done yesterday due to the resident was up in his/her chair. He/she reported it to Licensed Practical Nurse (LPN) NN at shift change that worked from 3:00 P.M. to 7:00 P.M. that he/she did not get the resident’s dressing change completed on the resident’s coccyx. During an interview on 3/19/19 at 3:00 P.M. and 4:15 P.M., LPN NN said he/she did not do a treatment on the resident yesterday (3/18/19). He/she did not have time. He/she was by |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0686 Level of harm – Actual harm Residents Affected – Few | (continued… from page 42) him/herself and the night nurse came in at 7:00 P.M. He/she didn’t have time to go to the resident’s room in the time span of 3:00 P.M. to 7:00 P.M. The order didn’t pop up on the TAR since he/she worked a different shift than the order was due. During an interview on 3/19/19 at 3:50 P.M., the unit manager LPN W said he/she keeps the wound measurement sheets. The unit manager measure wounds weekly on Mondays but it has not been done this week due to he/she was working the floor yesterday (Monday 3/18/19). The staff nurse should measure wounds with dressing changes. During an interview on 3/20/19 at 11:48 A.M., the resident’s physician said orders should be followed and if missed there should be documentation as to why the treatment was missed. He would check as to why the Santyl was not used as ordered when the resident returned from the hospital. Review of the Mobile Limb Preservation record, from the physician wound consultant, dated 3/20/19 at 1:52 P.M., showed the following: -Coccyx wound; -Pre debridement: 6.0 cm x 9.0 cm x 0.8 cm; -Post debridement: 6.0 cm x 9.0 cm x 0.9 cm; -[MEDICATION NAME] (an insoluble protein formed from [MEDICATION NAME] during the clotting of blood. It forms a fibrous mesh that impedes the flow of blood): yes, 50 %; -Granulation tissue (new vascular tissue in granular form on an ulcer or the healing surface of a wound): 50 % pink; -No odor; -No eschar; -Drainage amount: moderate; -Drainage color: serous; -Periwound appearance: intact; -Debridement: yes; -Debridement level: skin and subcutaneous tissue; -Bleeding: minimal; -Treatment ordered: Apply Santyl, Silver Alginate, 4 x 4’s, Abdominal Pad (ABD) Dressing, used for large wounds or for wounds requiring high absorbency), tape – change daily. Turn schedule, off – loading coccyx. Low air loss mattress and Roho (pressure relief) cushion. During an interview on 3/20/19 at 1:50 P.M. and 2:10 P.M., the physician wound consultant said it was the first time he/she had seen the resident and his/her wound. He/she makes rounds at the facility every two weeks. Orders should be followed as written by physician. Not changing a dressing could cause bacteria to grow. During an interview on 3/20/19 at 2:22 P.M., RN OO said he/she was the admitting nurse on 3/1/19 and he/she could not explain or find an order as to why the Santyl was discontinued and the Dakin’s treatment was started on the resident’s wound. The Santyl order was missed on the hospital discharge instructions. He/she thought the hospital nurse said they were using Dakin on the resident’s wound. 6. During interview on 3/22/19 at 3:53 P.M., the DON said the following: -Staff should report any pressure ulcer as soon as possible; -Skin assessments should be done daily; -Nurses should do the skin assessment and document; -CNAs can check the skin and report any changes to the nurse; -Nurses should inspect skin prior to calling for an order; -Dressings should be completed as ordered; -All licensed nurses are qualified to do a dressing change and assess; -Staff should document on the TAR when a dressing change is completed; |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0686 Level of harm – Actual harm Residents Affected – Few | (continued… from page 43) -She could not give a reason why there was missing documentation in the TAR; -Staff should follow physician orders; -Blanks in the MARS and TARS should be documented as refused or missed; -She expects all skin issues to be referred to the physician wound consultant; -A dressing done 48 hours after ordered could cause infection; -A dressing ordered at 9:00 A.M., should be done at 9:00 A.M.; -She would expect the next shift staff to get a dressing change completed if not completed as ordered on the prior shift. | |
F 0688 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0688 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 44) – Ambulation: one loop of square, approximately 575 feet with front wheeled walker and care giver assist; -Signed by the therapist 1/16/19. Review of the resident’s updated care plan, dated 1/31/19 showed the following: -The resident required minimal assistance due to fluctuating weakness; -Encourage and remind the resident to use walker when ambulating; -Observe for good endurance and steady gait; -Nursing rehab/restorative: Active Range of Motion (AROM) to bilateral upper extremities using two pound (lb) weight in all planes for 20 reps times two sets, except for right shoulder against gravity only as tolerated by the resident; initiated 6/27/18; -Nursing rehab/restorative: walking program: one loop around 500 hall/600 hall square equals 575 feet using front wheeled walker and care giver assist; initiated 1/07/19. Review of the resident’s (MONTH) 2019 POS showed the following: -[DIAGNOSES REDACTED]. -Restorative Therapy Program one time a day (two to five times a week) until goals are met. Record review of the resident’s Minimum Data Set (MDS), a federally mandated assessment instrument, completed by facility staff, dated 3/15/19, showed the following: -Brief interview for mental status (BIMS) of 15 indicating no cognitive impairment (BIMS scores range from 0-15, the higher the score, the lower the impairment to the cognitive response); -Limited assistance of one staff for bed mobility, transfer and walking in room; -Walking in corridor, activity did not occur, activity of daily living (ADL) activity itself did not occur; -Locomotion on/off unit required supervision with set up help only; -Extensive assistance of one staff for toilet use; -Not steady, only able to stabilize with staff assistance for walking, moving on/off the toilet and transferring between bed and chair and wheelchair; -Used wheelchair and walker for mobility device. Review of the resident’s Restorative Care Flow Record, dated (MONTH) 2019, showed the following: -Restorative therapy completed one time (3/7/19) for the week of 3/4/19 through 3/10/19; -Restorative therapy completed one time (3/15/19) for the week of 3/11/19 through 3/17/19; -The facility failed to complete restorative as ordered. During interview on 3/21/19 at 4:00 P.M. the resident said very rarely did any therapy work with him/her or did they walk him/her in the hallway. 4. Review of Resident #53’s (MONTH) 2019 POS showed the following: -[DIAGNOSES REDACTED]. -Restorative Therapy Program one time a day (two to five times a week) until goals are met. Review of the resident’s Restorative Therapy Program orders, dated 2/12/19, showed the following: -Frequency: two to five times a week; -Precautions: fall risk; -General Exercise: wheelchair push-ups, five reps times three sets; two lb weight, bilateral upper extremities times one set to all planes; -Ambulation assistance: ambulate 100 feet with front wheeled walker and stand by assist to gym and climb up and down stairs times two; -Signed by the therapist 2/16/19. |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0688 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 45) Review of the resident’s updated care plan, dated 2/27/19 showed the following: -Required extensive assistance with toileting due to transfers, maneuvering clothing and hygiene or incontinence; -Gait currently unsteady, therefore frequent reminders that assist is required for safety to be provided; -Limited assistance with bed/chair repositioning, grooming and locomotion on/off the unit; -Observe for gait unsteadiness when staff assisting with ambulation; -Remind resident not to stand without assistance; -Restorative therapy is ordered until goals are met; -Nursing rehab/restorative: AROM to bilateral upper extremity exercises in all planes for 20 reps times one set using two lb weight and wheelchair push-ups times five reps times three sets or as tolerated; initiated 2/13/19; -Nursing rehab/restorative: walking program: ambulate 100 feet with front wheeled walker and standby assist followed by up and down stairs times two as tolerated; initiated 2/13/19. Review of the resident’s (MONTH) 2019 POS showed the following: -[DIAGNOSES REDACTED]. -Restorative Therapy Program one time a day (two to five times a week) until goals are met. Record review of the resident’s MDS, dated [DATE], showed the following: -Limited assistance of one staff for transfers; -Requires extensive assistance and assist of one staff for walking in room and corridor; -Locomotion on unit required supervision with set up help only; -Locomotion off unit required limited assistance with assist of one staff; -Extensive assistance of one staff for toilet use; -Not steady, only able to stabilize with staff assistance for walking, -Used wheelchair and walker for mobility device. Review of the resident’s Restorative Care Flow Record, dated (MONTH) 2019, showed the following: -Restorative therapy completed one time (3/14/19) for the week of 3/9/19 through 3/15/19; -Restorative therapy completed only one time (3/18/19) for the week of 3/16/19 through 3/22/19; -The facility failed to complete restorative as ordered. During interview on 3/20/19 at 2:20 P.M. the resident’s spouse said he/she did not think therapy was working with him/her as much as they should be. 5. Review of Resident #71’s (MONTH) 2019 POS showed the following: -[DIAGNOSES REDACTED]. -Restorative Therapy Program one time a day (two to five times a week) until goals are met. Review of the resident’s Restorative Therapy Program orders, dated 1/16/19, showed the following: -Diagnoses: [REDACTED]. -Frequency: one time day/two to five times a week; -Passive Range of Motion (PROM): Bilateral lower extremities and trunk to reduce joint stiffness; -Signed by the therapist 1/16/19. Review of the resident’s updated care plan, dated 1/24/19 showed the following: -Nursing rehab/restorative: AROM to bilateral upper extremities in all planes as tolerated; initiated 10/22/18; |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0688 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 46) -Nursing rehab/restorative: walking program: sit to stand with prolonged standing at bar or in parallel bars to tolerance; initiated 6/27/18. Record review of the resident’s MDS, dated [DATE], showed the following: -BIMS of 6; -Extensive assistance of one staff for bed mobility, dressing, personal hygiene, eating and drinking; -Total dependence of two staff for transfers, and toileting; -Extensive assistance of one staff for locomotion on and off the unit; -Used wheelchair for mobility device. Review of the resident’s (MONTH) 2019 POS showed the following: -[DIAGNOSES REDACTED]. -Restorative Therapy Program one time a day (two to five times a week) until goals are met. Review of the resident’s Restorative Care Flow Record, dated (MONTH) 2019, showed the following: -Restorative therapy completed one time (2/4/19) for the week of 2/4/19 through 2/10/19; -Restorative therapy completed one time (2/11/19) for the week of 2/11/19 through 2/17/19; -Restorative therapy completed one time (2/18/19) for the week of 2/18/19 through 2/24/19; -The facility failed to complete restorative as ordered. 6. Record review of Resident #101’s quarterly MDS, dated [DATE], showed the following: -Cognitively intact for daily decision making; -No rejection of care (e.g., bloodwork, taking medications, ADL assistance); -Total dependence of two staff for bed mobility, transfers, and toileting; -Total dependence of one staff for locomotion on and off the unit, dressing, and bathing; -Extensive assist of one staff for personal hygiene; -Independent with set-up help for eating; -Had limitation in Range of Motion on both sides of lower extremity; -Used wheelchair for mobility; -Always incontinent of bladder; -Frequently incontinent of bowel; -Received [MEDICAL TREATMENT] while a resident; -No restorative nursing program in the previous seven days. Review of the resident’s Physician’s orders dated 1/24/19, showed may begin Restorative Therapy Program two to five times a week until progress ceases or goals are met. Review of the resident’s Restorative Therapy Program orders, dated 1/24/19, showed the following: -Frequency: two to five times a week; -Precautions: Left shoulder pain with limited flexion (action of bending or the condition of being bent)/abduction (the movement of a limb or other part away from the midline of the body, or from another part); -General Exercise: Bilateral upper extremity exercises using 1 pound weight times 20 reps for all planes; -Signed by the therapist 1/24/19. Review of the resident’s Restorative Care Flow Record, dated (MONTH) 2019, showed the following: -No record restorative therapy completed for the week of 2/4/19 through 2/10/19; -The facility failed to complete restorative as ordered. Record review of the resident’s quarterly MDS, dated [DATE], showed the following: -Cognitively intact for daily decision making; |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0688 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 47) -No rejection of care (e.g., bloodwork, taking medications, ADL assistance); -Total dependence of two staff for transfers, and toileting; -Total dependence of one staff for locomotion on and off the unit, dressing, and bathing; -Extensive assist of two staff for bed mobility; -Extensive assist of one staff for personal hygiene; -Independent with set-up help for eating; -Had limitation in Range of Motion on both sides of lower extremity; -Used wheelchair for mobility; -Always incontinent of bladder and bowel; -Received [MEDICAL TREATMENT] while a resident; -No restorative nursing program in the previous seven days. Review of the resident’s Restorative Care Flow Record, dated (MONTH) 2019, showed the following: -Restorative therapy completed one time during the week of 3/4/19 through 3/10/19; -Restorative therapy completed one time during the week of 3/11/19 through 3/17/19; -The facility failed to complete restorative as ordered. Observation and interview on 3/18/19 at 9:15 A.M., showed the following: -The resident in his/her wheelchair with his/her left arm pulled up close to him/her; -The resident said he/she had pain and limited range of motion in his/her left arm; -The resident said he/she was to be getting restorative therapy, but there would be days that the restorative aide would get pulled to work the floor. During an interview on 3/19/19 at 4:05 P.M., Restorative Aide (RA) V, said the following: -Resident #101 was on restorative therapy for his/her left arm; -He/she gets pulled from restorative therapy to work the floor. During an interview on 3/22/19 at 3:53 P.M., the Director of Nurses (DON) said the following: -Restorative should be done as ordered to prevent decline or improve the resident’s range of motion; -She would expect staff to document if a resident refuses restorative. | |
F 0689 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0689 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 48) smoking materials are allowed in resident rooms. This means no lighters, no cigarettes, no e-cigarettes, no chewing tobacco etc.; -Smoking by residents is only allowed during the posted smoking time while on company property. No exceptions allowed. 2. Review of the facility’s policy safe lifting and movement of the resident, revised 7/2017, showed the following: -In order to protect the safety and well-being of staff and residents, and to promote quality care, the facility uses appropriate techniques and devices to lift and move the the residents; -Manual lifting of residents shall be eliminated when feasible. 3. Review of the Nurse Assistant in a Long-Term Care Facility, Student Reference Manual, 2001 revision, showed the following: -For a resident who is weak, you must have control of the resident’s shoulders and hips during the transfer; -Do not attempt to transfer a resident who cannot bear any of his/her own body weight by yourself. Determine beforehand how many people are needed for the transfer. If it takes more than two persons to transfer the resident, use a mechanical lift. 4. Review of Resident #71’s care plan, last revised 2/8/19, showed the following: -Required assistance with activities of daily living (ADLs); -Dependent on staff for incontinent cares, dressing and bathing; -Required extensive assistance of one or two staff for personal grooming; -Required gait belt and two staff assistance for transfers; -Incontinent of bowel and bladder. Review of the resident’s quarterly Minimum Data Set (MDS), a federally mandated assessment instrument completed by facility staff, dated 2/13/19, showed the following: -Severe cognitive impairment; -Extensive assistance of two staff for personal hygiene and bed mobility; -Dependent on two or more staff for transfers; -Always incontinent of bowel and bladder. Observation on 3/19/19 at 6:45 A.M. showed the following: -Certified Nurse Assistant (CNA) J and CNA RR assisted the resident to sit on the side of the bed; -CNA RR placed a gait belt on the resident, stood on the resident’s right side, and grasped the gait belt at the resident’s waist; -CNA J stood on the resident’s left side and grasped the gait belt; -The CNAs lifted the resident from the side of the bed; -The resident’s feet dragged on the floor as the CNAs moved the resident to his/her wheelchair. The resident did not assist in lifting his/her feet or pivoting during the transfer; -CNA J and CNA RR cradled the resident and lifted the resident up and back into his/her wheelchair. During an interview on 3/19/19 at 10:35 A.M. CNA J said the following: -The resident did not bear weight during the transfer; -Sometimes the resident would bear weight and sometimes he/she did not; -He/she did not report the resident not bearing weight to anyone, it’s just part of the job; -The resident could not help with repositioning and that is why staff had to pick the resident up and position him/her in the wheel chair. During an interview on 3/19/19 at 10:40 A.M., CNA RR said the following; |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0689 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 49) -The resident did not bear weight during the transfer; -At times the resident would bear weight; -The resident required two person assist and a gait belt for all transfers. During an interview on 3/19/19 at 3:10 P.M., CNA/restorative aide (RA) V said the following: -The resident required two staff and the use of a sit-to-stand mechanical lift a couple of weeks ago when the resident wasn’t standing; -Some staff said the resident wasn’t standing and staff was having issues with transfers. During interview on 3/22/19 at 3:53 P.M., the director of nursing (DON) said the following: -He/she expected a resident to bear weight with a gait belt transfer; -He/she did not expect staff to cradle or pick up a resident; -There is risk for injury if staff pick up a resident, lift a resident, or if a resident does not bear weight with transfers. 5. Review of Resident #463’s face sheet showed the following: -admitted to the facility on [DATE]; -[DIAGNOSES REDACTED]. Review of the resident’s facility admit/readmit screener, dated 3/18/19 at 2:30 P.M., showed the resident was a current smoker. During interview on 3/18/19 at 4:36 P.M., the resident said he/she had his/her cigarettes and lighter in his/her pocket. He/she keeps his/her cigarettes and lighter in his/her pocket. Staff does not know he/she was smoking. Observation on 3/18/19 at 4:36 P.M. showed the following: -The resident entered a code at the keypad locked exit door off of the facility kitchen to open the door which lead to an entryway toward another locked door; -The resident entered a code at a second keypad locked exit door, beside the maintenance storage closet, leading outside to a parking lot to open the door; -The resident removed a pack of cigarettes and lighter from his/her pocket, lit the cigarette and smoked. The resident smoked two cigarettes. During interview on 3/19/19 at 8:24 A.M., the resident said he/she had his/her cigarettes and lighter in his/her pocket. Staff did not know he/she was smoking; Observation on 3/19/19 at 8:24 A.M., showed the following: -The resident entered a code at the keypad locked exit door off of the facility kitchen to open the door which lead to an entryway toward another locked door; -The resident entered a code at a second keypad locked exit door, beside the maintenance storage closet, leading outside to a parking lot to open the door; -The resident removed a pack of cigarettes and lighter from his/her pocket, lit the cigarette and smoked; the resident smoked a total of two cigarettes. During interview on 3/19/19 at 3:30 P.M., the resident said he/she was headed out to smoke and staff still did not know he/she was smoking. Observation on 3/19/19 at 8:24 A.M. showed the following: -The resident entered a code at the keypad locked exit door off of the facility kitchen to open the door which lead to an entryway toward another locked door; -The resident entered a code at a second keypad locked exit door, beside the maintenance storage closet, leading outside to a parking lot to open the door; -The resident removed a pack of cigarettes and lighter from his/her pocket, lit the cigarette and smoked. Record review of the resident’s Safe Smoking Assessment Form, dated 3/19/19, showed the |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0689 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 50) following: -The resident was safe to smoke unsupervised; -All smoking materials will be kept at the nurses’ station; -The resident was notified of restrictions. During interview on 3/20/19 at 1:18 P.M., the resident said he/she was headed out to smoke. He/She still had his/her cigarettes and lighter; he/she had not been told to turn them in. Observation on 3/20/19 at 1:18 P.M., showed the following: -The resident entered a code at the keypad locked exit door off of the facility kitchen to open the door which lead to an entryway toward another locked door; -The resident entered a code at a second keypad locked exit door, beside the maintenance storage closet, leading outside to a parking lot to open the door; -The resident removed a pack of cigarettes and lighter from his/her pocket, light the cigarette and smoked. During interview on 3/22/19 at 8:10 A.M., Licensed Practical Nurse (LPN) I said the following: -He/she was the resident’s facility admitting nurse; -He/she did not ask the resident if he/she was a smoker on admission or complete a smoking assessment at that time because the facility was a smoke free facility at that time; -He/she knew from the resident’s previous stay that he/she was a smoker and had refused to stop smoking; -In the afternoon on 3/18/19, after the resident was admitted , he/she learned the facility was a smoking facility; he/she did not complete a smoking assessment at that time. During interview on 3/22/19 at 3:53 P.M., the director of nursing (DON) said the following: -A smoking assessment should be completed upon admission; -Cigarettes and lighters should be kept with the nurse. | |
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: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0690 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 51) -Maintain a sterile, closed, gravity-drainage system and avoid breaking the system; -Secure catheters to the upper thigh or lower abdomen to avoid bladder and urethral trauma; -Keep the collection bag below the level of the bladder at all times. Do not rest the bag on the floor; -Use clean techniques in emptying and changing the drainage system. Wash hands before and after cleaning the resident’s catheter; -Clean the catheter daily in the evening with soapy water. Avoid frequent and vigorous cleaning of the catheter entry site; -Consider the resident’s privacy and cover or conceal the catheter drainage bag when the resident is in the common facility areas such as the dining room. 2. Review of the facility Perineal Care Policy, dated as revised (MONTH) 2010, showed the following: -Purpose: The purpose of this procedure are to provide cleanliness and comfort to the resident, to prevent infections and skin irritation, and to observe the resident’s skin condition; -Wash and dry hands thoroughly; -Put on gloves; -Wash the perineal area, wiping from front to back; -Remove gloves and discard into designated container. Wash and dry hands thoroughly. 3. Review of the Nurse Assistant in a Long Term Care Facility, 2001, revision, showed the following: -The bladder is considered sterile, the catheter, drainage tubing and bag are a sterile system; -Drainage tubing/bags must not touch the floor; -Prevent tubing from hanging below the level of the drainage bag. 4. Review of Resident #29’s face sheet showed the following: -He/she was admitted to the facility on [DATE]; -His/her [DIAGNOSES REDACTED]. Review of the resident’s Admission Minimum Data Set (MDS), a federally mandated assessment instrument required to be completed by facility staff, dated 1/7/19, showed the following: -Cognitively intact for daily decision making; -Had no rejection of care (e.g., bloodwork, taking medications, ADL assistance); -Required extensive assistance of one staff for personal hygiene; -Dependent on one staff for toileting; -Always incontinent of bladder; -Frequently incontinent of bowel; -Active [DIAGNOSES REDACTED]. Review of the resident’s care plan, dated 1/13/19, showed the following: -Problem: The resident required extensive to full staff assistance with ADL’s; -Interventions: The resident is to be toileted every two to three hours per urologist and family request to prompt voiding to assist with reducing reoccurring UTI. When toileted brief is moist therefore incontinent cares required. Preferred toileting times may be prior to dressing in the morning, mid morning, mid afternoon, and when preparing for the night. Do not wait until the resident notifies you of the urge to void. Toilet routinely per urologist. The resident is totally dependent on staff for toilet use or incontinent care; -Problem: The resident has a UTI requiring antibiotic with history of reoccurring infections prior to admission. At risk for repeat infection and/or complications from |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0690 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 52) infection; -Interventions: Check and change on routine rounds and provide cares for incontinence, including washing, rinsing, and drying soiled areas. Encourage adequate fluids. Give antibiotics as ordered and monitor/document for side effects and effectiveness. Monitor and report to physician as needed signs and symptoms of UTI: Frequency, urgency, malaise (general sense of being unwell), foul smelling urine, dysuria (difficulty voiding), fever, nausea, vomiting, flank pain, suprapubic pain (lower abdomen near where hips and many important organs are located), hematuria (blood in urine), cloudy urine, altered mental status, loss of appetite, and behavioral changes. Monitor vital signs as needed and notify physician of significant abnormalities. The resident, his/her family, and caregiver teaching should include: Good hygiene practices- wiping front to back, cleansing the peri area well after bowel movement in order to help prevent bacteria in the urinary tract. Offer cranberry juice or prune juice to help keep urine acidic. Void at first urge. Do not hold urine for extended amount of time. Wear clean underwear daily. Take the full course of antibiotic therapy even if much improved after a few days of therapy. The resident is to be toileted every two to three hours per urologist and family request to prompt voiding to assist with reducing reoccurring UTI. When toileted brief is moist therefore incontinent cares required. Preferred toileting times may be prior to dressing in the morning, mid morning, mid afternoon, and when preparing for the night. Do not wait until the resident notifies you of the urge to void. Toilet routinely per urologist. Observe for signs and symptoms of dehydration possible caused by infection. Obtain and monitor lab/diagnostic work as ordered and report results to physician and follow up as indicated. When toileting the resident in the main shower rooms, close the door and provide privacy during use of the toilet. Review of the resident’s nurse’s note dated 2/25/2019 at 10:21 A.M., showed the following: The resident was lethargic this a.m., and had difficulty eating breakfast. Trouble keeping eyes open and answering direct questions which is not baseline for this resident. VS: temperature was 99.0 temporal (normal= 97 to 99), blood pressure was 118/70 (normal= 120/80-140/90), pulse was 74 (normal= 60-100), and respirations was 18 (normal= 12 to 20). Lungs clear. Answered with some difficulty that he/she has pain in his/her pelvic area. Family member also expressed concern regarding the resident’s altered mental status. Physician notified, new order to send the resident to the emergency room (ER) for evaluation. Call placed for an ambulance and they arrived a brief time later and transferred the resident to the ER. Review of the resident’s Admission Summary Note dated 3/4/2019 at 6:46 P.M., showed the resident was readmitted to facility from the hospital with an admission [DIAGNOSES REDACTED]. During an interview on 3/17/19 at 3:05 P.M., the resident’s family member said the following: -The resident was to be toileted every two to three hours per the resident’s urologist orders; -On many occasions the resident did not get toileted every two to three hours and just had returned to the facility from the hospital with another UTI; -He/she was at the facility daily from about 8:30 A.M. until 5 or 6:00 P.M., everyday and had witnessed many days where the resident went five or six hours before getting toileted. Observation on 3/18/19 at 9:53 A.M., showed the following: -Certified Nurse Assistant (CNA) X transferred the resident from his/her wheelchair to the toilet; -The resident had been incontinent of bowel and bladder; |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0690 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 53) -CNA X applied gloves without washing his/her hands; -CNA X wiped the resident’s buttocks with disposable wipes until clean, then without changing gloves or washing his/her hands, CNA X applied barrier ointment to the resident’s buttocks; -CNA X assisted the resident to stand using the grab bar and with the same soiled gloved hands pull up the resident’s clean brief; -CNA X then removed his/her gloves and used alcohol based hand sanitizer; -CNA X did not provide peri care to the resident’s front perineum (area between anus and scrotum on males and area between anus and vulva on females). During an interview on 3/18/19 at 10:06 A.M., CNA X said the following: -He/she did not realize that he/she needed to change gloves and wash hands after cleaning the resident’s bowel movement and before applying protective barrier; -He/she did not clean the perineum because the resident could not stand for very long and tried to reach as best he/she could when the resident was sitting on the toilet. Observation and interview on 3/18/19 at 4:07 P.M., showed the following: -The resident sat in his/her wheelchair in his/her room; -The resident said that he/she had not been toileted since after breakfast. 5. Review of Resident #27’s Annual MDS, dated [DATE], showed the following: -Cognitively intact for daily decision making; -Required limited assistance of one staff for transfer and toileting; -Had an indwelling urinary catheter. Review of the resident’s care plan, dated as reviewed 1/6/19, showed the following: -Problem: The resident has an indwelling urinary catheter and requires assist times one for elimination care needs and is at risk for skin breakdown; -Interventions: Provide catheter care each shift and as needed. Report to charge nurse signs and symptoms of UTI- confusion, urgency, frequency, bladder spasms, nocturia (urinating frequently at night), burning pain, difficulty urinating, low back pain, malaise (general sense of being unwell), nausea/vomiting, chills, fever, foul odor, concentrated urine, blood in the urine. Store urinary drainage bag inside a protective dignity pouch. Review of the resident’s physician’s orders [REDACTED]. Review of the resident’s Treatment Administration Record (TAR) dated 1/1/19 through 1/31/19, showed the following: -Urinary catheter care every shift (Day, Eve, Night); -No documentation/evidence staff completed catheter care on 1/1, 1/8, 1/10, 1/12, 1/14, 1/25, and 1/27 day shift; -No documentation/evidence staff completed catheter care on 1/8, 1/9, 1/10, 1/11, 1/12, 1/17, 1/18, 1/20, 1/24, 1/25, 1/26, and 1/27 evening shift; -No documentation/evidence staff completed catheter care on 1/11, 1/13, 1/18, 1/19, 1/20, 1/21, 1/22, 1/23, 1/24, 1/25, 1/26, and 1/27 night shift. Review of the resident’s physician’s orders [REDACTED]. Review of the resident’s TAR, dated 2/1/19 through 2/28/19, showed the following: -Urinary catheter care every shift (Day, Eve, Night); -No documentation/evidence staff completed catheter care on 2/18, 2/22, and 2/23 day shift; -No documentation/evidence staff completed catheter care on 2/1, 2/2, 2/3, 2/8, 2/9, 2/10, 2/16, 2/17, 2/22, 2/23, and 2/24 evening shift; -No documentation/evidence staff completed catheter care on 2/1, 2/3, 2/15, 2/16, 2/17, 2/19, 2/21, 2/22, 2/23, 2/24, 2/26, and 2/28 night shift. |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0690 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 54) Review of the resident’s physician’s orders [REDACTED]. Review of the resident’s TAR, dated 3/1/19 through 3/20/19, showed the following: -Urinary catheter care every shift (Day, Eve, Night); -No documentation/evidence staff completed catheter care on 3/1, 3/2, 3/3, 3/10, 3/15, 3/16, and 3/17 on evening shift; -No documentation/evidence staff completed catheter care on 3/1, 3/2, 3/3, 3/6, 3/7, 3/8, 3/9, 3/10, 3/11, 3/12, 3/13, 3/15, 3/16, and 3/17 on night shift. Observation and interview on 3/17/19 at 4:20 P.M., showed the following: -The resident sat on the edge of his/her bed to the left side of his/her bed, his/her urinary catheter drainage bag was attached to wheelchair underneath to the right of the resident and was half on the floor and half hanging from the wheelchair; -The resident said his/her catheter was to be changed monthly and some months it did not occur and he/she would have to remind the staff. Observation on 3/18/19 at 10:10 A.M., showed the resident sat on the edge of his/her bed to the left side of his/her bed, his/her urinary catheter drainage bag was attached to wheelchair underneath to the right of the resident and was half on the floor and half hanging from the wheelchair. 6. Review of Resident #97’s quarterly MDS, dated [DATE], showed the following: -Cognitively intact for daily decision making; -Had no rejection of care; -Required limited assistance of one staff for toileting and personal hygiene; -Had an indwelling urinary catheter. Review of the resident’s care plan dated as reviewed 12/4/18, showed the following: -Problem: The resident has a history of [MEDICAL CONDITION] and has a suprapubic catheter and is at risk for complications or infection; -Interventions: Assess the resident for pain or discomfort at catheter site/abdomen. Assist him/her in emptying the catheter leg bag and in changing the leg bag to 24 hour bag at night. Assure catheter cares performed daily either by the resident or with staff assistance. Change catheter as ordered. Observe output after every catheter change. Encourage the resident to keep drainage bag below bladder level when in bed, during transfer or during ambulation if using leg bag. Limited assistance with urine elimination due to the need for staff assist at times emptying bag or catheter care daily. Monitor and report any signs/symptoms of infection: redness, irritation or leakage from suprapubic insertion site. Observe for sedimentation, blood in the urine, odor, and/or color of urinary output which could signify possible infections. Review of the resident’s physician’s orders [REDACTED].>Review of the resident’s TAR, dated 1/1/19 through 1/31/19, showed the following: -Urinary catheter care every shift (Day, Eve, Night); -No documentation/evidence staff completed catheter care on 1/1, 1/3, 1/4, 1/6, 1/7, 1/9, 1/12, 1/21, 1/25, and 1/28 day shift; -No documentation/evidence staff completed catheter care on 1/6, 1/9, 1/11, 1/12, 1/17, 1/18, 1/20, 1/21, 1/25, 1/26, and 1/27 evening shift; -No documentation/evidence staff completed catheter care on 1/11, 1/13, 1/18, 1/19, 1/20, 1/21, 1/22, 1/23, 1/24, 1/25, 1/26, and 1/27 night shift. Review of the resident’s physician’s orders [REDACTED].>Review of the resident’s TAR, dated 2/1/19 through 2/28/19, showed the following: -Urinary catheter care every shift (Day, Eve, Night); -No documentation/evidence staff completed catheter care on 2/2, 2/3, 2/16, 2/17 and 2/24 day shift ; |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0690 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 55) -No documentation/evidence staff completed catheter care on 2/1, 2/2, 2/3,2/8, 2/9, 2/10, 2/16, 2/17, 2/22, 2/23 and 2/24 evening shift; -No documentation/evidence staff completed catheter care on 2/1, 2/3, 2/15, 2/16, 2/17, 2/19, 2/21, 2/22, 2/23, 2/24 and 2/26 night shift. Review of the resident’s physician’s orders [REDACTED].>Review of the resident’s TAR, dated 3/1/19 through 3/20/19, showed the following: -Urinary catheter care every shift (Day, Eve, Night); -No documentation/evidence staff completed catheter care on 3/15 day shift; -No documentation/evidence staff completed catheter care on 3/1, 3/2, 3/3, 3/10, and 3/15 evening shift; -No documentation/evidence staff completed catheter care on 3/1, 3/2, 3/3, 3/6, 3/7, 3/8, 3/9, 3/10, 3/11, 3/12, 3/13, 3/15, 3/16, and 3/17 night shift. Observation and interview on 3/17/19 at 2:00 P.M., showed the following: -The resident sat on the edge of his/her bed; -His/her drainage bag was to the left of the resident hanging half off the bed frame and half on the floor with urine in the bag and the drainage tube laying on the floor; -The resident said he/she currently wore a leg bag. Staff was to empty the catheter bag and put it up during the day and staff failed to do that on most days. 7. During an interview on 3/19/19 at 10:40 A.M., Certified Nurse Assistant (CNA) K said the following: -Catheter care was to be done shiftly; -Drainage bags and tubing should not be on the floor; -Catheters should be emptied at the end of the shift. During an interview on 3/19/19 at 10:35 A.M., Licensed Practical Nurse (LPN) I said the following: -Catheter care should be done shiftly; -If catheter care was not done, it should be documented in the notes as to why it was not completed; -Drainage bags and tubing should not be on the floor because could this could lead to an infection. During an interview on 3/22/19 at 3:53 P.M., the Director of Nurses (DON) said the following: -She expected staff to provide peri care as taught in the CNA manual, front to back and from clean to dirty; -Nurses should clean catheters every shift; -Catheter drainage bags, and catheter tubing should not be on the floor; -Catheter care should be documented on the TAR/MAR or in the progress note. | |
F 0692 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | Provide enough food/fluids to maintain a resident’s health. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0692 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 56) Hydration (undated) showed the following: -It is the policy of the facility to ensure that the residents receive sufficient fluid to maintain proper hydration and health; -Staff will offer comfort measures, such as frequent mouth care and/or other interventions that are acceptable to the resident; -Interventions will be developed and placed in the care plan to treat and/or prevent the occurrence of dehydration; -Each resident’s hydration needs will be met by the interdisciplinary care team; -Staff will be educated on the signs and symptoms of dehydration; -Offering fluids to residents is the responsibility of all staff who are qualified to assist with fluid intake; -Fluids will be offered when staff is interacting with residents throughout each shift. 2. Review of Resident #71’s care plan, dated (MONTH) (YEAR), showed the following: -Requires mechanically altered diet; -Has difficulty holding a cup; -Is at risk for poor nutritional intake and aspiration; -May need assistance with eating and drinking; -Resident is not able to feed him/herself, therefore staff assistance is required; -Encourage fluids between meals. Review of the resident’s quarterly Minimum Data Set (MDS), a federally mandated assessment instrument completed by facility staff, dated 2/19/19 showed the following: -Brief interview for mental status (BIMS) of six indicating cognitive impairment (BIMS scores range from 0-15, the higher the score, the lower the impairment to the cognitive response); -Resident required extensive assistance with eating and drinking. Review of the resident’s physician orders (POS) dated (MONTH) 2019, showed the following: -[DIAGNOSES REDACTED]. -A physician ordered diet of mechanical soft texture, regular consistency; -Med pass (nutritional supplement) with meals. Observation on 3/17/19 at 2:15 P.M., in the resident’s room showed the following: -The resident lay awake in bed; -The resident had no water pitcher or cup in his/her room; -There were no fluids available for the resident in his/her room. Observation and interview on 3/17/19 at 4:15 P.M. in the resident’s room, showed the following: -The resident lay in bed on his/her left side; -There were no fluids available in the resident’s room; -When asked if staff offered fluids, the resident said no; -When asked if he/she was thirsty the resident said yes. Observation on 3/18/19 at 10:00 A.M. in the resident’s room showed the following: -The resident lay in bed with his/her eyes closed; -His/her lips had dry patches with white matter at the corner of his/her mouth; -No fluid container in the resident’s room. Observation on 3/18/19 at 10:30 A.M., showed the following: -Certified Nursing Assistant (CNA) G and Licensed Practical Nurse (LPN) H at the resident’s bedside providing incontinence care and wound care; -CNA G and LPN H did not offer the resident a drink during or after providing care; -No fluid container in the resident’s room. Observation on 3/19/19 at 5:15 A.M. in the resident’s room showed the following: |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0692 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 57) -The resident lay in bed on his/her left side with his/her eyes open; -No fluid container in the resident’s room. Observation on 3/19/19 at 7:05 A.M., showed the following: -CNA G transported the resident to the dining room; -CNA G left the resident at the dining room table with no drinks; -The resident’s lips were dry and cracked; -The resident sat at the dining room table without drinks from 7:05 A.M. until 8:20 A.M. Continuous observation on 3/20/19 in the assisted dining room showed the following: -At 8:14 A.M. an unidentified staff member pushed the resident up to the assisted dining room table, placed a clothing protector on the resident, sat three drinks (one being an unopened carton of milk) on the dining room table out of the resident’s reach and left the resident sitting at the table; -The resident sat at the table with his/her eyes and mouth open; the resident’s lips were dry and cracked, reddened with white flakes and the resident’s tongue appeared dry; -At 8:25 A.M. the resident sat at the table with his/her eyes closed; the resident’s drinks sat on the table out of reach of the resident; -At 8:34 A.M. CNA K opened the resident’s milk carton and sat it back down on the table in front of the resident, the resident had his/her eyes closed. CNA K stood beside the resident, touched the resident’s shoulder and asked if he/she wanted a drink; the resident opened his/her eyes but did not respond; the drinks sat on the table in front of the resident, CNA K did not attempt to offer the resident fluids; -At 8:37 A.M. unidentified staff brought a tray to the resident. CNA K sat in a chair next to the resident and assisted the resident with eating and drinking; the resident drank two of the three drinks staff assisted him/her with. During interview on 3/21/19 at 2:00 P.M. CNA N said the following: -Resident #71 required staff to provide all cares for him/her; -Resident #71 was not always able to verbally request a drink or help due to cognitive impairment; -Staff was to offer drinks to the residents during and after cares and in between meals, but he/she thought the licensed staff did that with the medication pass; -He/she was so busy with his/her own job duties he/she did not have time to pass fresh water or ice. 3. Review of Resident #12’s quarterly MDS dated [DATE], showed the following: -BIMS of 15 indicating intact cognition; -Eating, required limited assistance of one staff member; physical assist. Review of the resident’s care plan revised 1/31/19, showed the following: -[DIAGNOSES REDACTED]. -Monitor for signs of [MEDICAL CONDITION] ( high blood sugar), including increased thirst; -Report refusal of meals/liquids; instruct resident on importance of not skipping meals or snacks; -Offer fluids between meals, ensure water pitcher is in room and is filled with water and ice. Review of the resident’s POS dated (MONTH) 2019 showed the following: -A physician ordered regular diet, regular consistency; -Med pass supplement three times daily. Observation on 3/17/19 at 4:05 P.M. in the resident’s room showed the following: -The resident lay in bed with his/her eyes closed; -His/her lips were dry and cracked and his/her oral cavity was visibly dry; -No fluid container in the resident’s room. |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0692 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 58) Observation and interview on 3/18/19 at 2:00 P.M., in the resident’s room showed the following: -The resident lay in bed with his/her eyes open; -The resident’s lips were dry with peeling skin; -No fluid container in the resident’s room; -When asked if staff offers him/her fresh water or ice, he/she said, no, they never do; -He/she only gets fluids at meal times and then he/she sometimes has to beg for what he/she wants; -If he/she is thirsty between meals, he/she has to get his/her own drink, sometimes cupping his/her hand under the bathroom sink to collect the water. 4. Review of Resident #22’s quarterly MDS dated [DATE], showed the following: -BIMS of 14 indicating intact cognition; -Was independent with eating, only required set up assistance; -Had an indwelling catheter. Review of the resident’s care plan revised 2/21/19, showed the following: -[DIAGNOSES REDACTED]. -Provide homelike environment for the resident on a daily basis; -At risk for dehydration due to diuretic therapy; -Discuss and educate the resident about the importance of maintaining adequate fluid intake; -Encourage resident to consume 100% of fluids at meals and self consume water from water pitcher kept in room between meals; water pitcher to be kept within reach of recliner; -Mechanically altered diet; mechanical soft; -Enjoys coffee, chocolate milk and hot chocolate at meals; -Supra pubic catheter placement; -Keep water pitcher within reach and refresh as needed throughout the day, encouraging 100% consumption of fluids at meals and water between meals. Review of the resident’s POS dated (MONTH) 2019 showed the following: -No physician ordered diet; -Med pass supplement three times daily. Review of the resident’s dietician note, dated 3/08/19 showed the resident received a mechanical soft diet. Observation on 3/17/19 at 4:10 P.M. in the resident’s room showed the following: -The resident’s lower extremities were dry, with peeling skin; -The resident’s lips had a dry cracked appearance; -No fluid container in the resident’s room. Observation and interview on 3/18/19 at 9:00 A.M., in the resident’s room showed the following: -The resident was up in his/her wheelchair; -The resident’s lips were dry with peeling skin; -No fluid container in the resident’s room; -When asked if staff offers him/her fresh water or ice, he/she said, no, they never have; -The resident said he/she only gets fluids at meal times; -The resident said he/she sometimes asks the staff administering medications if he/she can keep the cup given to him/her at that time so if he/she is thirsty between meals, he/she has a cup to get water from the bathroom sink; -Observation in the resident’s bathroom showed a stack of three disposable cups on the back of the toilet. 5. Review of Resident #5’s quarterly MDS dated [DATE] showed the following: |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0692 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 59) -BIMS of nine indicating cognitive impairment; -Supervision, requiring set up assistance with eating. Review of the resident’s care plan dated 12/13/18 showed the following: -[DIAGNOSES REDACTED]. -Continues to try and transfer on his/her own; -Keep personal items close by to avoid reaching or transferring to get them. Review of the resident’s (MONTH) 2019 POS showed a physician ordered regular diet. Observation on 3/19/19 at 6:06 A.M., showed the following: -The resident lay in bed with his/her eyes closed; -His/her lips had dry patches with white matter at the corner of his/her mouth; -A fluid container sat on a table out of he resident’s reach in the resident’s room; -CNA L provided incontinence care, dressing assistance and transferred the resident from his/her bed to his/her wheelchair; -CNA L did not offer the resident a drink during or after providing care. 6. Review of Resident #28’s care plan revised 10/02/18, showed the following: -[DIAGNOSES REDACTED]. -The resident is at risk for dehydration due to receiving a diuretic; -Observed for signs and symptoms of dehydration due to diuretic use; -Encourage 100% fluid intake at meals and assist as needed consuming fluids/water from water pitcher between meals; -Offer fluids between meals to assist with flushing bladder and free from signs and symptoms of infection. Review of the resident’s annual MDS dated [DATE], showed the following: -BIMS of seven indicating cognitive impairment; -Eating, required limited assistance of one staff member; physical assist. Review of the resident’s POS dated (MONTH) 2019 showed the following: -A physician ordered diet of mechanical soft, regular consistency; -Med pass supplement three times daily; -Increase oral fluid intake three times daily (each shift), due to weakness. Observation on 3/19/19 at 5:52 A.M., showed the following: -The resident lay in bed with his/her eyes closed; -The resident’s lips and tongue were visibly dry; -CNA L provided incontinence care, dressing assistance and transferred the resident from his/her bed to his/her wheelchair; -CNA L did not offer the resident a drink during or after providing care. 7. During resident council meeting on 03/18/19 at 3:00 P.M. residents said the following: -Resident #101 said staff does not bring him/her water in his/her room to drink; he/she has no jug or cup in his/her room; -Resident #43 said staff does not provide ice or fresh water to him/her when he/she is in his/her room; -Resident #69 said staff does not keep his/her cup filled with ice or fresh water; if he/she wants ice he/she has to ask and does not always get it and he/she usually has to get fresh water him/herself from the fountain. During interview on 3/18/19 at 9:55 A.M., CNA K said he/she can tell if someone is thirsty if they are licking their lips, their mouth was parched or if they had dry debris in the corner of their mouth. During interview on 3/19/18 at 6:50 A.M., CNA L said the following: -He/she does not know if the residents are supposed to have a water pitcher or cup in their rooms; |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0692 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 60) -Residents appear to be thirsty when they have parched lips; -He/she tries to wet residents’ mouths every time he/she gives care especially if their mouth is open and appeared dry. During interview on 3/20/19 at 8:55 A.M., CNA J said if residents’ lips and mouth were dry, he/she would wipe their lips and apply Chap Stick. During interview on 3/21/19 at 10:00 A.M. CNA V said the following: -Resident #71 required total care from staff for all cares; -Resident #71 required staff assistance to eat and drink; -Resident #28 and #5 were probably the same as #71; -He/she thought Resident #12 and #22 could get their own drinks; -Nursing staff was to offer drinks when providing cares, but he/she frequently forgot, he/she had so many tasks to complete it was just something he/she did not think to do. During interview on 03/22/19 at 3:53 P.M., the Director of Nursing (DON) said the following: -Residents should have cups or water readily available; -Water should be passed at least twice a shift; -Residents should have cups in their rooms; -She would expect staff to give residents drinks in their room between meals; -Signs and symptoms of dehydration included dry mouth, dry skin and dry lips. | |
F 0698 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | Past noncompliance – remedy proposed **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0698 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 61) confusion, and/or behavioral symptoms that interfere with treatments. [MEDICAL TREATMENT] adverse reactions/complications and/or recommendations for follow up observations and monitoring, and/or concerns related to the vascular access site/PD catheter. Change and/or decline in condition unrelated to [MEDICAL TREATMENT]. This would include communication related to care concerns such as a resident who is at risk for or who has a pressure ulcer, receiving appropriate interventions. The occurrence or risk of falls and any concerns related to transportation to and from the [MEDICAL TREATMENT] facility; -Coordination of Physician Services between the Nursing Home and the [MEDICAL TREATMENT] facility. For a resident receiving [MEDICAL TREATMENT], the nursing home staff must immediately contact and communicate with the attending physician practitioner, resident/resident representative, and designated [MEDICAL TREATMENT] staff regarding any significant changes in the resident’s status related to clinical complications or emergent situations that may impact the [MEDICAL TREATMENT] portion of the care plan; -Procedures for methods of communication between the nursing home and the [MEDICAL TREATMENT] facility include how it will occur, with whom, and where the communication and responses will be documented; -The development and implementation of coordinated comprehensive care plans that identifies nursing home and [MEDICAL TREATMENT] responsibilities and provides direction for nursing home staff; -The development and implementation of interventions, based upon current standards of practice handling, but not limited to documentation and monitoring of complications, pre-and-post [MEDICAL TREATMENT] weights, access sites, nutrition and hydration, lab tests, vital signs including blood pressure, and medications; -The provision of medications on [MEDICAL TREATMENT] treatment days; -Procedures for monitoring and documenting nutritional/hydration needs including the provision of meals on days that [MEDICAL TREATMENT] treatments are provided; -Assessing, observing, and documenting care of access sites, as applicable, such as: Auscultation/palpation of the AV fistula (pulse, bruit, and thrill) to assure adequate blood flow. Significant changes in the extremity when compared to the opposite extremity ([MEDICAL CONDITION], pain, redness). Steal Syndrome (pain, numbness, discoloration, or cold to touch in the fingers or hand indicating inadequate arterial flow). Skin integrity (waxy skin, ulcerations, drainage from incisions). Bruising/hematoma. Collateral vein distention (veins in access are close to AV fistula becoming larger). Complaints of pain or numbness. Evidence of infection at the surgical site, such as drainage, redness, tenderness at incision site, and fever; -A copy of the Advanced Directive will be furnished to the receiving [MEDICAL TREATMENT] Center; -The [MEDICAL TREATMENT] Center will be notified when the resident declines [MEDICAL TREATMENT]; -Two or more refusals then a referral will be made to the social worker and physician(s) for adjustment in plan, however physician will be notified immediately upon the first refusal. 2. Record review of Resident #101’s face sheet showed the resident was admitted to the facility on [DATE] and then readmitted on [DATE] with a [DIAGNOSES REDACTED]. Record review of the resident’s Physician order [REDACTED]. Review of the resident’s physician orders [REDACTED]. Record review of the resident’s care plan, dated 12/5/18, showed the following: -Problem: The resident needs [MEDICAL TREATMENT] related to [MEDICAL CONDITION] since returning from the hospital; |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0698 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 62) -Approaches: Encourage the resident to go for the scheduled [MEDICAL TREATMENT] appointments. The resident receives [MEDICAL TREATMENT] Monday, Wednesday, and Friday unless changed by [MEDICAL TREATMENT] center. Monitor/document and report to physician signs and symptoms of depression. Obtain order for mental health consult if needed. Monitor/document report as needed signs/symptoms of infection to access site: Redness, swelling, warmth, or drainage. Monitor/document/report as needed for signs/symptoms of [MEDICAL CONDITION]: changes in level of consciousness, changes in skin turgor, oral mucosa, changes in heart and lung sounds. Monitor/document/report as needed for signs/symptoms of the following: Bleeding, hemorrhage (copious or heavy discharge of blood from the blood vessels), bacteremia (presence of bacteria in the blood), septic shock (a widespread infection causing organ failure and dangerously low blood pressure). Work with the resident to relieve discomfort for side effects of the disease and treatment: cramping, fatigue, headaches, itching, [MEDICAL CONDITION], bone demineralization, body image change, and role disruption. Review of the resident’s physician’s orders [REDACTED].>Record review of the resident’s weight record, showed no documentation the facility weighed the resident as ordered on [DATE], 12/9/18, 12/10/18, 12/12/18, 12/15/18, 12/16/18, 12/18/18, 12/19/18, 12/20/18 and 12/21/18. Record review of the resident’s nurse’s notes, dated 12/23/18 through 12/30/18, showed the following: -No documentation of assessment or monitoring of the resident’s [MEDICAL TREATMENT] catheter (used for exchanging blood to and from a [MEDICAL TREATMENT] machine and a patient); -No documentation of assessing or monitoring the resident before or after [MEDICAL TREATMENT] treatments. Record review of the resident’s weight record, showed no documentation the facility weighed the resident as ordered on [DATE], 12/24/18, 12/25/18, 12/26/18, 12/27/18, 12/29/18 and 12/30/18. Record review of the resident’s nurse’s notes, dated 12/31/18 at 5:21 P.M., showed the [MEDICAL TREATMENT] clinic called and said the resident was being taken to the hospital for an infected [MEDICAL TREATMENT] catheter. Record review of the resident’s physician’s orders [REDACTED]. Record review of the resident’s nurse’s notes, dated 1/1/19 at 11:22 A.M., showed the resident was admitted to the hospital for an infected [MEDICAL TREATMENT] catheter. Record review of the resident’s nurse’s notes, dated 1/2/19 at 3:13 P.M., showed the resident was being treated for [REDACTED]. Record review of the resident’s nurse’s notes, dated 1/4/19 at 10:23 P.M., showed the resident returned to the facility by ambulance. Record review of the resident’s nurse’s notes, dated 1/5/19 through 1/8/19 showed the following: -No documentation of assessment or monitoring of the resident’s [MEDICAL TREATMENT] catheter; -No documentation of assessing or monitoring the resident before or after [MEDICAL TREATMENT] treatments. Record review of the resident’s weight record, showed the facility failed to weigh the resident on 1/6/19 and 1/8/19. Record review of the resident’s nurse’s notes, dated 1/9/19 at 10:20 A.M., showed the following: |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0698 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 63) -The resident was alert and able to make his/her needs known. The resident was responsible for self and had made the choice not to go to [MEDICAL TREATMENT] today; -No documentation the resident’s physician was notified of the refusal to go to [MEDICAL TREATMENT]. Record review of the resident’s nurse’s notes, dated 1/10/19 through 1/15/19 showed the following: -No documentation of assessment or monitoring of the resident’s [MEDICAL TREATMENT] catheter; -No documentation of assessing or monitoring the resident before or after [MEDICAL TREATMENT] treatments. Record review of the resident’s weight record, showed no documentation the facility failed weighed the resident as ordered on [DATE]. Record review of the resident’s nurse’s notes, dated 1/17/19 through 1/30/19 showed the following: -No documentation of assessment or monitoring of the resident’s [MEDICAL TREATMENT] catheter; -No documentation of assessing or monitoring the resident before or after [MEDICAL TREATMENT] treatments. Record review of the resident’s weight record, showed the facility failed to weigh the resident on 1/20/19 and 1/25/19. Record review of the resident’s physician’s orders [REDACTED]. Record review of the resident’s nurse’s notes, dated 2/1/19 through 2/28/19 showed the following: -No documentation of assessment or monitoring of the resident’s [MEDICAL TREATMENT] catheter; -No documentation of assessing or monitoring the resident before or after [MEDICAL TREATMENT] treatments. Record review of the resident’s weight record, showed no documentation the facility weighed the resident as ordered on [DATE], 2/9/19, 2/12/19, 2/13/19, 2/18/19, 2/20/19, 2/25/19 and 2/27/19. Record review of the resident’s physician’s orders [REDACTED]. Record review of the resident’s weight record showed no documentation the facility obtained the resident’s ordered weights on 3/1/19, 3/3/19, 3/5/19 and 3/10/19. Review of the resident’s medical record showed the following: -No documentation of assessment and/or monitoring of the resident’s [MEDICAL TREATMENT] catheter; -No documentation of any communications between the facility and the [MEDICAL TREATMENT] clinic, including daily weights, vital signs, fluid intake, and resident status prior to and post [MEDICAL TREATMENT]; -No documentation of assessment for signs and symptoms of infection and bleeding. During an interview on 4/3/19 at 6:34 A.M., Licensed Practical Nurse (LPN) Z, said the following: -He/she had no specialized training with [MEDICAL TREATMENT] residents other than what he/she had received in school; -The facility does not have communication sheets that they fill out and send with the [MEDICAL TREATMENT] residents to the [MEDICAL TREATMENT] Clinic; -physician’s orders [REDACTED]. -The facility does not do intake sheets on the resident as he/she was non-compliant with |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0698 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 64) his/her fluid restriction; -When a resident is non-compliant it should be documented in their medical record and the resident’s physician should be notified. During an interview on 3/22/19 at 3:53 P.M., the Director of Nursing said the following: -She expected physician’s orders [REDACTED]. -She expected a resident receiving [MEDICAL TREATMENT] to have an order for [REDACTED].>-She expected staff to document in the resident’s medical record post assessments following [MEDICAL TREATMENT] appointments and with any changes. Review of e-mail communication dated 4/2/19 at 4:23 P.M., showed the administrator wrote the following: -The facility had no communication sheets between the facility and the [MEDICAL TREATMENT] Clinic for the resident; -The facility had no intake records on the resident. During an interview on 4/2/19 at 4:48 P.M., the resident’s physician, said the following: -He expected physician orders [REDACTED].>-He expected to be notified when orders were not being followed; -He expected the facility to communicate information to the [MEDICAL TREATMENT] clinic for continuum of care, such as weights, vital signs and fluid intake as could impact the actual [MEDICAL TREATMENT] for that day. | |
F 0725 Level of harm – Minimal harm or potential for actual harm Residents Affected – Many | Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0725 Level of harm – Minimal harm or potential for actual harm Residents Affected – Many | (continued… from page 65) 2. During group interview on 03/18/19 at 2:00 P.M., eight residents in attendance said they had to wait extensive amounts of time (1.5 hours) for staff assistance, for things such as toileting. 3. Review of Resident #14’s revised care plan, dated 12/17/18, showed the following: -Assist the resident with transfers; -Required limited assist with toileting; -Requires staff assistance with maneuvering of clothing at times due to left sided weakness. Review of the resident’s quarterly Minimum Data Set (MDS), a federally mandated assessment instrument, completed by facility staff, dated 3/13/19, showed the following: -Cognitively intact; -Required limited assistance of one staff for transfers; -Required limited assistance of one staff for toileting. During interview on 03/18/19 at 2:00 P.M., the resident said the following: -Staff is not readily available for things such as toileting; -Many times he/she has accidents or has to urinate in his/her incontinent brief because it takes staff too long to get to him/her or he/she cannot find help; -Urinating in his/her incontinent briefs makes him/her feel humiliated. 4. Review of Resident #25’s revised care plan, dated 12/24/18, showed the following: -Limited assistance with toileting needs and incontinence; -Has frequent incontinent episodes requiring adult brief use. Review of the resident’s quarterly MDS, dated [DATE], showed the following: -Cognitively intact; -Required extensive assistance of one staff for transfers; -Required extensive assistance of one staff for toileting; -Frequently incontinent of urine. During interview on 03/18/19 at 2:00 P.M., the resident said the following: -Staff is not readily available for things such as toileting; -Frequently he/she has accidents or has to urinate in his/her incontinent brief because it takes staff too long to get to him/her or he/she cannot find help; -Urinating in his/her incontinent briefs makes him/her feel embarrassed and humiliated. 5. Record review of Resident #27’s annual MDS, dated [DATE], showed the following: -Cognitively intact for daily decision making; -Did not reject care; -Required limited assistance of one staff for transfers, dressing, and toileting; -Required physical help in part of bathing activity with assist of one staff; -Had an indwelling catheter; -Was always continent of bowel. Review of the resident’s care plan, dated as revised 1/6/19 and 2/1/19, showed the following: -Problem: The resident is at risk for falls due to potential for weakness due to respiratory problem and psychoactive medication; -Interventions: Keep call light within reach at all times. Respond to call light promptly; -Problem: The resident requires staff assistance with grooming and bathing; -Approaches: Extensive assist with bathing needs especially with washing and drying of lower body. Limited assist with toileting needs. Staff does have to assist with catheter cares and emptying of catheter drainage bag. Set up at sink for the resident to self perform own grooming needs. Review of the facility shower assignment showed the resident was to get a shower on Monday |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0725 Level of harm – Minimal harm or potential for actual harm Residents Affected – Many | (continued… from page 66) and Thursday day shift. Observation and interview on 3/17/19 at 4:20 P.M., showed the resident said he/she does not get showers. Observations showed the resident’s hair was disheveled and greasy. He/She had an area of dried blood on his/her lower right leg. The resident wore a yellow hospital gown. The resident had a brownish colored area to the foot of his/her bed on the sheets. Observation and interview on 3/18/19 at 10:10 A.M., showed the resident was wearing the same yellow gown as on 3/17/19 and the area of dried blood on his/her lower right leg remained. The resident said he/she had not had a shower and had not had his/her sheets changed. Observation showed the resident’s hair was disheveled and greasy and he/she still had the brownish colored area to the foot of his/her bed on the sheets. Observations on 3/19/19 showed the following: -At 5:26 A.M., the resident had turned on his/her call light; -At 5:56 A.M. (30 minutes later), CNA AA answered the call light. The resident requested ice. During an interview on 3/19/19 at 5:57 A.M., CNA AA said he/she was the only aide on the resident’s hall until 7:00 A.M. and that was why it took so long to answer the resident’s call light. Observation and interview on 3/19/19 at 10:49 A.M., showed the resident wore the same yellow gown as 3/17/19 and still had an area of dried blood on his/her lower right leg. The resident said he/she had not had a shower and had not had his/her sheets changed. Observation showed the resident’s hair was disheveled and greasy and he/she still had the brownish colored area to the foot of his/her bed on the sheets. The resident resided in the room by himself/herself. The resident’s room had a foul odor. Observation and interview on 3/20/19 at 11:53 A.M., showed the resident wore the same yellow gown as 3/17/19 and still had an area of dried blood on his/her lower right leg. The resident said he/she had not had a shower and had not had his/her sheets changed. Observation showed the resident’s hair was disheveled and greasy and he/she still had the brownish colored area to the foot of his/her bed on the sheets. The resident’s room had a foul odor. Observation and interview on 3/21/19 at 9:07 A.M., showed the resident wore the same yellow gown as on 3/17/19 and still had an area of dried blood on his/her lower right leg. The resident said he/she had not had a shower and had not had his/her sheets changed. Observation showed the resident’s hair was disheveled and greasy and he/she still had the brownish colored area to the foot of his/her bed on the sheets. The resident’s room had a foul odor. 6. Review of Resident #43’s face sheet showed [DIAGNOSES REDACTED]. Review of the resident’s revised care plan, dated 1/15/19, showed the following: -Limited assistance of one staff for transfer; -Toilet after dinner meal. Do not wait for the resident to notify staff. Staff to assist with toileting. Review of the resident’s quarterly MDS, dated [DATE], showed the following: -Cognitively intact; -Required limited assistance of one staff for transfers and toileting; -Frequently incontinent of urine. During interview on 03/18/19 at 2:00 P.M., the resident said the following: -Staff is not readily available for things such as toileting; -Many times he/she has accidents or has to urinate in his/her incontinence brief because it takes staff too long to get to him/her or he/she cannot find help; -Urinating in his/her incontinent briefs makes him/her feel mad. |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0725 Level of harm – Minimal harm or potential for actual harm Residents Affected – Many | (continued… from page 67) 7. Review of Resident #69’s face sheet showed he/she had [DIAGNOSES REDACTED]. Review of the resident’s revised care plan, dated 2/7/19, showed the following: -Provide limited assistance with toileting as requested; -Transfer with minimal assistance of one staff; -Encourage resident to alert staff as soon as urge to void is present. Review of the resident’s quarterly MDS, dated [DATE], showed the following: -Cognitively intact; -Required extensive assistance of one staff for transfers and toileting; -Occasionally incontinent of urine. During interview on 03/18/19 at 2:00 P.M., the resident said the following: -Staff is not readily available for things such as toileting; -Many times he/she has accidents or has to urinate in his/her incontinent brief because it takes staff too long to get to him/her or he/she cannot find help; -Urinating in his/her incontinent briefs makes him/her feel humiliated, mad and angry. 8. Review of Resident #101’s face sheet showed he/she had [DIAGNOSES REDACTED]. Review of the resident’s physician’s orders, dated 1/24/19, showed may begin Restorative Therapy Program two to five times a week until progress ceases or goals are met. Review of the resident’s Restorative Care Flow Record, dated (MONTH) 2019, showed no record restorative therapy was completed for the week of 2/4/19 through 2/10/19. Review of the resident’s Restorative Care Flow Record, dated (MONTH) 2019, showed the following: -Restorative therapy completed one time during the week of 3/4/19 through 3/10/19; -Restorative therapy completed one time during the week of 3/11/19 through 3/17/19; -The facility did not to complete restorative as ordered. Review of the resident’s revised care plan, dated 3/1/19 showed the following: -Limited in physical mobility and requires assistance of one to three staff for daily care; -Can make needs known; -Incontinent and dependent on staff for incontinent care. Review of the resident’s quarterly MDS, dated [DATE], showed the following: -Cognitively intact; -Totally dependant on two or more staff for transfer and toileting needs; -Always incontinent of bowel and bladder. During interview on 03/18/19 at 2:00 P.M., the resident said the following: -Staff is not readily available for things such as toileting; -Many times he/she has accidents or has to urinate in his/her incontinent brief because it takes staff too long to get to him/her or he/she cannot find help; -Urinating in his/her incontinent briefs makes him/her feel embarrassed. 9. Review of Resident #71’s Restorative Therapy Program orders, dated 1/16/19, showed the following: -Frequency: one time day/two to five times a week; -Passive Range of Motion (PROM): Bilateral lower extremities and trunk to reduce joint stiffness; -Signed by the therapist 1/16/19. Review of the resident’s care plan, revised 2/8/19, showed the following: -Dependent on staff for locomotion; -Transfer with two staff; -At risk for functional decline, social isolation and increased agitation; -Allow to make simple decisions; |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0725 Level of harm – Minimal harm or potential for actual harm Residents Affected – Many | (continued… from page 68) -Requires mechanically altered diet; -At risk for aspiration; -Difficulty holding a cup and utensils; -At risk for poor nutritional intake; -May need assistance with eating and drinking; -Staff to spoon feed at meals; encourage participation although resident is not successful. Review of the resident’s quarterly MDS, dated [DATE], showed the following: -BIMS of six indicating severely impaired cognition; -Extensive assistance of one staff for bed mobility, eating and drinking; -Total dependence of two staff for transfers; -Extensive assistance of one staff for locomotion on and off the unit; -Used wheelchair for mobility device. Review of the resident’s Restorative Care Flow Record, dated (MONTH) 2019, showed the following: -Restorative therapy completed one time (2/4/19) for the week of 2/4/19 through 2/10/19; -Restorative therapy completed one time (2/11/19) for the week of 2/11/19 through 2/17/19; -Restorative therapy completed one time (2/18/19) for the week of 2/18/19 through 2/24/19; -The facility did not to complete restorative as ordered. Review of the resident’s (MONTH) 2019 physician order sheets (POS) showed the following: -[DIAGNOSES REDACTED]. -Physician ordered diet of mechanical soft texture, regular consistency. Observation on 3/20/19 at 4:40 P.M. showed the resident lay in bed in his/her room. During interview on 3/20/19 at 4:40 P.M., the resident said he/she knew it was about supper time. He/she was hungry. Staff usually helped him/her get up for meals. Observation on 3/20/19 at 5:40 P.M. showed the resident lay in his/her bed. The head of the resident’s bed was elevated and he/she lay on his/her left side. CNA N assisted the resident with his/her evening meal at the resident’s bedside. During interview on 3/20/19 at 6:00 P.M., the resident said the following: -He/she ate supper in bed; -He/she did not know why staff did not get him/her up; -No one asked him/her if he/she wanted to eat in bed. 10. Review of Resident #75’s care plan, revised 2/16/19, showed the following: -Use Hoyer lift (mechanical lift) if resident is weak, with assist of two staff; -Resident is limited in physical mobility and requires assistance from one to two staff with daily care; -Resident uses a wheelchair for locomotion, can stand and ambulate with a quad cane/grab bar with assist times from one to two staff; -He/she is able to make his/her needs known and can be impatient, may transfer himself/herself; -Mechanical soft diet with recommendation to be on thickened liquids but has requested to remain on thin liquids; at risk for aspiration; -Eats in the assisted dining area; observe closely for signs of difficulty swallowing and or/aspiration; alert charge nurse of increased coughing or choking. Review of the resident’s annual MDS, dated [DATE], showed the following: -Cognition intact; -Extensive assistance of one staff for bed mobility and locomotion on and off the unit; -Extensive assistance of two staff for transfers; -Independent with eating, requiring set up help only; |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0725 Level of harm – Minimal harm or potential for actual harm Residents Affected – Many | (continued… from page 69) -Used wheelchair for mobility device. Observation on 03/20/19 at 4:50 P.M. showed the resident lay in his/her bed in his/her room. During interview on 03/20/19 at 4:50 P.M., the resident said the following: -He/she knew it was about supper time; -He/she was hungry; -Staff usually helped him/her get up for meals but CNA N told him/her he/she would be eating in bed this evening because CNA N was the only one working the hall; -He/she would rather be up for meals, but what was he/she to do? Observation on 3/20/19 at 5:45 P.M. showed the following: -The resident lay in his/her bed; -The resident’s evening meal was on his/her bedside table and the resident fed himself/herself; During interview on 3/20/19 at 5:45 P.M., the resident said the facility was always short staffed and this occasionally happened that they did not get him/her up for the supper meal. During an interview on 3/20/19 at 4:22 P.M., CNA N said the following: -Resident #71 and #75 required two staff to transfer; -He/she was the only staff working the unit at that time; -There was a floating staff member, but they were usually too busy to assist him/her when needed; -Resident #71 and #75 would be staying in bed for the evening meal because he/she did not have help to get them up; -The facility was frequently short staffed and it was difficult for him/her to complete her tasks for his/her shift. 11. Review of Resident #110’s care plan, dated 2/8/19, showed the following: -Totally dependent on staff to provide bath/shower two times weekly and as necessary; -Totally dependent on staff for personal hygiene and oral care. Review of the resident’s 14-day Prospective Payment System (PPS) MDS, dated [DATE], showed the following: -Cognitively intact; -Did not reject care; -Required total assistance of two or more staff for bathing. Review of the resident’s comprehensive CNA shower review documentation, provided by the facility for 1/17/19 through 3/22/19, showed the following: -No evidence the resident received a shower/bath from 1/28/19 through 2/2/19 (five days); -The resident received a shower on 2/3/19, abed bath on 2/8/19, a shower on 2/17/19, and a bed bath on 2/19/19; -The resident was in the hospital on [DATE] and 2/26/19; -There was no documentation the resident received a shower 3/1/19 through 3/22/19 (22 days). Observation on 3/17/19 at 1:45 P.M., showed the resident lay in bed . The resident’s fingernails were long. During an interviews on 3/17/19 at 1:45 P.M. and 3/19/19 at 7:44 A.M., the resident said he/she has told staff he/she wants his/her fingernails trimmed but they have never been trimmed. Staff just come in and do a bed bath when they are ready. It can be a long period between baths and he/she has went a couple of weeks without a shower before. He/she doesn’t know why he/she doesn’t get a bath/shower when scheduled. 12. Record review of Resident #9’s admission MDS, dated [DATE], showed the following: |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0725 Level of harm – Minimal harm or potential for actual harm Residents Affected – Many | (continued… from page 70) -Cognitively intact for daily decision making; -Had no rejection of care; -Required limited assist of one staff for personal hygiene; -Required physical help of one staff for bathing; -Was occasionally incontinent of urine; -Was always continent of bowel. Review of the resident’s care plan, dated as reviewed 3/11/19, showed the following: -Problem: The resident requires limited to extensive assist with ADLs; -Interventions: The resident requires extensive assist from staff with showering two times weekly and as necessary. Review of the facility’s shower assignment sheet, showed the resident was to receive a shower on Tuesday and Friday during the day shift. Review of the resident’s comprehensive CNA shower review documentation, provided by the facility for 1/17/19 through 3/22/19, showed the following: -On 1/30/19, there was no hot water, so shower was not given; -The resident received a shower on 2/25/19, 3/2/19, and 3/8/19; -No documentation to show the resident received a shower on other days between 1/17/19 and 3/22/19. Observation on 3/18/19 at 4:12 P.M., showed the resident was in bed. He/she only wore an incontinence brief and was covered with a sheet. The resident’s hair was disheveled and greasy. The room had an unidentifiable odor. During an interview on 3/18/19 at 4:12 P.M., the resident said he/she does not get showers. He/she had not received a shower for over ten days. He/she would prefer his/her family member be at the facility when he/she takes a shower and would prefer a bench over the shower chair. 13. Review of Resident #12’s updated care plan, dated 1/31/19, showed the following: -Requires minimal assistance due to fluctuating weakness for many ADLs and/or requiring supervision for completion for ADLs; -Does need extensive assistance with bathing needs; -Does refuse showers at times; approach at different times of day for showers; -Supervise to ensure personal hygiene is met; -Refuses to shave chin at times; continue to offer assistance in tasks until resident is agreeable with completion. Record review of the resident’s quarterly MDS, dated [DATE], showed the following: -Cognition intact; -Required limited assistance from one staff for personal hygiene, including bathing, combing of hair and shaving. Review of the resident’s (MONTH) 2019 physician order sheets (POS) showed Restorative Therapy Program one time a day (two to five times a week) until goals are met. Review of the resident’s Restorative Care Flow Record, dated (MONTH) 2019, showed the following: -Restorative therapy completed one time (3/7/19) for the week of 3/4/19 through 3/10/19; -Restorative therapy completed one time (3/15/19) for the week of 3/11/19 through 3/17/19; -The facility did not to complete restorative as ordered. Record review of the facility’s shower assignment sheet showed the resident was to have a shower on Monday and Thursday on the day shift. Review of the resident’s comprehensive CNA shower review documentation, provided by the facility for (MONTH) 2019 through (MONTH) 2019, showed the following: -The resident’s last documented shower was on 2/21/19; |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0725 Level of harm – Minimal harm or potential for actual harm Residents Affected – Many | (continued… from page 71) -No documentation to show the resident had been shaved or that cares had been provided or refused on 02/25/19, 02/28/19, 03/04/19, 03/07/19, 03/11/19, 03/14/19, 03/18/19 and 03/21/19. Observation on 3/17/19 at 12:58 P.M. showed the following: -The resident sat in his/her wheelchair in the main dining room; -The resident had unshaven facial hair resembling stubble; -The resident’s hair appeared greasy and was unkempt. Observation on 3/18/19 at 9:25 A.M. showed the following: -The resident sat in his/her wheelchair in the main dining room; -The resident had unshaven facial hair resembling stubble; -The resident’s hair appeared greasy and unkempt. Observation on 3/19/19 at 8:10 A.M. showed the following: -The resident lay in bed in his/her room; -The resident had unshaven facial hair resembling stubble; -The resident’s hair appeared greasy and unkempt. Observation on 3/22/19 at 10:05 A.M. showed the following: -The resident sat in his/her wheelchair in the facility hallway; -The resident had unshaven facial hair resembling stubble; -The resident’s hair appeared greasy and unkempt; During interview on 3/22/19 at 10:05 A.M., the resident said the following: -He/she needed help shaving his/her facial hair and staff never assisted him/her; -He/she sometimes asked for supplies to shave and assistance, but staff never brought them or offered to help; -He/she likes to be clean shaven; -Staff does not always help him/her with bathing; -He/she used to go to the shower room and linen room on his/her own because he/she got tired of waiting on staff to help, but he/she got in trouble with staff for doing that so he/she doesn’t do it anymore; -He/she does not even have a comb or wash clothes to clean up at the sink if he/she wanted to. 14. Review of Resident #22’s quarterly MDS, dated [DATE], showed the following: -Cognitively intact; -Required limited assistance with personal hygiene, including shaving; -Required physical help in part of bathing assistance. Review of the resident’s care plan, revised 2/21/19, showed the following: -Requires supervision to limited assistance at times with ADLs; -The resident will be appropriately assisted with ADLs as needed; -Allow the resident to do as much as possible for him/herself and offer assistance when needed; -Encourage the resident to allow staff to assist with hygiene and bathing; encourage staff assist and completion of these tasks; -Limited assistance with bathing; -Set up and supervision for grooming needs to assure the resident is completing task. Record review of the facility’s shower assignment sheet showed the resident was to have a shower on Monday and Thursday on the day shift. Review of the resident’s comprehensive CNA shower review documentation, provided by the facility for (MONTH) 2019 through (MONTH) 2019, showed the following: -The resident’s last documented shower was on 2/21/19; -No documentation to show the resident had been shaved or that cares had been provided or |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0725 Level of harm – Minimal harm or potential for actual harm Residents Affected – Many | (continued… from page 72) refused on 02/25/19, 02/28/19, 03/04/19, 03/07/19, 03/11/19, 03/14/19, 03/18/19 and 03/21/19. Observation on 03/17/19 at 12:02 P.M. showed the following: -The resident sat in his/her wheelchair in the main dining room; -The resident had unshaven facial hair resembling stubble. Observation on 3/18/19 at 9:25 A.M. showed the following: -The resident sat in his/her wheelchair in the main dining room; -The resident had unshaven facial hair resembling stubble. Observation on 3/19/19 at 8:10 A.M. showed the following: -The resident sat in a wheelchair in his/her room; -The resident had unshaven facial hair resembling stubble. Observation on 3/22/19 at 10:15 A.M. showed the following: -The resident sat in his/her wheelchair in his/her room; -The resident had unshaven facial hair resembling stubble. During an interview on 3/22/19 at 10:15 A.M., the resident said the following: -He/she needed help shaving his/her facial hair and staff never assisted him/her; -He/she sometimes asked for supplies to shave and assistance, but they never brought them or offered to help; -He/she likes to be clean shaven; -Staff does not always help him/her with bathing because they are short staffed; -It had been a long time since he/she had a shower and he/she felt dirty. 15. Record review of Resident #29’s admission MDS, dated [DATE], showed the following: -Cognitively intact for daily decision making; -No rejection of care; -Was dependent on one staff for dressing, toileting, and bathing; -Required extensive assist of one staff for bed mobility, transfers, and personal hygiene; -Always incontinent of bladder; -Frequently incontinent of bowel. Review of the resident’s care plan, dated 1/13/19, showed the following: -Problem: The resident requires extensive to full staff assistance with ADLs; -Interventions: The resident is totally dependent on one staff to provide showers twice weekly and as necessary. Record review of the facility’s shower assignment sheet showed the resident was to have a shower on Monday and Thursday on the evening shift. Review of the resident’s comprehensive CNA shower review documentation, provided by the facility for 1/17/19 through 3/22/19, showed the following: -The resident received one shower on 3/7/19; -No documentation to show the resident refused or received a shower for the other days. Observation on 03/17/19 at 3:05 P.M., showed the resident’s hair appeared greasy. During interview on 03/17/19 at 3:05 P.M., the resident’s family member said the resident did not receive showers like he/she should. The resident had been at the facility since 12/31/18 and as far as he/she knew had only received three showers. During an interview on 3/19/19 at 8:30 A.M., the resident’s family member said the resident did not receive his/her shower last night. Observation showed the resident’s hair appeared greasy. Observation on 3/22/19 at 10:53 A.M., showed a hand written sign on the resident’s door that said, Shower time! During an interview on 3/22/19 at 11:13 A.M., the resident’s family member said he/she put the sign on the resident’s door to remind staff to do the resident’s shower. He/she was |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0725 Level of harm – Minimal harm or potential for actual harm Residents Affected – Many | (continued… from page 73) unsure if the resident received his/her shower the night before. 16. Review of Resident #38’s quarterly MDS, dated [DATE], showed the following: -Cognitively intact; -Required extensive assistance from one staff for personal hygiene; -Totally dependent on staff for bathing. Review of the resident’s care plan, revised 1/22/19, showed the following: -Requires extensive assist to full assist with daily cares; -Staff to assist to make sure basic care needs are met; -Is incontinent of bladder with occasional incontinence of bowel. Record review of the facility’s shower assignment sheet showed the resident was to have a shower on Monday and Thursday on the evening shift. Review of the resident’s comprehensive CNA shower review documentation, provided by the facility for (MONTH) 2019 through (MONTH) 2019, showed the following: -The resident received a shower on 2/07/19; -No documentation the resident received a shower as scheduled on 02/11/19, 02/14/19, 02/18/19, 02/21/19, 02/25/19, 02/28/19, 03/04/19, 03/10/19, 03/11/19, 03/14/19 and 03/18/19. Observation on 03/17/19 at 2:45 P.M. showed the resident lay in bed watching television. The resident’s hair appeared greasy. The resident ran his/her hands through his/her hair and it stood up on end. During an interview on 03/17/19 at 2:45 P.M., the resident said the following: -He/she had not had a shower for six weeks; -Staff said he/she does not get his/her shower because they are low on staff; this includes no hair washing; -His/her hair felt greasy. 17. Review of Resident #53’s (MONTH) 2019 POS showed Restorative Therapy Program one time a day (two to five times a week) until goals are met. Review of the resident’s Restorative Care Flow Record, dated (MONTH) 2019, showed the following: -Restorative therapy completed one time (3/14/19) for the week of 3/9/19 through 3/15/19; -Restorative therapy completed only one time (3/18/19) for the week of 3/16/19 through 3/22/19; -The facility did not complete restorative as ordered. 18. Review of Resident #57’s care plan, dated 7/25/18, showed the following: -Check frequently for wetness and change after incontinence occurs; -Continent of bowel and bladder with occasional incontinence requiring pads/briefs; -The resident often refuses showers. Does shave as needed. Staff is to encourage shower or at minimal washing body at sink to prevent odor or complications from poor hygiene. Review of the resident’s annual MDS, dated [DATE], showed the following: -Cognition moderately impaired; -Had no rejection of care; -Bathing somewhat important; -Required extensive assistance of one staff for bathing; -Frequently incontinent of urine. Review of the resident’s comprehensive CNA shower review documentation, provided by the facility for 1/17/19 through 3/22/19, showed the following: -Refused a shower on 3/8/19; -The resident received a shower on 3/14/19; -There was no documentation the resident received a shower 1/17/19 through 3/13/19 (55 |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0725 Level of harm – Minimal harm or potential for actual harm Residents Affected – Many | (continued… from page 74) days). Observation on 3/20/19 at 1:35 P.M., showed the resident walked the halls of the facility. The resident’s hair was disheveled. 19. During interview on 3/19/19 at 4:05 P.M., Restorative Aide (RA) V said he/she gets pulled from restorative therapy to work the floor. During interview on 3/18/19 at 2:32 P.M., Unit Manager LPN W said the following: -He/she was the staffing coordinator until just recently; -He/she staffed according to census not acuity. During interview on 4/4/19 at 9:57 A.M., LPN WW said he/she feels like there is not enough staff. When two staff are caring for a resident and they are needed in another room and the staff cannot get to them, the resident then tries to do it on their own and may fall. During interview on 3/19/19 at 7:35 A.M., Registered Nurse (RN) PP said the following: -He/she worked double shifts to help with staffing; -One CNA to work the hall was not enough staff to answer call lights in a timely manner or provide care for the residents; -The facility was short staffed. During interview on 03/22/19 at 3:53 P.M. the director of nursing (DON) said the following: -There is not sufficient staff; -She still expects staff to get help to get residents out of bed for things like meals, unless the resident wishes to stay in bed; -Call lights sh (TRUNCATED) | |
F 0732 Level of harm – Potential for minimal harm Residents Affected – Some | Post nurse staffing information every day. Based on observation and interview, the facility failed to post the total number of |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0732 Level of harm – Potential for minimal harm Residents Affected – Some | (continued… from page 75) about the facility that included the facility name, the current date, the total number and the actual hours worked by licensed and unlicensed nursing staff directly responsible for resident care per shift including RNs, LPNs or LVNs, CNAs and the resident census 4. Observation on 03/19/19 from 4:30 A.M. to 5:10 P.M. showed no posted nursing staff seen about the facility that included the facility name, the current date, the total number and the actual hours worked by licensed and unlicensed nursing staff directly responsible for resident care per shift including RNs, LPNs or LVNs, CNAs and the resident census. 5. Observation on 03/20/19 from 8:10 A.M. to 6:30 P.M. showed no posted nursing staff seen about the facility that included the facility name, the current date, the total number and the actual hours worked by licensed and unlicensed nursing staff directly responsible for resident care per shift including RNs, LPNs or LVNs, CNAs and the resident census. 6. Observation on 03/21/19 from 8:00 A.M. to 7:15 P.M. showed no posted nursing staff seen about the facility that included the facility name, the current date, the total number and the actual hours worked by licensed and unlicensed nursing staff directly responsible for resident care per shift including RNs, LPNs or LVNs, CNAs and the resident census. 7. Observation on 03/22/19 from 8:00 A.M. to 6:00 P.M. showed no posted nursing staff seen about the facility that included the facility name, the current date, the total number and the actual hours worked by licensed and unlicensed nursing staff directly responsible for resident care per shift including RNs, LPNs or LVNs, CNAs and the resident census. During an interview on 3/18/19 at 2:32 P.M. Unit Coordinator/LPN W said the staffing was posted back by the employee clock and should be posted at the receptionist desk. During interview on 03/22/19 at 3:53 P.M., the Director of Nursing (DON) said staffing should be posted where residents and families can see the information. | |
F 0802 Level of harm – Minimal harm or potential for actual harm Residents Affected – Many | Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0802 Level of harm – Minimal harm or potential for actual harm Residents Affected – Many | (continued… from page 76) Styrofoam regularly with plastic silverware. During an interview on 3/21/19 at 9:54 A.M., Resident #95 said the following: -It bothers him/her to use plastic silverware; -He/she can’t do anything with plastic silverware; -It is usually the spoon that is plastic, but can be all plastic utensils at times; -Have been served plastic utensils a lot lately. During an interview on 3/17/19 at 6:30 P.M., Resident #97 said the facility served meals regularly on Styrofoam. During an interview on 3/17/19 at 6:18 P.M., Resident #111 said the facility served on Styrofoam and used plastic utensils on a regular basis. During the resident council meeting on 03/18/19 at 2:50 P.M. residents in attendance said the following: -Meals were frequently served on Styrofoam/paper products; -Reasons given for the use of the Styrofoam/paper products vs. real dishes included the facility being short staffed, not enough time for staff to wash real dishes and/or the dishwasher was broken. During interview on 3/18/19 at 12:40 P.M., Dietary Aide DD said sometimes he/she was the only one staff working in the kitchen and could not get everything completed. They had to serve off of Styrofoam plates and use disposable utensils and cups just to get the residents served. Observation and interview on 03/20/19 at 8:30 A.M. showed the following: -Resident #59 sat in the main dining room eating Rice Krispie cereal with a plastic fork; -The resident said staff told him/her there were no spoons available; -Two other unidentified residents were eating oatmeal and cream of wheat cereal with a plastic fork. During an interview on 3/20/19 at 1:42 P.M., Dietary Aide CC said there wasn’t enough staff to get everything done including dishes. They had to serve the residents on disposable plates, silverware and cups because staff couldn’t get the dishes clean in time. 2. Observations on 3/18/19 showed the following: -At 12:48 P.M., staff announced food service was to begin in the main dining room over the intercom system; -At 1:04 P.M., dietary staff prepared meal trays in the kitchen for the main dining ran. Staff ran out of clean and prepared flatware for the meal before all meal trays were prepared; -Between 1:04 P.M. and 1:09 P.M., Dietary Aide SS obtained soiled flatware (which had been on the dirty side of the dishmachine since breakfast) and washed it in the dish machine; -At 1:09 P.M., showed Dietary Aide FF wrapped wet flatware in paper napkins; -At 1:14 P.M., staff placed the meal trays for the main dining room on the meal cart and took the cart to the main dining room. Not all residents received flatware and were waiting on more flatware; -At 1:25 P.M., staff ran out of spoons. Residents in the main dining room did not receive spoons for the meal. 3. During an interview on 03/19/19 at 9:50 A.M., Resident #12 said staff does not offer the residents a bedtime snack. During an interview on 03/18/19 at 3:00 P.M., Resident #14 said staff only gives him/her a snack if he/she asked, but they did not always have something available. During an interview on 03/20/19 at 2:00 P.M., Resident #22 said staff doesn’t offer snacks at bedtime. |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0802 Level of harm – Minimal harm or potential for actual harm Residents Affected – Many | (continued… from page 77) During an interview on 03/18/19 at 3:00 P.M., Resident #25 said staff does not offer bedtime snacks. During an interview on 3/17/19 at 4:20 P.M., Resident #27 said he/she did not get bedtime snacks. During an interview on 03/18/19 at 3:00 P.M., Resident #59 said he/she sometimes gets hungry through the night and staff does not offer snacks. During an interview on 03/18/19 at 3:00 P.M., Resident #62 said staff used to come along with a juice and snack cart in the evenings, but they have not done so for over a year. During an interview on 03/18/19 at 3:00 P.M., Resident #69 said staff will give him/her a snack in the evening only if they have something available and they often times do not. During an interview on 03/18/19 at 3:00 P.M., Resident #92 said staff does not offer him/her a bedtime snack and he/she wished they did. During interview on 3/19/19 at 7:35 A.M. Registered Nurse (RN) PP said they did not have bedtime snacks or any snacks to give the residents on 3/18/19 evening. He/she did not think they passed bedtime snacks to the residents. During interview on 3/20/19 at 8:28 A.M., Dietary Aide EE said evening snacks were not prepared because there wasn’t enough staff to prepare snacks. 4. Observations on 3/18/19 at 11:44 A.M. and on 3/19/19 at 8:15 A.M. showed the following: -The fryer baskets were hanging above the fryer with dark crispy debris stuck to them; -The oil in the deep fat fryer was almost black; -There was a heavy greasy buildup on the sides, behind, underneath, and around the fryer; -The front of the fryer had white splatters across the surface; -Inside the vat of the fryer was a black buildup all across the stainless steel; -Where the baskets hung from the fryer there was a buildup of solid crumb-like debris; -The tilt skillet was dirty with a buildup of a yellowish debris along the cooking surface; -The convection oven had a buildup of dark debris on the outside and inside surfaces; -The griddle was dark with debris, large chunks of solid debris littered the cooking surface of the griddle, a dirty spatula lay resting on the griddle. The outside surface of the griddle was layered with dark and light debris; -The stainless steel backsplash of the range was dark with a buildup of debris; -Eight of eight ceiling vents, located above the food preparation areas, cooking surfaces, clean side of the dishwashing area, and clean dish storage, were all dirty with a buildup of fuzzy and dark debris; -The vent above the steamtable had a heavy buildup with debris that extended to four ceiling tiles surrounding the vent and 2 feet across one tile to the light fixture on the other side that was also above the steamtable. Observations on 3/18/19 at 12:04 P.M. showed the reach-in refrigerator had remnants of what appeared to be a yellow liquid that was spilled as well as a dried puddle and splatters of blood-red substances. Above the staining was an opened tube of Braunschweiger (a pork liverwurst) that was undated. Observations on 3/18/19 at 12:08 P.M. showed the milk cooler had a large accumulation of dried solidified spilled milk that extended across most of the floor in either a pool or splatters. The spilled milk had turned yellow and green. During interview on 3/19/19 at 11:39 A.M., Dietary Aide HH said there used to be a cleaning list and chores in the kitchen, but with such little staff there isn’t enough people to get things done so something had to fall off in order to get the residents fed. 5. Observations on 3/18/19 at 12:11 P.M. showed dishes were stacked wet. Drops of water dripped off the dishes and when separated, water was on the surfaces of the dishes. All |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0802 Level of harm – Minimal harm or potential for actual harm Residents Affected – Many | (continued… from page 78) dishes that were stacked were stacked wet. Staff placed the flatware in a utensil [MEDICATION NAME] while wet. Observations on 3/18/19 at 12:13 P.M. showed Dietary Aide FF rolled flatware. Further observations showed the flatware was wet. Staff placed the damp flatware on a tray for food service. Observations on 3/18/19 between 12:31 P.M. showed staff placed food on the wet plates and bowls that had been stacked wet. The trays, plates, bowls, and napkin wrapped flatware were wet when used for the meal service. During interview on 3/18/19 at 12:40 P.M., Dietary Aide SS said staff stacked the dishes when they were wet because there isn’t enough help to get all the dishes done and let them dry before more dishes are needed for meal service. 6. Observations on 3/19/19 at 7:45 A.M. showed a large stack of dishes piled in the dish area. During interview on 3/20/19 at 2:50 P.M., Dietary Aide CC said he/she left the dirty dishes in the dish area on the evening of 3/18/19 because there was not enough staff to get them done. During interview on 3/19/19 at 11:40 A.M., Dietary Aide EE said none of the dishes were cleaned the evening of 3/18/19. When he/she wanted to make breakfast, all dishes had to be cleaned first. 7. Review of an undated facility provided document titled Meal Times, showed supper was to be served at 5:30 P.M. Observations on 3/18/19 between 6:28 and 7:00 P.M. staff passed meal trays to residents in the main dining room. During interview on 3/18/19 at 6:22 P.M., Dietary Aide CC said meals are often late because there isn’t enough staff to get everything done on time. During interview on 3/18/19 at 1:10 P.M., Dietary Aide EE said meals are almost always late because there isn’t enough staff to get things done, including getting dishes washed and ready to cook on, dishes cleaned to serve on, items cooked on time, food items prepared on time for individual service, meals passed out to residents, equipment cleaned and ready for use, items put away correctly after receiving truck order, and truck order placed correctly. | |
F 0804 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. Based on observation and interview, the facility failed to serve food that was palatable |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0804 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 79) had turned brown. Observation on 3/19/19 at 1:35 P.M. of the test tray, provided by the facility during meal service, showed the following: -The chicken was 80 degrees F and was tough; -The rice was 96 degrees F; -The potatoes were 100 degrees F; -The broccoli was 108 degrees F and was overcooked and mushy. During an interview on 3/19/19 at 1:27 P.M., Resident #421 and Resident #422 said the food was cold and not very good. The chicken was too tough to eat. During an interview on 03/17/19 at 3:05 P.M., Resident #29’s family member said the food is terrible. He/she fed the resident his/her lunch meal and there would be days he/she would have to leave and go get something different because the food was so bad. | |
F 0805 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0805 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 80) food and I’m not eating it. The food is not any good but the mashed up food is disgusting. During an interview on 4/5/19 at 10:10 A.M., the registered dietician said Resident #39 | |
F 0806 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0806 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 81) 4. Review of Resident #43’s MDS, dated [DATE], showed the following: -Cognitively intact; -Independent with eating, set up help only. During interview on 3/17/19 at 2:07 P.M., the resident said he/she would like to have coffee with every meal but when he/she requested coffee, staff said they do not have any coffee and they are sorry. He/She gets disappointed because he/she enjoys drinking coffee. 5. Review of Resident #111’s annual MDS, dated [DATE], showed the following: | |
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, |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0809 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 82) 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to provide nourishing snacks |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0809 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 83) During an interview on 03/18/19 at 3:00 P.M., the resident said staff will give him/her cookies, but only if he/she asks; he/she would just like staff to offer them like they used to. 9. Review of Resident #59’s face sheet showed he/she had [DIAGNOSES REDACTED]. During an interview on 03/18/19 at 3:00 P.M., the resident said there are too many hours between supper and breakfast, and a bedtime snack would help tide him/her over. He/She sometimes gets hungry through the night and staff does not offer snacks. 10. Review of Resident #62’s face sheet showed he/she had [DIAGNOSES REDACTED]. During an interview on 03/18/19 at 3:00 P.M., the resident said staff used to come along with a juice and snack cart in the evenings, but they have not done so for over a year. He/She mainly ate snacks in his/her room that he/she purchased because he/she could not depend on the facility to have snacks available. 11. Review of Resident #69’s face sheet showed he/she had [DIAGNOSES REDACTED]. During an interview on 03/18/19 at 3:00 P.M., the resident said he/she is a diabetic; staff will give him/her a snack in the evening only if they have something available and they often times do not. He/She snacks on his/her own foods in his/her room. Nursing staff that administer his/her insulin always tell him/her to eat a snack from his/her room because they know the meals are never on time. 12. Review of Resident #92’s face sheet showed he/she had [DIAGNOSES REDACTED]. During an interview on 03/18/19 at 3:00 P.M., the resident said staff does not offer him/her a bedtime snack and he/she wished they did. 13. Review of Resident #101’s face sheet showed he/she had [DIAGNOSES REDACTED]. During an interview on 03/18/19 at 3:00 P.M., the resident said the facility does not offer bedtime snacks, but if they did, he/she would eat them. 14. During the group interview on 03/18/19 at 3:00 P.M., all eight residents in attendance said if staff offered them a bedtime snack, they would eat the snack. No staff had ever asked them about their input on what snacks they would like to see available. During interview on 3/19/19 at 7:35 A.M. Registered Nurse (RN) PP said they did not have bedtime snacks or any snacks to give the residents on 3/18/19 evening. He/she did not think they passed bedtime snacks to the residents. During interview on 3/20/19 at 8:28 A.M., Dietary Aide EE said evening snacks were not prepared because there wasn’t enough staff to prepare snacks. During an interview on 3/22/19 at 3:53 P.M., the director of nursing (DON) said she expected bedtime snacks to be passed and offered to residents nightly. | |
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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0812 Level of harm – Minimal harm or potential for actual harm Residents Affected – Many | (continued… from page 84) -There was a heavy greasy buildup on the sides, behind, underneath, and around the fryer; -The front of the fryer had white splatters across the surface; -The tilt skillet had a buildup of a yellowish debris along the cooking surface; -The convection oven had a buildup of dark debris on the outside and inside surfaces; -The griddle was dark with debris. Large chunks of solid debris littered the cooking surface of the griddle. A dirty spatula lay resting on the griddle. The outside surface of the griddle was layered with dark and light debris; -The stainless steel backsplash of the range was dark with a buildup of debris; -Eight of eight ceiling vents, located above the food preparation areas, cooking surfaces, clean side of the dishwashing area, and clean dish storage, were all dirty with a buildup of fuzzy and dark debris; -The vent above the steamtable had a heavy buildup with debris that extended to four ceiling tiles surrounding the vent and 2 feet across one tile to the light fixture on the other side that was also above the steamtable. Observations on 3/19/19 at 8:15 A.M. showed the following: -The fryer baskets were hanging above the fryer with dark crispy debris stuck to them; -Where the baskets hung from the fryer there was a buildup of solid crumb-like debris; -The oil in the deep fat fryer appeared almost black in color; -Inside the vat of the fryer was a black buildup all across the stainless steel; -There was a heavy greasy buildup on the sides of, behind, underneath, and around the fryer; -The front of the fryer had white splatters across the surface; -The convection oven had a buildup of dark debris on the outside and inside surfaces; -The griddle was dark with debris, large chunks of solid debris littered the cooking surface of the griddle, a dirty spatula lay resting on the griddle. The outside surface of the griddle was layered with dark and light debris; -The stainless steel backsplash of the range was dark with a buildup of debris; -Eight of eight kitchen vents, located above food preparation areas, cooking surfaces, clean side of the dishwashing area, and clean dish storage, were all dirty with a buildup of fuzzy and dark debris; -The vent above the steamtable had a heavy buildup with debris that extended to four ceiling tiles surrounding the vent and two feet across one tile to the light fixture on the other side that was also above the steamtable. 2. Observations on 3/18/19 at 12:11 P.M. showed dishes were stacked wet. Drops of water dripped off the dishes and when separated, water was on the surfaces of the dishes. All dishes that were stacked were stacked wet. Staff placed the flatware in a utensil [MEDICATION NAME] while wet. Observations on 3/18/19 at 12:13 P.M. showed Dietary Aide FF rolled flatware without washing his/her hands or wearing gloves. He/she grabbed the flatware by the food contact surface and placed them on top of a napkin. Further observations showed the flatware was wet, causing the napkins to become saturated in some places. Staff then placed the damp flatware on a tray for food service. Observations on 3/18/19 between 12:31 P.M. showed staff placed food on the wet plates and bowls that had been stacked wet. The trays, plates, bowls, and napkin wrapped flatware were wet when used for the meal service. Observations on 3/18/19 at 12:37 P.M. showed Dietary Aide FF stopped wrapping flatware, got ice out of the ice machine, placed a milk container from the milk cooler into a container with the ice, and returned to wrapping the flatware without washing his/her hands and putting on gloves. |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0812 Level of harm – Minimal harm or potential for actual harm Residents Affected – Many | (continued… from page 85) Observations on 3/18/19 at 1:09 P.M. showed Dietary Aide SS began washing soiled flatware. He/she moved to the clean side of the dish machine, and without washing his/her hands and putting on gloves, touched the clean flatware on the food contact surfaces, and began wrapping the flatware in napkins while the flatware was still wet. Observations on 3/18/19 at 1:37 P.M. showed the flatware served on the test tray was soiled with chunks of solid debris. Observations on 3/18/19 at 4:03 P.M. showed Dietary Aide DD, without washing his/her hands and putting on gloves, wrapped flatware in napkins and touched the food contact surfaces of the flatware with his/her bare hands. Observations on 3/18/19 at 6:04 P.M. showed Dietary Aide DD, without washing his/her hands and wearing gloves, began wrapping plasticware and touched the food contact surfaces with his/her bare hands. During interview on 3/18/19 at 12:40 P.M., Dietary Aide SS said staff stacked the dishes when they were wet because there isn’t enough help to get all the dishes done and let them dry before more dishes are needed for meal service. 3. Observations on 3/18/19 at 11:58 P.M. showed the following: -Two boxes of juices sat on the floor of the walk-in refrigerator; -A stack of boxes 10 boxes high in the walk-in freezer were stacked from floor to ceiling. The bottom box sat directly on the freezer floor; -Two other boxes of food items sat directly on the freezer floor; -A large accumulation of ice on the freezer floor that measured approximately 2 feet by 4 feet and ice had formed in a mound that was approximately 6 inches high. Ice had formed on bags and boxes located within the freezer along with the shelving. Observations on 3/19/19 at 8:15 A.M. showed boxes were stacked on the floor in the dry food storage. Observations on 3/19/19 at 8:12 A.M. showed 12 crates of 50 cartons of milk each, sat out at room temperature. Observations on 3/19/19 at 8:36 A.M. showed the following: -Dietary Aide SS began putting the 600 cartons of milk in the milk cooler; -The milk had an internal temperature that measured to be 50 degrees Fahrenheit. During interview on 03/18/19 at 4:09 P.M., Dietary Aide CC said the freezer has had an ice accumulation in it for several weeks and no one has been able to clean it or anything else due to a lack of staffing. He/she said this was the same reason boxes were stacked on the floor. During interview on 3/19/19 at 11:07 A.M., Dietary Aide EE said truck came in at 7:30 A.M. and the milk and all the other boxes got stacked on the floor because there wasn’t enough staff to put the stuff away and cook. 4. Observations on 3/18/19 at 12:04 P.M. showed the reach-in refrigerator had remnants of what appeared to be a yellow liquid that was spilled as well as a dried puddle and splatters of blood-red substances. Above the staining was an opened tube of Braunschweiger (a pork liverwurst) that was undated. Observations on 3/18/19 at 12:08 P.M. showed the milk cooler had a large accumulation of dried solidified spilled milk that extended across most of the floor in either a pool or splatters. The spilled milk had turned yellow and green. Observations on 3/19/19 at 8:36 A.M. showed the milk cooler was still dirty with a buildup of old spilled milk at the bottom of the cooler. Observations on 03/18/19 at 12:09 P.M. showed scoops were stored in the large flour and sugar bins. The scoop handles were buried underneath the contents in the containers. 5. Observation on 3/18/19 at 11:44 A.M. showed four of five trash cans in the kitchen did |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0812 Level of harm – Minimal harm or potential for actual harm Residents Affected – Many | (continued… from page 86) not have lids on them. The trash cans were not in use. Observations on 3/18/19 at 4:05 P.M. showed four of five trash cans in the kitchen contained trash. The trash cans were not in use and were left uncovered. Observation on 3/18/19 at 4:16 P.M. showed the counter mounted can opener had a buildup of black and brown chunky debris along the blade. Then non-food contact surfaces had splatter and debris on them. Observations on 3/19/19 at 8:15 A.M. showed four of five trash cans in the kitchen did not have lids on them, food was being prepared, and the trash cans were not in use. Observations on 3/19/19 at 10:34 A.M. showed four of five trash cans were uncovered and not in use. 6. Observations on 3/18/19 at 4:21 P.M. showed the dish machine in the kitchen utilized chemical sanitizer to sanitize the dishes. The container of sanitizer that supplied the dish machine and the container of washing agent that supplied the dish machine were both empty. During interview on 3/18/19 at 4:24 P.M., Dietary Aide DD said they were out of sanitizer until the truck delivered more on 3/19/19. Observations on 3/18/19 at 4:22 P.M. showed staff washed dishes in the dish machine. The dish machine had run out of both soap and sanitizer. Further observations showed the water temperature in the dish machine (as observed on the temperature dial on the machine) did not get above 110 degrees Fahrenheit. During interview on 03/18/19 at 6:15 P.M., Dietary Aide DD said the dish machine water was coming out ice cold. 7. Observations on 3/18/19 at 12:00 P.M. showed the following; -Two large cans of tomato salsa had deep, angled dents along the lip of the cans; -A 4-pound, 2.5 ounce can of tuna had a long dent and fold along the lip; -A large can of kidney beans had a large dent along the lip; -A large can of butterscotch pudding had a 2 inch dent along the lip. 8. Observations on 3/18/19 between 5:45 P.M. and 7:00 P.M. showed Dietary Aide TT had facial hair and served the supper meal without wearing a beard restraint. 9. During interview on 3/19/19 at 11:39 A.M., Dietary Aide HH said there used to be a cleaning list and chores to complete in the kitchen, but with such little staff, there aren’t enough people to get things done so something had to fall off in order to get the residents fed. | |
F 0814 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | Dispose of garbage and refuse properly. Based on observation and interview, the facility failed to ensure the dumpsters, utilized |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0814 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 87) Observations on 3/19/19 at 11:10 A.M. showed all three dumpsters contained bags of trash and were not covered. Observations on 3/19/19 at 4:09 P.M. showed all three dumpsters contained bags of trash and were not covered. Large pieces of refuse including boxes, bags, and paper were littered along the grounds, east of the dumpsters. Observations on 3/19/19 at 7:40 P.M. showed all three dumpsters contained bags of trash and were not covered. During interview on 3/20/19 at 1:42 P.M., Dietary Aide CC said the dumpsters were always open; it makes it easier to take out the trash. | |
F 0842 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0842 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 88) -Dakin’s Solution, apply to coccyx wound topically every 12 hours for coccyx wound. Start date 3/1/19 at 9:00 P.M.; -Scheduled for 9:00 A.M. and 9:00 P.M.; -3/1/19 at 9:00 P.M., treatment blank (blank indicates treatment not completed); -3/2/19 at 9:00 A.M. and 9:00 P.M., treatment blank; -3/3/19 at 9:00 P.M., treatment blank; -3/6/19 at 9:00 P.M., treatment blank; -3/7/19 at 9:00 P.M., treatment blank; -3/11/19 at 9:00 A.M. and 9:00 P.M., treatment blank; -3/12/19 at 9:00 P.M., treatment blank; -3/15/19 at 9:00 A.M. and 9:00 P.M., treatment blank. -3/16/19 at 9:00 P.M., treatment blank; -3/17/19 at 9:00 P.M., treatment blank; -3/18/19 at 9:00 A.M., treatment blank. Record review of the resident’s same TAR on 3/20/19 at 5:56 P.M., showed the previous missing documentation on the (MONTH) 2019 TAR, 14 treatments total, were documented as completed by Licensed Practical Nurse (LPN) QQ. During interview on 3/21/19 at 9:28 A.M., LPN M said the initials on the TAR for the dates that were previously blank belonged to LPN QQ. He/She thought LPN QQ’s last day of employment was a couple weeks ago around 3/8/19. During interview on 3/21/19 at 9:50 A.M., Registered Nurse (RN) R said the initials on the TAR belonged to LPN QQ and that he/she no longer worked at the facility and had been gone for a couple of weeks. During telephone interview on 3/21/19 at 10:51 A.M., 12:32 P.M. and 5:01 P.M., LPN QQ said the following: -He/she worked the floor on 3/4/19 on the evening shift and had to stay over to cover the next shift due to a Certified Nurse Aide (CNA) called in. He/She did not get out of the facility until 4:00 A.M. to 4:30 A.M. on 3/5/19. (MONTH) 4, 2019 was the last shift he/she worked at the facility; -He/She has not returned to the facility since 3/4/19; -He/She has not signed into the facility’s Electronic Medical Record from outside the facility and signed off on any resident’s TARs regarding treatments being completed. During interview on 3/21/19 at 2:13 P.M., unit manager/LPN W said TARs can be charted on late, but it will show late if charted late. Record review of the facility Signature List provided by the facility on 3/21/19 at 6:07 P.M. showed there was only one set of initials matching the initials on the TAR for the holes that had been previously blank and those initials belonged to LPN QQ. During interview on 3/22/19 at 3:53 P.M., the Director of Nurses (DON) said the following: -Staff should document on the TAR when a dressing change is completed; |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0842 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 89) -If a treatment is not done, then it should be documented as such; -She was not aware of anyone having access to another staff member’s login on the computer, she only has access to her computer login. | |
F 0850 Level of harm – Minimal harm or potential for actual harm Residents Affected – Many | Hire a qualified full-time social worker in a facility with more than 120 beds. Based on interview and record review, the facility failed to employee a full time Social |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0850 Level of harm – Minimal harm or potential for actual harm Residents Affected – Many | (continued… from page 90) resident population; -Other support services (dietary, activities/recreational, social, therapy, environmental, etc) are adequately staffed to ensure that resident needs are met. 3. Record review of the facility assessment tool completed by the administrator dated 2/15/19, showed the following: -Average daily census was 84; -In addition to nursing staff other staff needed for behavioral healthcare and services included Social Services Director. 4. During interview on 03/21/19 at 12:00 PM the administrator said the following: -The facility did not currently employ a full time SSD; -The SSD walked out and left a mess; -The SSD’s last day of employment was 3/3/19. 5. During an interview on 3/17/19 at 1:10 P.M. Resident #39 said the following: -The facility had been through multiple administrators in the last year and terminated the SSD a few weeks ago. He/she did not have anyone tell his/her concerns to and if he/she did report concerns to nursing staff and/or the administrator they did nothing about them. During an interview on 3/17/19 at 3:05 P.M., . Resident #29’s family member said the following: -The resident had needed assistance with transportation to physician appointments six times since admission 12/31/18 and had only received help twice; -The resident needs to see the podiatrist and dentist and the facility had no one to assist with making those appointments, he/she had told the nurses over a month ago and nothing had been done. During an interview on 3/17/19 at 6:34 P.M., Resident #46 said the following: -He/she had wanted to see dentist due to a broken tooth and an ENT (ear, nose, and throat) physician because he/she was having difficulty hearing; -He/she had informed staff of these requests about one to two months ago, but nothing had ever been done. During an interview on 3/19/19 at 10:00 A.M. Resident #43 said: -He/she had been without bottom dentures since (MONTH) (YEAR); -He/she had reported the loss of his/her dentures to the previous SSD, nursing staff, and administrator; -He/she continued to report the loss of his/her dentures to the new administrator and nursing staff but the facility did not have a SSD to report to and had not had an SSD to report to for several weeks; -He/she also needed his/her hearing aids that he/she had been tested for in the facility in (MONTH) (YEAR); -He/she had difficulty hearing and had to try to read peoples’ lips; -His/her mouth hurt and he/she could not eat meats and certain foods because he/she did not have his/her bottom dentures; -It frustrated and made him/her sad that staff were not helping him/her get his/her hearing and dentures; -He/she had been reporting to staff his/her need for bottom dentures and hearing aids for months. During an interview on 3/21/19 at 11:30 A.M. Resident #43’s family member said the following: -The resident had been without his/her bottom dentures since (MONTH) (YEAR); -He/she had reported the resident’s missing dentures and desire to get new dentures to the previous SSD, the administrator, and to staff back in (MONTH) (YEAR) and finally two weeks |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0850 Level of harm – Minimal harm or potential for actual harm Residents Affected – Many | (continued… from page 91) ago he/she reported the issue to the DON; -He/she did not feel the previous SSD, administrator, and/or other staff listened to the resident or followed up on the resident’s concerns; -The resident has a sore mouth from eating food without his/her bottom dentures and cannot eat certain food because he/she did not have dentures; -The previous SSD assisted the resident in getting tested for a hearing aid back in (MONTH) (YEAR). The hearing test showed the resident needed hearing aides. He/she has reported the resident’s need for hearing aides to the facility staff but nobody has followed up on it; -He/she had even given the administrator and nursing staff a copy of the correspondence letter with the hearing aid company that outlined what was needed from the facility for the resident to receive hearing aids but the staff still have not provided the information to allow the resident to get hearing aids. Review of Resident 43’s correspondence with the hearing aid company dated (MONTH) 13, (YEAR) showed the hearing aid company sent a letter outlining the benefit and needed information for the resident to get hearing aids. MO 7 | |
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: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0880 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 92) site during resident care, after contact with the resident’s skin, after contact with blood or bodily fluids, after removing gloves; -Hand hygiene is the final step after removing and disposing of personal protective equipment. 2. Review of the Nurse Assistant in a Long-Term Care Facility manual, 2001 revision, showed the following: -Handwashing is the single most important means of preventing the spread of infections; -Wash hands before and after contact with residents; -Always wash hands for at least 15 seconds before and after glove use. 3. Review of Resident #5’s care plan, updated 12/13/18, showed the following: -The resident will have all of his/her basic needs met with staff assistance; -Assist times one for elimination care needs; -Extensive assistance with bathing needs; -Limited assistance with toileting needs to assure proper hygiene during toileting; -Keep clean and dry. Review of the resident’s quarterly Minimum Data Set (MDS), a federally mandated assessment instrument required to be completed by facility staff, dated 3/13/19, showed the following: -Extensive assistance of one staff for toileting; -Limited assistance of one staff for personal hygiene; -Frequently incontinent of bowel and bladder. Observation on 3/19/19 at 05:52 A.M., showed the following: -The resident lay in his/her bed on his/her left side; -CNA L entered the room, washed hands and applied gloves; -CNA L removed wipes from a package, placed them in a trash bag and applied peri-wash to the wipes and then placed the trash bag on the resident’s bed; -CNA L assisted the resident to lay on his/her back; -The resident was incontinent of bowel and bladder; -CNA L provided perineal care to the resident’s front genitalia, removing a clean wipe from the trash bag and after use, placing it in another trash bag on the resident’s bed; -Without removing his/her gloves or washing his/her hands, CNA L assisted the resident to roll to his/her left side, touching the resident’s right hip and shoulder areas with soiled gloved hands; -CNA L cleansed the resident’s buttock and rectal area, reaching in the trash bag with his/her soiled gloves to get clean wipe and then placing the soiled wipe in the dirty trash bag; -Without removing his/her gloves or washing his/her hands, CNA L picked up a clean incontinence brief, tucked it behind the resident, assisted the resident to roll to his/her right side, cleansed the resident’s left hip/buttock area, untucked the left side of the clean incontinence brief, assisted the resident to roll to his/her back and secured the clean incontinence brief; -With the same soiled gloves, CNA L gathered the resident’s clean clothing, dressed the resident and transferred the resident to his/her wheelchair; -CNA L removed his/her gloves, placed the gloves and the remaining wipes from the clean trash bag down into the soiled trash bag, and without washing his/her hands, combed the resident’s hair and applied a stocking cap; -With the same soiled hands, CNA L made the resident’s bed, gathered the trash bag, tying it closed, and held the trash bag in his/her left hand while assisting the resident to the day area by pushing his/her wheelchair with his/her soiled hands; |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0880 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 93) -CNA L carried the trash bag to the dirty utility room and washed his/her hands. 4. Review of Resident #28’s annual MDS, dated [DATE], showed the following: -Frequent incontinence of bowel and bladder; -Extensive assistance of one staff for toileting and hygiene needs. Review of the resident’s care plan, updated 11/12/18, showed the following: -The resident was limited in ability for all ADL’s and required the assist of one staff; -Extensive assistance with grooming, toileting, hygiene, incontinence cares and bathing needs, both upper and lower body; -At risk for pressure ulcers due to frequent incontinent episodes and the need for extensive assist from staff; -Receives daily diuretics; -Staff to ensure resident remains clean and dry. Observation on 3/19/19 at 6:06 A.M. showed the following: -The resident lay in bed on his/her back; -CNA L entered the room, washed his/her hands and put on gloves; -CNA L removed wipes from a package, placed them in a trash bag and applied peri-wash to the wipes and then placed the trash bag on the resident’s bed; -CNA L removed the resident’s urine saturated incontinence brief, placing it in a trash bag on the resident’s bed; -CNA L obtained a clean wipe from the trash bag and cleansed the resident’s right groin crease with an upward stroke and then used the same soiled wipe to cleanse the left groin crease before placing the soiled wipe in the dirty trash bag; -CNA L assisted the resident to roll to his/her left side touching the resident’s right hip and shoulder areas with his/her soiled gloves; -CNA L reached into the trash bag to remove a wipe and cleansed the resident’s buttock and rectal area and placed with wipe in the dirty trash bag; -Without removing his/her gloves, CNA L picked up a clean incontinence brief, tucked it behind the resident, assisted the resident to roll to his/her right side, untucked the left side of the incontinence brief, assisted the resident to roll to his/her back and secured the clean incontinence brief; -With the same soiled gloves, CNA L gathered the resident’s clean clothing and assisted the resident in dressing and transferred the resident to his/her wheelchair; -CNA L removed his/her gloves, placed them and the remaining wipes from the clean trash bag down into the soiled trash bag, did not wash his/her hands with soap and water and combed the resident’s hair; -CNA L made the resident’s bed, gathered the trash bag, tying it closed, and held the trash bag in his/her left hand while assisting the resident to the day area off by pushing the resident’s wheelchair with his/her soiled hands; -CNA L took the trash bag to the dirty utility room and washed his/her hands. During interview on 3/19/19 at 6:25 A.M., CNA L said the following: -He/she had been a CNA for over a year; -He/she had been trained on proper handwashing; -He/she should wash his/her hands when he/she enters resident rooms; -He/she should replace gloves when they become soiled; -He/she should wash his/her hands after providing care; -He/she should wash his/her hands before touching clean items. 5. Review of Resident #71’s care plan last revised 2/8/19 showed the following: -Resident required assistance with ADLS; -Dependent on staff for incontinent cares, dressing and bathing; |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0880 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 94) -Required extensive assistance of one or two staff for personal grooming; -Required gait belt and two staff assistance for transfers; -Incontinent of bowel and bladder. Review of the resident’s quarterly MDS dated [DATE] showed the following: -Severe cognitive impairment; -Extensive assistance of two staff for personal hygiene and bed mobility; -Dependent on two or more staff for transfers; -Always incontinent of bowel and bladder. Observation on 3/19/19 at 6:45 A.M. showed the following: -CNA J and CNA RR entered the resident’s room; -The resident lay in his/her bed; -CNA J and CNA RR applied gloves; -CNA RR pulled the resident’s covers back; -The resident was visibly soiled from middle of his/her back to his/her knees in urine; -The resident’s sheets were visibly saturated through to the mattress; -CNA RR rolled the soiled sheets under the resident; -With same soiled gloves CNA RR turned the resident toward him/her holding onto the resident’s arm and back; -CNA J removed the soiled sheets; -With the same soiled gloves CNA J put a clean sheet under the resident; -The resident’s bed had visible wet and dried rings on it and smelled of urine; -CNA RR provided perineal care; -With the same soiled gloves CNA J and CNA RR turned the resident from left to right and put the sheet and clean brief under the resident. CNA RR secured the brief; -CNA J changed his/her gloves without washing hands; -CNA J put the resident’s pant on the bed; -With the same soiled gloves CNA RR assisted with putting the residents pants on the resident, touching the clean clothes and the resident’s legs, hips, back and arms. During an interview on 3/19/19 at 10:35 A.M. CNA J said; -He/she normally washed his/her hands and changed his/her gloves when they became soiled; -He/she forgot to change gloves and wash his/her hands; -He/she made the resident’s bed and did not clean the mattress; -The resident’s mattress was visibly soiled with urine and he/she should have cleaned it prior to making the bed. During an interview on 3/19/19 at 10:40 A.M. CNA RR said the following; -He/she should have washed his/her hands and changed his/her gloves after cleaning the resident; -He/she was rushing and forgot to change his/her gloves and wash his/her hands. During interview on 3/22/19 at 3:53 P.M., the director of nursing (DON) said she expected staff change gloves or use alcohol hand sanitizer when their hands became dirty. 6. Review of the Assure Platinum glucometer manufacturer’s guidelines, showed the following for the Cleaning and Disinfecting Procedures: -Two disposable wipes will be needed for each cleaning and disinfecting procedure, one wipe for cleaning and a second wipe for disinfecting; -Cleaning: Wear appropriate protective gear such as disposable gloves; -Open the cap of the disinfectant container and pull out one towelette and close the cap; -Wipe the entire surface of the meter three times horizontally and three times vertically using one towelette to clean blood and other body fluids; -Dispose of the used towelette in a trash bin. The meter should be cleaned prior to each |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0880 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 95) disinfection step; -No actual drying of the meter is necessary before starting the disinfecting procedure; -Disinfecting: Pull out one new towelette and wipe the entire surface of the meter three times horizontally and three times vertically using a new towelette to remove blood-borne pathogens; -Dispose of the used towelette in a trash bin; -Allow exteriors to remain wet for the corresponding contact time for each disinfectant; -After disinfection, the user’s gloves should be removed to be thrown away and hands washed before proceeding to the next patient. 7. Review of Resident #77’s electronic medical record (EMR) showed the following: -[DIAGNOSES REDACTED]. -Accucheck (a quick check for the amount of glucose in the blood) four times a day. Observation on 3/19/18 at 5:10 A.M., showed the following: -RN PP picked the glucometer off the medication cart and carried the glucometer into Resident #77’s room; -RN PP sat the glucometer on the resident’s bed; -RN PP checked the resident’s blood glucose by sticking the resident’s finger with a lancet, obtaining a drop of blood and applying the drop to the test strip in the glucometer; -RN PP held the glucometer, used lancet, and used alcohol swab in one hand; -RN PP carried the glucometer and used supplies out of the resident’s room to the medication cart; -RN PP threw the used lancet and glucose strip in the sharps dispenser, threw the alcohol swab in the trash and placed the lactometer on top of the medication cart; -RN PP pushed the medication cart to Resident #69’s room. 10. Review of Resident #69’s EMR showed the following: -[DIAGNOSES REDACTED]. -Accucheck before meals. Observation on 3/19/18 at 5:15 A.M., showed the following: -RN PP picked up the same glucometer he/she used on Resident #77 without cleaning it and carried the glucometer into Resident #69’s room. RN PP laid the glucometer on the arm of the resident’s chair; -RN PP checked the resident’s blood glucose with the glucometer and disposable one use lancet; -RN PP held the glucometer, used lancet, and used alcohol swab in one hand; -RN PP carried the glucometer and used supplies out of the resident’s room to the medication cart; -RN PP threw the used lancet and glucose strip in the sharps dispenser, threw the alcohol swab in the trash and placed the glucometer on top of the medication cart; -RN PP pushed the medication cart to Resident #53’s room. 11. Review of Resident #53’s EMR showed the following: -[DIAGNOSES REDACTED]. -Accucheck four times a day. Observation on 3/19/18 at 5:23 A.M., showed the following: -RN PP picked the dirty glucometer up off the medication cart and carried the glucometer into Resident #53’s room and laid the glucometer on the resident’s bed; -RN PP cleaned the resident’s finger; -The resident said no and closed his/her fingers into a fist; -RN PP said ok, he/she would come back later; |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265319 |
| (X3) DATE SURVEY COMPLETED | |||||||
NAME OF PROVIDER OF SUPPLIER PARKLANE CARE AND REHABILITATION CENTER | STREET ADDRESS, CITY, STATE, ZIP 401 MAR-LE DRIVE | |||||||||
For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
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F 0880 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 96) -RN PP picked the glucometer up off the resident’s bed and carried the glucometer to the medication cart; -RN PP placed the glucometer on top of the medication cart. During interview on 3/19/19 at 7:35 A.M., RN PP said the following: -He/she forgot to clean the glucometer in between residents; -He/she normally cleaned the glucometer with an alcohol swab; -He/she did not think he/she needed a barrier between the glucometer and the resident’s personal belongings; -He/she should have cleaned the medication cart in between resident’s with an alcohol swab too but he/she forgot. 12. During interview on 3/22/18 at 3:50 P.M., the Director of Nurses (DON) said the following: -She expected staff to clean the glucometer before and after every use with a sani cloth; -He/she expected staff to use a barrier of some sort before placing any equipment or supplies on any of the resident’s personal belongings; -Alcohol was not appropriate for cleaning equipment including glucometers. | |
F 0908 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | Keep all essential equipment working safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** | |