| 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: 265693 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER REDWOOD OF INDEPENDENCE | STREET ADDRESS, CITY, STATE, ZIP 1800 S SWOPE 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) | |
|---|---|---|
| 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: 265693 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER REDWOOD OF INDEPENDENCE | STREET ADDRESS, CITY, STATE, ZIP 1800 S SWOPE 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) | |
|---|---|---|
| F 0550 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 1) underwear on the resident. During an interview at 5/8/19 at 2:02 P.M., CNA A said: – The resident just needed staff to wipe him/her after he/she went to the bathroom; – Sometimes the resident was wet and sometimes not, the resident was happy if he/she was not wet; – The resident knew what he/she meant when he/she pointed to the wall and then pointed for the resident to roll the other way. It was just the way he/she communicated, especially early in the morning; – He/she had not thought about how the resident felt when he/she put someone else’s underpants on him/her That would be nasty, but at least he/she put a pad between the resident and the underwear. During an interview on 5/14/19 at 1:28 P.M., the resident said: – He/she had started having to pee more in bed than he/she ever wanted to. If staff would come and help him/her out of bed, he/she would be able to use the bathroom; – It hurt him/her to try and hold the pee so long and after an hour or so, he/she just had to let it go and pee on him/herself; – I don’t like it, but they tell me I am not the only one on the hall they need to help. – He/she did not like having someone else’s underwear on; – CNA A doesn’t speak to me, he/she just gestures. The resident said when he/she points at the wall, he/she was supposed to turn that way; – It would nice to wake up and look forward to a smiling face and a kind word from who is helping you; He/she tried to be understanding that the CNAs had a lot of work to do. 3. Review of Resident #46’s Minimum Data Set (MDS), a federally mandated assessment instrument completed by facility staff, dated 3/9/19, showed: – Difficulty making daily decisions; – Required assistance of staff for toilet use and personal hygiene; – Indwelling catheter and frequently incontinent of bowel; – [DIAGNOSES REDACTED]. Observation on 5/14/19 at 10:11 A.M., showed the resident lay in bed with a supra-pubic catheter (a urinary catheter that is inserted into the abdominal wall and into the bladder). The resident wore a shirt and jeans with suspenders. After CNA A finished cleaning the resident’s catheter, he/she flicked his/her wrist and pointed to the wall. The resident rolled over to the wall so CNA A could adjust the resident’s shirt, jeans and suspenders. During an interview on 5/14/19 at 4:00 P.M., the Director of Nurses said: – Staff should talk with the resident’s while they provide care, it let the resident know what they were doing; – Unless a resident could only communicate with sign language, it was not acceptable for staff to use sign language and not speak to them; – Staff should use the resident’s own clothes to dress them. 4. Review of the undated facility policy titled Dining Service Standards showed: |
| 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: 265693 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER REDWOOD OF INDEPENDENCE | STREET ADDRESS, CITY, STATE, ZIP 1800 S SWOPE 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) | |
|---|---|---|
| F 0550 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 2) – Four staff members sitting with residents assisting residents with eating, including Resident #5, each at different tables; – The four staff members were engaged in conversation amongst themselves regarding getting their (the staff’s) hair done, as well as staff assignments; – The staff were not talking with the residents. 6. During a group interview with 15 resident on 5/9/19 at 10:05 A.M. all of the resident said they are not treated with dignity and respect from facility staff. 7. During an interview on 5/14/19 at 4:00 P.M. the Director of Nursing (DON) said: – Staff assisting with feeding should not being about other things and should be talking to the residents. | |
| F 0584 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | 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. Based on observation and interview, the facility failed to ensure they provided a safe, | |
| F 0607 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | Develop and implement policies and procedures to prevent abuse, neglect, and theft. Based on record review and interview the facility failed to ensure they provided the dates |
| 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: 265693 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER REDWOOD OF INDEPENDENCE | STREET ADDRESS, CITY, STATE, ZIP 1800 S SWOPE 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) | |
|---|---|---|
| F 0607 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 3) – Prior to employment or commencement of a contract, the facility will verify and document or obtain a copy, if applicable, of the following information that may include, but no limited to: – A previous and/or current employer regarding work history, allegations of abuse against resident, employee or others; – Criminal Background Checks; – National Sex Offender Public Website; – Office of Inspector General Exclusion Screening; – State exclusion screening, if applicable; – Current Licenses and Certifications; – References; – Disclosure of information (i.e. self-disclosure of any criminal convictions or actions that exclude them from any government healthcare program). 1. Review of Dietary Staff E’s employee file showed: – Hire date 4/30/19; – An NA registry check was found, with no findings, in the file but it did not have a date when the check was completed. 2. Review of CNA A’s employee file showed: – Hire date 4/5/19; – An NA registry check was found, with no findings, in the file but it did not have a date when the check was completed. 3. Review of CNA C’s employee file showed: – Hire date 4/24/19; – An NA registry check was found, with no findings, in the file but it did not have a date when the check was completed. 4. During an interview on 5/14/19 at 10:39 A.M. the Administrator said: – Human Resources (HR) was responsible for completing NA checks; – They were supposed to be completed prior to employment; – The previous HR person was responsible for the checks not having the dates on them. | |
| F 0636 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months. Based on observation, interview and record review, the facility failed to complete |
| 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: 265693 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER REDWOOD OF INDEPENDENCE | STREET ADDRESS, CITY, STATE, ZIP 1800 S SWOPE 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) | |
|---|---|---|
| F 0636 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 4) -No restraints used. Review of the resident’s care plan, last updated on 4/2/19, showed: -Able to make his/her own choices; -Required total assistance for transfers using a mechanical lift; -Used an electric wheelchair for mobility; -At risk for falls; -Did not address the use of a wheelchair seatbelt. Review of the resident’s assessments showed staff completed no assessment during the past year for the use of a wheelchair seatbelt to determine if the seatbelt was safe or appropriate for use for this resident. Observation on 05/09/19 at 2:04 P.M. showed the resident in his/her electric wheelchair with a seatbelt fastened at the waist. Observation on 5/10/19 at 11:43 A.M. showed staff transferred the resident from bed to an electric wheelchair and fastened the seatbelt. The resident said she needed the seatbelt to prevent him/her from sliding, and it made him;her feel safer with it fastened. He/she said it did not restrain him/her because he/she could unfasten it any time he/she wanted. During an interview on 5/14/19 at 1:20 P.M., MDS staff A (MDSS A) said: -He/she normally did the MDS assessments for the express rehabilitation unit (ERU) rather than the long term side. -He/she searched the resident’s records and found no wheelchair seatbelt assessment since a date in (YEAR). -He/she found no care plan entry related to use of a wheelchair seatbelt. -The charge nurses completed assessments for use of devices with the potential to be a restraint. -MDS staff entered a prompt in the computer that showed up on the nurses’ computer screen on the date the assessment was due, and the assessment was completed by the charge nurse who worked that day. During an interview on 5/14/19 at 1:32 P.M., the MDS coordinator (MDSC) said: -Use of a wheelchair seatbelt should be assessed by nursing staff, and possible therapy, as well. -Approximately five to seven days prior to the MDS assessment review date, MDS staff opened a trigger in the computer system that showed up on nursing staff’s dashboard (computerized screen) that prompted them to complete the required assessments. -He/she expected an assessment to be done quarterly and as needed related to the use of a device that could potentially be a restraint. -Use of a wheelchair seatbelt should be included in the care plan. During an interview on 5/14/19 at 4:00 P.M., the director of nurses said: -Staff should assess use of wheelchair seatbelts annually and with a significant change to ensure it is not a restraint and the resident can still self-release it. -Use of a wheelchair seatbelt should be included in the care plan. | |
| F 0656 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | Develop and implement a complete care plan that meets all the resident’s needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** |
| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265693 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER REDWOOD OF INDEPENDENCE | STREET ADDRESS, CITY, STATE, ZIP 1800 S SWOPE 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) | |
|---|---|---|
| F 0656 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 5) used residents’ comprehensive assessments to develop, implement and update each resident’s comprehensive, person-centered care plan that included measurable objectives and time frames to meet each resident’s medical, nursing, mental and psychosocial needs for four out of 24 sampled residents (Residents #62,# 51, #5, #47. The facility census was 106. 1. Review of Resident #62’s quarterly Minimum Data Set (MDS), a federally mandated assessment instrument completed by facility staff, dated 3/19/19, showed: -Total dependence on staff for transfers; -Used a wheelchair for mobility; -No falls; -Used no restraints. Resident’s medical records from (MONTH) (YEAR) through (MONTH) 2019 showed no assessments related to the use of a wheelchair seatbelt. Review of the resident’s care plan, last revised on 4/2/19, showed: -Required use of a mechanical lift for transfers; -Used an electric wheelchair for mobility; -Did not address the use of a wheelchair seatbelt. Observation on 5/09/19 at 2:04 P.M., showed the resident in his/her electric wheelchair with a seatbelt secured across his/her waist. Observation on 5/10/19 at 11:43 A.M., showed staff transferred the resident from bed to his/her electric wheelchair and the resident secured a seatbelt across his/her waist. The resident stated that he/she needed the seatbelt as he/she tended to slide and it made him/her feel safer with it fastened. The resident said he/she could unfasten it any time he/she wanted. During an interview on 5/14/19 at 1:20 P.M., MDS staff (MDSS) A said he/she found no assessment for use of the resident’s wheelchair seatbelt since (YEAR), and found nothing in the resident’s care plan related to use of a wheelchair seatbelt. During an interview on 5/14/19, at 1:32 P.M., the MDS coordinator (MDSC) said he/she expected quarterly assessments related to the use of a restraint or device that could potentially be a restraint, and use of that device should be included in the resident’s care plan. 2. Review of Resident # 51’s quarterly MDS dated [DATE] showed: – IV Antibiotics for MDRO (multi-drug resistant organism) – On [MEDICATION NAME] due to yeast infection Review of the Resident’s current care plan on 5/14/19 for Urinary Catheter or UTI (urinary track infection)., showed the resident received IV antibiotics and has a Urinary Tract Infection due to (Escherichia coli (abbreviated as E. coli) are bacteria found in the environment, foods, and intestines of people and animals and ESBL (Extended – Spectrum Beta -Lactamase); a bacteria not resolved with common antibiotics and are spread via direct and indirect contact with colonized/infected patients and contaminated environmental surfaces. Contact Isolation started 2/27/2019 (no discontinued date). Review of the resident’s current (MONTH) 2019 physician orders [REDACTED]. During an interview on 05/14/19 at 12:29 PM., MDS/Care Plan Coordinator B, said she was the MDS/Care Plan Coordinator for the Long Term Care residents. She went to training a couple of months ago and found out she needed to pull the 24 hour report daily so she could keep the care plans up to date. She had started pulling the 24 hour reports about a month ago but had not gotten the information carried over to the care plans. She was behind updating the resident’s care plan as well as the care plan of other residents. The resident’s care plan has not been updated. The resident has not received IV antibiotics or been on isolation precautions for a couple of months. She was unsure with the [MEDICATION |
| 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: 265693 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER REDWOOD OF INDEPENDENCE | STREET ADDRESS, CITY, STATE, ZIP 1800 S SWOPE 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) | |
|---|---|---|
| F 0656 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 6) NAME] order was discontinued. 3. Review of Centers of Disease Control and Prevention (CDC) Guideline for Isolation Precautions showed: – Healthcare personnel caring for patients on Contact Precautions wear a gown and gloves for all interactions that may involve contact with the patient or potentially contaminated areas in the patient’s environment. Review of Resident #5’s current care plan showed: – The resident was on antibiotic therapy with regards to a urinary tract infection and on contact isolation, precautions to prevent transmission of infectious agents, for Extended Spectrum Beta-Lactamase (ESBL) in urine. During an observation on 5/10/19 at 2:36 P.M. of wound care showed: – LPN E provided wound care, wearing gloves but did not wear a gown. Review of the resident’s (MONTH) 2019 physician order [REDACTED].>4. Review of Resident #47’s comprehensive MDS dated [DATE] showed: – Cognitively intact; -Indwelling catheter. Review of the resident’s care plan dated 5/3/19 showed the resident had a urinary catheter. The intervention included staff to monitor and document intake and output (I/O) as per facility policy. During an interview on 5/08/19 at 1:27 P.M. the resident said it was hard to get ice water at the facility. Observation at the same time showed no water was in the resident’s room, the resident’s water cup was empty. The resident had fruit punch served with lunch but said the facility staff knew he/she does not drink it. Observation on 5/10/19 at 8:51 A.M. showed: – The Resident yelled from his/her room that he/she needed some water, maintenance staff walked by the resident’s door at the time he/she yelled it, did not say anything to the resident. – At 8:55 A.M. the resident yelled again, I need some ice water; An unknown staff member in to the room asked if the resident had gotten his/her room tray, the resident said no and that he/she wanted some ice water, staff took the resident’s cup got ice from the storage closet and filled the resident’s cup at his/her sink. During an interview on 5/14/19 at 1:23 P.M. Regional Cooperate staff said the facility did not have I/O records for the resident and did not know why. 5. During an interview on 5/14/19 at 4:00 P.M. the Director of Nursing (DON) said: – Staff should provide fresh water/ice as desired at least each shift; – Care Plans should have been updated with regards to changes in the residents’ conditions, for example interventions, antibiotic therapy; – Care plans should have been followed. | |
| 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: 265693 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER REDWOOD OF INDEPENDENCE | STREET ADDRESS, CITY, STATE, ZIP 1800 S SWOPE 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) | |
|---|---|---|
| F 0658 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 7) medications at residents’ bedsides, failed to wrap the resident’s legs as ordered , which affected of six 24 sampled residents (Resident #4, #34, #85, #17, #51, and #86). The facility census was 106. 1. Review of the facility’s undated Blood Glucose Monitoring policy, showed: – Clean the site (finger) with alcohol and allow to dry completely. 2. Review of Resident #4’s current (MONTH) 2019, physician order [REDACTED]. – [MEDICATION NAME]100 units/milliliters (ml) Inject 10 units before meals. – The physician order [REDACTED].>Observation on 5/8/19 at 7:21 A.M.,showed Licensed Practical Nurse (LPN) A wiped the resident’s finger with an alcohol pad, waved his/her gloved hand over it a couple of times, pricked the finger with a lancet and used the the first drop of blood to test the resident’s blood sugar. Observation on 5/8/19 at 7:43 A.M., showed LPN A did not clean the port of the [MEDICATION NAME] kwikpen before he/she applied a new needle, drew up the ordered amount of insulin and without cleaning an area on the resident’s skin, administered it to the resident. During an interview on 5/8/19 at 10:38 A.M., LPN A said: – He/she should have cleaned the kwikpen port with alcohol before he/she put the new needle on and should have cleaned an area on the resident’s skin, but did not have any alcohol pads on his/her cart. During an interview on 5/14/19 at 4:00 P.M., the Director of Nurses (DON) said: – Staff should clean the port of the kwikpen with an alcohol pad before they applied a new needle. Should also clean resident’s skin with alcohol pad before administering an injection; – Staff should let the alcohol on the finger air dry, wipe away the first drop of blood and use the second drop for the blood sugar reading. 3. Review of the facility’s copy of the manufacturer’s guideline for Ilevro eye drops showed to gently shake the eye drop before use. The facility did not have a manufacturer’s guideline for Durazol eye drops. Review of www.drugs.com showed Durazol [MEDICATION NAME] eye drops, hold gentle pressure for one minute to prevent medication from entering the tear duct. 4. Review of Resident #34’s current May, 2019 physician order [REDACTED]. – [MEDICATION NAME] 0.005 % Instill one drop in left eye two times a day; – Ilevro Suspension 0.3 % Instill one drop in left eye two times a day. Observation on 5/8/19 at 8:12 A.M., showed Certified Medication Technician (CMT) C put on gloves, did not shake or roll the eye drop bottle, did not make a pouch with the left lower eye lid, instilled one drop of medication into the left eye, held pressure to the inner canthus (inner corner of the eye) for 15 seconds while the resident blinked. A drop of medication rolled down the side of the resident’s cheek. Observation on 5/8/19 at 8:42 A.M., showed CMT C did not wash or sanitize hands, put on gloves, did not shake or roll the eye drop bottle, instilled one drop in to the left eye and held pressure on the inner canthus for 23 seconds. During an interview on 5/919 at 9:43 A.M., CMT C said: – He/she should shake all medicated eye drops as the solution in the drops could separate and settle to the bottom; – He/she thought staff should hold pressure to the inner canthus for 30 seconds to a minute after they instilled the drop into the resident’s eye. During an interview on 5/14/19 at 4:00 P.M., the DON said: – Staff should shake or roll the eye drop medication before they administered the medication – Staff should apply gentle pressure to the inner canthus for 30 seconds to a minute after |
| 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: 265693 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER REDWOOD OF INDEPENDENCE | STREET ADDRESS, CITY, STATE, ZIP 1800 S SWOPE 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) | |
|---|---|---|
| F 0658 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 8) they administered the medication. 5. Review of the website https://www.[MEDICATION NAME].com/asthma/talking-to-you-doctor/how-to-use-the-inhaler.html showed to take [MEDICATION NAME] exactly as prescribed by the physician. It is important not to miss a dose or take more doses than prescribed. 6. Review of Resident #86’s (MONTH) 2019 physician order [REDACTED].>-[MEDICATION NAME] inhaler 80/4.5 (used to decrease inflammation and dilate air pathways in the lungs) inhale two times a day for breathing, ordered 4/15/19; -[DIAGNOSES REDACTED]. Observation on 5/8/19 at 11:36 A.M. showed LPN B administered one inhalation of [MEDICATION NAME], had the resident rinse his/her mouth with water and spit it out, then returned at 11:50 A.M. and administered a second inhalation of [MEDICATION NAME]. During an interview on 5/8/19 at 12:08 P.M., LPN B said the order directed to give two inhalations a day, so she administered two inhalations. Review of the resident’s (MONTH) 2019 Medication Administration Record [REDACTED] -[MEDICATION NAME] inhaler 80/4.5, inhale two times a day for breathing; -Administer at 8:00 A.M. and 8:00 P.M. -Staff documented that the resident received the inhaler twice a day 5/1/-5/8/19. During an interview on 5/14/19 at 4:00 P.M., the director of nurses said that staff should have clarified the [MEDICATION NAME] order with the physician. 7. Review of the facility’s undated medication administration policy showed that medications must be given to the resident by a licensed nurse or licensed independent practitioner, or as consistent with state law. Medications will not be left at the bedside. 8. Review of Resident #85’s admission Minimum Data Set (MDS), a federally mandated assessment instrument completed by facility staff, dated 2/27/19, showed: -Moderate cognitive impairment; -Required extensive staff assistance for transfers and toileting; -Required supervision and set-up assistance for eating; -Took medications that included antidepressants, blood thinners, diuretics and narcotic pain medications. Review of the resident’s (MONTH) 2019 physician order [REDACTED]. (for swelling. Observation on 5/7/19 at 9:59 A.M., showed the resident sat in a wheelchair in his/her room with a medication cup on the over-bed-table which contained seven pills, a second medication cup which was 1/2 full of a white liquid, and a third medication cup full of a golden colored liquid. The resident said staff left the medications while he/she was in the bathroom. During an interview on 5/14/19 at 4:00 P.M., the director of nurses (DON) said staff should not leave medications in resident rooms. 9. Review of Resident 17’s ‘ quarterly MDS showed: – BIM of 5 – impaired for decision making. – One person physical assist with bed mobility. – [DIAGNOSES REDACTED]. Observation and interview on 05/7/19 at 10:59 AM., showed Resident #17 asleep in bed. Multiple medications (pills) in a small plastic cup sat beside a small glass of liquid containing an unmixed powdery substance on the resident’s nightstand. The resident’s room-mate said the nurse sometimes leaves medications on his/her room-mates bedside table. His/her roommate is very confused. |
| 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: 265693 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER REDWOOD OF INDEPENDENCE | STREET ADDRESS, CITY, STATE, ZIP 1800 S SWOPE 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) | |
|---|---|---|
| F 0658 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 9) Review of the resident’s physician orders [REDACTED].>- [MEDICATION NAME] Tablets 5 MG one tablet each morning [MEDICAL CONDITION](high blood pressure). – [MEDICATION NAME] Light Packets 4 GM by mouth one time a day for diarrhea mix with 8 ounces of liquid. – [MEDICATION NAME] Capsules 1.5 MG give one capsule by mouth in the morning for dementia GIVE WITH FOOD. – Lactobacillus Tablet Give one tablet by mouth in the morning for supplement. – Multiple Vitamin Tablet – Give one tablet by mouth in the morning for supplement-wound healing. – Xarelto Tablets 10 MG give one table by mouth in the morning for anticoagulant. During an interview on 5/14/19 at 10:55 AM., the Assistance Director of Nursing (ADON) said staff should not leave medications on the resident’s bedside table and should not preset medications. Staff should go back a short time later and try to administer the mediations. 10. Review of Resident # 51’s quarterly MDS dated [DATE] showed: – BIMS score of 15 indicating resident has no impairment for decision making skills or memory loss. – Resident has occasional pain. Observation and interview on 05/08/19 10:53 AM., showed Resident # 51., sat in a wheelchair with loose wraps around both legs; a brown substance showed through one of the leg wraps. The resident said staff do not change his/her legs dressings per the physician orders. Some of the staff do not have a clue what they are doing and wrap them poorly and they fall down. He/she was a retired nurse and knew a thing or two about how to wrap a leg wound. Thank goodness he/she goes to the wound clinic or his/her legs would be in worse shape than they are. The facility has had several wound nurses’s and he/she has no idea who the wound nurse is at this time. Record review of physician orders [REDACTED]. Wound #2 Left Lower Leg Care of Wound: * Remove Dressing, Cleanse with soap & water or Wound Cleanser, Pat Dry – Apply Xeroform to weeping areas, cover with ABD Pad Wrap with 4 Layer compression (cotton, Kerlix, Ace, Coban) Change Dressings Mon/Wed/Fri one time a day every Mon, Wed, Fri for Wound Care Wound #1 Right Lower Leg Care of Wound: * Remove Dressing, Cleanse with soap & water or Wound Cleanser, Pat Dry – Apply Xeroform to weeping areas cover with ABD Pad wrap with 4 Layer compression (cotton, Kerlix, Ace, Coban) Change Dressings Mon/Wed/Fri one time a day every Mon, Wed, Fri for Wound Care Other Active 5/1/2019 09:00 4/30/2019. Review of the resident’s Treatment Administration Records (TAR) for (MONTH) showed the following orders and treatments to the resident’s legs. – Lower right Leg ( change dressing weekly on Wednesday and as needed): Dressing not marked as done on (MONTH) 3rd and (MONTH) 24th. – Lower left leg (change dressing weekly on Wednesday and as needed): Dressing not marked as done on (MONTH) 3rd and 24th Review of the Resident’s TAR for (MONTH) 2019 on 05/14/19 showed the following: Wound 1: Right lower leg change dressing Monday, Wednesday and Friday. Staff did not mark TAR to show dressing was changed on (MONTH) 3rd. Wound Treatment BLE (Both lower extremities) wound: Document compression wraps intact daily check every shift; Can be off for bath/shower care needs. Wrap with plastic protection BLE compression wraps. Staff did not mark that the wraps were in place on the day shift on (MONTH) 4th and 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: 265693 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER REDWOOD OF INDEPENDENCE | STREET ADDRESS, CITY, STATE, ZIP 1800 S SWOPE 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) | |
|---|---|---|
| F 0658 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 10) evening shift on (MONTH) 9, 10th, and 12th. During an interview on 5/14/19 at 4:00 P.M., the Director of Nurses said: – All treatments and monitoring ordered by the physician should be completed and documented. | |
| 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: 265693 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER REDWOOD OF INDEPENDENCE | STREET ADDRESS, CITY, STATE, ZIP 1800 S SWOPE 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) | |
|---|---|---|
| F 0677 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 11) During an interview on 5/8/19, at 2:02 P.M., CNA A said: – He/she wiped the front from top to bottom and wiped more times if the resident had pubic hair; – If there was no fecal material, it was okay to wipe back and forth in different directions. 3. Review of Resident #22’s MDS, dated [DATE], showed: – Unable to make daily decisions; – Required assistance of facility staff for toilet use and personal hygiene; – Frequently incontinent of bowel and bladder; – [DIAGNOSES REDACTED]. Review of the nurse’s note, dated 3/10/19, showed the physician ordered [MEDICATION NAME] (an antibiotic) 100 milligrams (mg) for a urinary tract infection. Review of the resident’s care plan, dated 3/21/19, showed: – Assist with toilet use and peri-care; – Monitor and document signs and symptoms of urinary tract infection. Observation and interview on 5/10/19, at 10:41 A.M., showed the resident in his/her wheel chair trying to get into the bathroom. CNA E provided peri-care in the following way: – He/she assisted the resident to remove his/her soiled brief and assisted him/her to the toilet; – While the resident sat on the toilet, CNA E reached between the resident’s legs and provided partial peri-care; – He/she assisted the resident to stand and wiped twice from the rectum to coccyx and one hand width on each buttock; – CNA E did not separate and thoroughly clean all perineal folds, inner legs or complete buttocks; – CNA E said the resident would not stand long enough to complete the peri-care. The resident might fall. 4. Review of Resident #62’s quarterly MDS, dated [DATE], showed: – Cognitively intact; – Required extensive assistance for personal hygiene; – Totally dependent on staff for toileting and bathing; – Incontinent of bowel and bladder. Review of the resident’s care plan, last revised on 4/2/19, showed: – Incontinent of bowel and bladder; – Clean peri-area with each incontinent episode; – Had moisture-associated skin damage to the groin and buttocks; – Required total assistance for toileting. Observation on 5/14/19, at 10:24 A.M., showed CNAs A and D provided incontinent care in the following manner as the resident lay in bed: – Both washed their hands and put on gloves. – CNA A unfastened the resident’s brief and wiped back and forth multiple times across the area between the resident’s groin areas, using the same moist wipe and same area of moist wipe. – Staff did not cleanse the groin areas or between the front genital skin folds. – CNA D turned the resident on his/her right side. – CNA A pulled out several moist wipes, folded them together, and used the same wipes and area of wipes to cleanse the buttocks and rectal areas as he/she wiped back and forth across the buttocks. – CNA D turned the resident on his/her back. |
| 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: 265693 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER REDWOOD OF INDEPENDENCE | STREET ADDRESS, CITY, STATE, ZIP 1800 S SWOPE 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) | |
|---|---|---|
| F 0677 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 12) – With the same gloves on, CNA A obtained several folded moist wipes and wiped between the resident’s front genital folds several times, using the same wipes and area of wipes each time. – Staff then dressed the resident and transferred him/her to a wheelchair. 5. During an interview on 5/14/19, at 4:00 P.M., the Director of Nurses said: – Staff should not use the same area of the wipe to clean different areas of the skin; – Staff should wipe away from the urethra, should wipe front to back; – Staff should clean every area that is touched by urine or fecal material; – Staff should cleanse the inner legs, thighs front and back also. 6. Review of the facility’s undated policy related to showering residents showed: – A shower/bath is given to residents to provide cleanliness, comfort and to prevent body odors. – Residents are offered a shower, at a minimum, once weekly, and provided per resident request. 7. Review of Resident #1’s annual MDS, dated [DATE], showed that it was very important for the resident to choose between a bath, shower or sponge bath. Review of the resident’s quarterly MDS, dated [DATE], showed: – Cognitively intact; – Required extensive assistance for toileting, personal hygiene and bathing; – Always incontinent of bladder and frequently incontinent of bowel. Review of the resident’s bathing documentation for (MONTH) 2019 showed: – Two different types of documentation forms (electronic documentation and paper skin monitoring/shower review sheets); – No documentation to show the resident’s preferred bathing choice; – Paper shower sheets documented one shower not taken with no other explanation (2/1/19), three received (2/13/19, 2/20/19 and 2/26/19), and two with was pulled or pulled to floor written on them. – Electronic documentation showed one bath/shower done on 2/12/19, and all other entries showed and X, a blank, or Not Applicable. Review of the resident’s bathing documentation for (MONTH) 2019 showed: – Two paper shower sheets which documented pulled (3/1/19) and refused (3/5/19). – Electronic documentation showed three refused baths/showers (3/5/19, 3/27/19 and 3/30/19) and the remaining dates showed an X, a blank, or Not Applicable. Review of the resident’s bathing documentation for (MONTH) 2019 showed: – No paper shower sheets; – Electronic documentation showed two baths/showers completed 4/19/19 and 4/26/19 and the remaining dates showed and X, a blank, or Not Applicable. Review of the resident’s bathing documentation for (MONTH) 1 through (MONTH) 8, 2019 showed: – No paper shower sheets; – Electronic documentation showed Not Applicable for 5/1/19, 5/4/19 and 5/8/19, and an X on all other dates. Review of the resident’s urine culture and sensitivity (lab showing specific bacteria identified and antibiotic specific to treating the bacteria), dated as collected on 5/1/19, showed the presence of E. coli (commonly found in the bowel) in sufficient amounts to indicate the probability of a urinary tract infection. Review of the resident’s care plan, last updated on 5/7/19, showed: – Had a urinary catheter; – Incontinent of bowel; |
| 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: 265693 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER REDWOOD OF INDEPENDENCE | STREET ADDRESS, CITY, STATE, ZIP 1800 S SWOPE 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) | |
|---|---|---|
| F 0677 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 13) – At risk for urinary tract infections; – Required assistance with bathing/showering and hygiene; – Did not indicate the resident’s bathing/showering preferences. Observation and interview on 5/8/19, at 1:06 P.M., showed and the resident said: – The resident had long hair that appeared greasy. – He/she should receive two showers or baths a week. – Staff offered him/her a shower yesterday, and the resident initially said he/she did not feel like taking one. The nurse encouraged him/her, so he/she then consented to take it, but it never happened. – This Friday, it would be two weeks since he/she had a bath/shower. – His/her hair was driving him/her crazy because it was so dirty and felt so bad. – He/she had a large bowel movement and really needed a good shower. – Staff tried to get him/her to take a bed bath, but he/she needed a good shower. – Staff told him/her that he/she would get a shower today, but he/she was still waiting. This occurred often. – The facility previously had a shower aide, but currently did not have one. 8. Review of Resident #14’s admission MDS, dated [DATE], showed: – Cognitively intact; – Very important to choose between a bath, shower or bed bath. Review of the resident’s quarterly MDS, dated [DATE], showed: – Cognitively intact; – Independent for transfers and ambulation; – Continent of bowel and bladder. The facility provided no bathing documentation for the resident for (MONTH) 2019. Review of the resident’s (MONTH) 2019 bathing documentation showed: – No paper shower sheets; – Electronic documentation showed the resident received a bath/shower on 3/12/19, 3/19/19 and 3/30/19, and refused a bath/shower on 3/16/19. Review of the resident’s (MONTH) 2019 bathing documentation showed: – One paper shower sheet for 4/22/19; – Electronic documentation showed the resident received a bath/shower on 4/6/19 and 4/17/19, refused a bath/shower on 4/27/19, and the remainder of dates showed a blank, and X or Not Applicable. Review of the resident’s bathing documentation for (MONTH) 1 through (MONTH) 8, 2019 showed: – No paper shower sheets; – Electronic documentation showed the resident received a bath/shower on 5/8/19 and the remaining dates showed either and X or Not Applicable. During an interview on 5/7/19, at 9:15 A.M., the resident said: – Staff do not provide showers as scheduled. – He/she sometimes received none, and other times received one a week. – When he/she, or other residents spoke up, then staff would do a couple of showers, then they stopped providing them again. – He/she also had to sleep in the same pissy bed for five days. Review of the resident’s care plan, last revised on 5/10/19, showed: – Required set-up assistance with bathing/showering; – Had moisture-associated skin damage under abdominal fold; – Did not indicate the resident’s bathing/showering preferences. 9. Review of Resident #49’s (MONTH) 2019 bathing documentation showed: |
| 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: 265693 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER REDWOOD OF INDEPENDENCE | STREET ADDRESS, CITY, STATE, ZIP 1800 S SWOPE 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) | |
|---|---|---|
| F 0677 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 14) – Paper shower sheets showed the resident received baths/showers on 2/1/19, 2/5/19, 2/12/19, 2/15/19, 2/19/19, 2/22/19 and 2/26/19. – Electronic documentation only documented the resident received baths/showers on 2/12/19, 2/19/19 and 2/26/19, and the remainder of the dates were either blank or showed Not Applicable. Review of the resident’s (MONTH) 2019 bathing documentation showed: – One paper shower sheet, dated 3/1/19; – Electronic documentation showed the resident received baths/showers on 3/5/19 and 3/27/19, and the remaining dates were either blank, showed an X or Not Applicable. Review of Resident #49’s quarterly MDS, dated [DATE], showed: – Cognitively intact; – Limited range of motion of one side of the lower extremities; – Required extensive assistance with toileting; – Required physical help with part of bathing; – Occasionally incontinent of bladder. Review of the resident’s (MONTH) 2019 bathing documentation showed: – No paper shower sheets; – Electronic documentation showed the resident received baths/showers on 4/3/19, 4/10/19, 4/24/19 and 4/27/19 and the remaining dates were either blank, showed an X or Not Applicable. Review of the resident’s care plan, last revised on 4/25/19, showed: – Occasionally incontinent of bladder; – Required extensive assistance with bathing/showering; – Did not indicate his/her bathing/showering preferences. Review of the resident’s bathing documentation dated (MONTH) 1 through (MONTH) 8, 2019 showed: – One paper shower sheet dated 5/7/19; – Electronic documentation showed the resident received a bath/shower on 5/8/19 and the remaining dates showed either an X or Not Applicable. During an interview on 5/7/19, at 11:51 A.M., the resident said he/she did not receive two showers a week and had to fight to get one a week. The facility did have a shower aide, but he/she did not know if there was a shower aide any longer. 10. Review of Resident #66’s quarterly MDS dated [DATE], showed: – Cognitively intact – One person physical assistance with toilet use, dressing and showers. – Uses Wheel-chair – Has an indwelling catheter. Review of the resident’s care plan, dated 4/29/19, showed the resident needs extensive assist with bathing, No preferences related to bathing was noted. Review of the resident’s (MONTH) 2019 bathing documentation showed: – One paper shower sheet, dated 3/1/19; – Electronic documentation showed the resident received baths/showers on 3/5/19 and 3/27/19, and the remaining dates were either blank, showed an X or marked Not Applicable. Review of the resident’s shower sheets and electronic records for (MONTH) and (MONTH) on 5/8/19 showed staff documented only one shower as given to the resident in the last 30 days. Staff documented a shower as given on 4/25/19. During an interview on 5/7/19, at 2:51 P.M., the resident said he/she needed a shower. He/she had asked and asked for a shower. The facility did away with shower aides. It has been at least two weeks since he/she received a shower. Staff mark baths as given 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: 265693 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER REDWOOD OF INDEPENDENCE | STREET ADDRESS, CITY, STATE, ZIP 1800 S SWOPE 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) | |
|---|---|---|
| F 0677 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 15) refused when they do not have time to give a shower. He/she was starting to smell; he/she uses the sink and a wash cloth to wash his/her face and arms, but he/she is unable to wash the bottom half of his/her body. He/she fell s dirty. He/she often has to take his/herself to the bathroom or empty his/her catheter bag. He/she is unable to clean his/herself up well after using the bathroom. Sometimes it take two hours for staff to respond to the call light so he/she can either poop his/her pants or take his/herself. He/she just needs a good shower so he/she does not stink. 11. Review of Resident #75’s admission (re-admission) MDS, dated [DATE], showed: – Cognitively impaired; – Has dementia and a mental health [DIAGNOSES REDACTED].>- Resident requires assistance of one for dressing, hygiene and bathing; – Resident uses a wheelchair or walker for mobility. Review of the resident’s bathing follow-up report showed the resident received a bath/shower on: – 4/1/19, 4/15/19, 4/18/19, and 4/29/19; – 5/2/19. During an interview on 5/7/19, at 11:05 A.M., Guardian/Family Member A said: – He/she had requested that the resident be bathed/showered daily for two weeks. – He/she is in the facility daily and would know when and if the resident received a shower. – The resident last showers was over two weeks ago. – The resident has an unpleasant body order. – He/she thinks staff mark showers as given when they run out of time and do not get their work done. During an interview on 5/10/19, at 1:50 PM., CNA J said if he/she is the only CNA on unit, he/she might get two showers done per day if he/she is lucky. He/she can only do them when the certified medication technician (CMT) is on the floor. He/she tells the charge nurse the showers were not done at the end of the shift but he/she does not document anything in the computer or on paper. During an interview on 5/14/19, at 8:40 A.M., CMT E said when showers are not given, staff should mark the shower as not given so the shower will pop up for the next shift to give the shower. Too many times, the CNAs mark not available when they (staff) are no available to give the showers, then the showers do not show up for the next shift to give the shower. Too many residents are not getting the showers they need. He/she often worked the floor when they are short-handed instead of passing medications or doing his/her paper work. There is just not enough staff to care for the residents. He/she cares and he/she is working way too many hours but there is no one else to do it. When staff fail to come to work and do not call in, it make it hard for the good employees; because they have to works doubles and extra hard to cover for the staff that did not show up. Observation and interview on 5/14/19, at 2:20 P.M., showed CNA G checking off tasks on the computer. He/she said he/she had a long list of showers that were supposed to be given today. He/she did not have time to do showers as he/she was busy helping with meals and resident care. He/she marked the showers as not available. He/she did not know if the shower marked not available would be triggered for someone to give the next shift or the next day. There was just to must to do and not enough help. It is impossible to get everything done. 12. During an interview on 5/10/19, at 7:35 A.M., the Administrator said: – A lot of staff quit due to not being able to meet job performance expectations and a few were dismissed. |
| 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: 265693 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER REDWOOD OF INDEPENDENCE | STREET ADDRESS, CITY, STATE, ZIP 1800 S SWOPE 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) | |
|---|---|---|
| F 0677 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 16) – She revamped the shower schedule in (MONTH) and put bathing in the electronic documentation system as a task and the process is on-going. – Corporate staff previously directed to quit using the paper shower sheets, but some staff continued to use them on a hit-or-miss basis. – The administrator directed to start using them again as of 5/1/19. – She runs an audit weekly to monitor bathing and had done this three or four times. – Residents should receive two baths/showers a week, although they have one resident who was care planned for one a week and that resident usually refused it. – The administrator looked at the electronic documentation for one resident but was unable to decipher what the bathing documentation meant and said she would e-mail another staff for an explanation. – She could not explain why some bath sheets and electronic documentation did not match and was not aware that some residents voiced that staff documented that they received or refused baths/showers when they did not receive or refuse them. – She stated that the current Director of Nurses (DON) had worked at the facility for about three weeks and the previous DON had quit without notice. During an interview on 5/14/19 at 4:00 P.M., the DON said: – Staff should offer residents at least two baths/showers each week. – Residents have a right to decline baths/showers and staff should care plan a resident’s preference to bathe less than two times a week. – Staff were to complete paper bath sheets and document bathing electronically. – She did not know what Not Applicable meant related to electronic documentation of bathing. – Staff run bathing reports each morning, and if a bath is noted as not done, then the resident should be offered one the next day. – The facility currently had an evening staff scheduled to do bathing. – They previously had a staff scheduled to do bathing on days, but not at this time. – The CNAs should be assigned to do baths/showers if there is no bath aide. – The nurse manager should follow-up if bathing is not documented, and if refused, staff need to find out why the resident is refusing it. | |
| 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. Based on observations, interview and record review, the facility failed to document 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: 265693 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER REDWOOD OF INDEPENDENCE | STREET ADDRESS, CITY, STATE, ZIP 1800 S SWOPE 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) | |
|---|---|---|
| F 0689 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 17) – When the resident stood up, CMT D pulled down his/her pants and briefs, but did not take them off, just left them around his/her ankles; – He/she was sitting on the side of the bed when CMT D turned his/her wheelchair on and started backing it up when the wheels caught his/her pants and briefs; -The resident told the staff to stop four times but was pulled off the bed and hit the floor; – Medical Records staff came in the next day and ask if he/she got hurt and he/she said no. Medical Records staff told the resident that CMT D said the cause of the fall was due him/her to being a fall risk; -Medical Records staff helped the resident fill out a grievance form and she turned it in to whomever handles the complaints, he/she saw her fill out grievance form; – When a nurse came in the next shift (unknown staff) he/she also told him/her the story of what happened; – The resident said he/she has fallen two times since living at the facility. Review of the Resident’s medical record did not show any documented falls. During an interview on 5/10/19 at 10:19 A.M. Medical Records staff said: – She thought the resident had a fall in the shower a couple months ago but did not recall when it happened, and did not complete a grievance about it. She said the resident came in and told her he had a fall but that was it. During an interview on 5/10/19 at 11:00 A.M. the Administrator said there is was not any reports of falls or incidents involving the resident. During an interview on 5/10/19 at 11:16 A.M. Registered Nurse LPN B said; – He/she knew the resident had fallen while living at the facility; – There was an incident a month or two ago in the resident’s bathroom or bedroom area but it was on the 500 Unit; – He/she did not recall any falls on the 800 hall, he/she not fallen with her with her, and was not sure if the falls were documented; – He/she did not recall if the resident said anything about a fall being due to actions of a staff member. During an interview on 5/14/19 at 4:00 P.M. the Director of Nursing (DON) said falls should be documented and investigated. | |
| 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: 265693 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER REDWOOD OF INDEPENDENCE | STREET ADDRESS, CITY, STATE, ZIP 1800 S SWOPE 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) | |
|---|---|---|
| F 0690 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 18) – Remove the leg strap and inspect the area for signs and symptoms of adhesive burns, redness, tenderness, blisters or open skin areas; – Cleanse the perineum from front to back and cleanse the outside of the catheter wiping away from the meatus; – Reattach the catheter to the leg strap. Ensure the catheter is properly anchored to prevent tearing; – Keep the urinary drainage bag will be kept below the level of the bladder; – Empty the urinary drainage bag each shift or more often as indicated. Use a separate container for each resident and avoid touching the spigot to the container. 2. Review of Resident #46’s Minimum Data Set (MDS), a federally mandated assessment instrument completed by facility staff, dated 3/9/19, showed: – Difficulty making daily decisions; – Required assistance of staff for toilet use and personal hygiene; – Indwelling catheter and frequently incontinent of bowel; – [DIAGNOSES REDACTED]. Observation on all days (5/7, 5/8, 5/9, 5/10 and 5/14) at various times throughout the day the resident was observed in his/her room, the hallways of the facility and in the dining room areas with the catheter tubing dragging the floor. Observation and interview on 5/14/19 at 10:11 A.M., showed the resident lay in bed with a supra-pubic catheter (a urinary catheter that is inserted into the abdominal wall and into the bladder) and no leg strap to aide in preventing the catheter from being pulled or dislodged. The urinary drainage bag hung under the resident’s wheel chair next to his/her bed and touched the floor, the drain spout lay on the floor and was not placed in the sleeve attached to the drainage catheter bag. Certified Nurse Aide (CNA) A said the insertion site looked infected then he/she provided catheter care in the following way: – Without washing his/her hands, he/she put on a pair of gloves; – Did not fully manipulate and cleanse the perineal folds; – Did not anchor the tubing close to the insertion cite of the catheter into the body; – Took one wet wipe and wiped down the catheter, used a second wet wipe and cleansed around the insertion site then proceeded to wipe down the catheter and also cleaned the ports on the catheter with the second wet wipe; – Retrieved a graduate (plastic measuring container) from the bathroom, set it down on the floor without a clean field, opened the drain spout and drained the urine; – Without cleaning the drain spout placed it in the sleeve on the urinary drainage bag. 3. Review of Resident # 56’s MDS, dated [DATE], showed: – Difficulty making daily decisions; – Required assist with toilet use and personal hygiene; – Indwelling catheter and [MEDICAL CONDITION]; – [DIAGNOSES REDACTED]. Observation on 5/7/19 at 11:51 A.M., showed the resident lay in bed and the dignity bag that contained the urinary drainage bag, dragged the floor. Observation on 5/14/19 at 9:11 A.M., showed CNA A retrieved the graduate from the bathroom. He/she sat the graduate on the floor in the plastic bag it was stored in from the the bathroom, emptied the urine from the urinary drainage spout and without cleaning the spout replaced it in the sleeve. During an interview on 5/14/19 at 3:59 P.M., CNA A said: – He/she should have placed a mat or something on the floor to set the graduate on; – He/she should have cleaned the port with hot water or some type of sanitary something; – He/she didn’t think the facility had alcohol pads; |
| 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: 265693 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER REDWOOD OF INDEPENDENCE | STREET ADDRESS, CITY, STATE, ZIP 1800 S SWOPE 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) | |
|---|---|---|
| F 0690 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 19) – He/she should anchor the tubing at the insertion site before cleaning the catheter; – The residents should have a leg strap. 5. During an interview on 5/14/19 at 4:10 P.m., the Director of Nurses said: – Staff should clean anything heavily soiled away from the area that might cause infection; – Staff should provide incontinent care prior to catheter care; – Staff should use one swipe per wipe for any care; – It is not acceptable to clean around an insertion site and with the same wipe clean the catheter tubing; – Staff should set the graduate on a clean surface before they drained urine into the graduate; – Staff should clean the drainage spout with either an alcohol wipe or a disinfectant wipe of some type; – Staff should use a leg strap to secure the tubing unless contraindicated and if so, it should be care planned. 4. Review of Resident #1’s quarterly MDS, dated [DATE], showed: -Incontinent of bladder; -No UTI; -Required extensive assistance for toileting and personal hygiene. Review of the resident’s care plan, last revised on 5/7/19, showed: -Had a catheter due to urine retention and neuromuscular dysfunction; -Catheter care each shift; -Started on antibiotic therapy on 5/6/19 for a UTI. During interviews on 5/7/19 at 4:06 P.M. and 4:12 P.M., the resident said: -He/she currently had a UTI and started receiving an intramuscular antibiotic injection. -It was hard to get staff to empty his/her catheter bag and it got so full that it pulled on his/her catheter tubing secured to his/her leg. -He/she wondered if the urine backflushed when it got so full. During an observation on 5/8/19 at 1:15 P.M., Licensed Practical Nurse (LPN) A provided the following care: -Set a container on the bare floor, emptied urine from the resident’s catheter bag and returned the drain spout to the holder without cleansing the spout; -Emptied the urine in the toilet; -Removed his/her gloves and left the room without sanitizing or washing his/her hands. -During an interview on 5/8/19 at 1:34 P.M., LPN A said he/she did not know staff should place a barrier between the bare floor and container when they emptied a catheter, and did not know staff should cleanse the drain spout before they returned it to the holder. | |
| F 0692 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | 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: 265693 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER REDWOOD OF INDEPENDENCE | STREET ADDRESS, CITY, STATE, ZIP 1800 S SWOPE 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) | |
|---|---|---|
| F 0692 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 20) resident was able to swallow when they fed him/her. Staff also failed to ensure residents of the memory care (dementia) unit who did not have a way to obtain fluids anytime day or night received sufficient hydration. The facility census was 106. 1. Review of Resident #70’s Minimum Data Set (MDS) a federally mandated assessment completed by facility staff, dated 3/29/19, showed: – Resident severely impaired for decisions making (never or rarely made decisions); – Swallowing issues; – History of coughing or chocking during meals and medication pass. – Mechanically altered diet; – One person assist with feeding. Review of the resident’s care plan created on 3/8/18, and last revised on 4/10/19, showed: – Serve puree texture food, regular thin liquids as ordered; – Serve ice cream at every meal; – Must have mechanical soft snacks with supervision; – Divided plates at all meals in order to increase self-feeding tasks; – House supplement three times daily. Review of the resident’s physician order [REDACTED]. – Ice cream at evening meal for weight management; start date 3/2/19; – Yogurt with breakfast for weight management; start date 3/2/19; – House supplement three times daily for weight management (8:00 A.M., 12:00 P.M, and 4:00 P.M.). Review of the resident’s current dietary card showed: – Ice cream with every meal; – No information about yogurt with his/her breakfast; – Double portion; – Divided plate. Observation on 5/7/19, at 12:15 P.M., showed the resident sat in a wheelchair with his/her head tilted backwards. Certified Medication Technician (CMT) B held the resident’s head forward and feed him/her gritty pureed chicken and gravy; mashed potatoes, pureed carrots. Staff did not fed the resident the regular textured cubed pineapple that was on the resident’s tray. The tray did not contain ice cream and no health/supplement shake was provided to the resident nor was there an empty supplement cup at the table like in the main dining room. Observation on 5/8/19, at 12:41 P.M., showed dietary staff sent a food tray containing pureed food, regular pineapple chunks and no ice cream. The resident sat at the dining room table with his/her head projected backwards. Certified Nurse Aide (CNA) I tried to hold the resident’s head up and give him/her bites of food except for the pineapple chunks which the resident should not have been served. CNA I told CMT B that the resident was not swallowing and he/she was going to get the nurse and a magic cup (a frozen ice cream like fortified food used as a dietaty supplement). CMT B picked up the resident’s spoon, held his/her head forward and started to feed the resident. The CMT said he/she could get the resident to swallow, so it was no big deal and continued feeding the resident pureed chicken and gravy, mashed potatoes and pureed carrots. Observation on 5/9/19, at 9:08 A.M., showed dietary staff prepared the resident’s tray and sent it to the unit. The tray contained pureed eggs, pureed sausage and cream of wheat; no ice cream or yogurt was on the tray. No supplement cup sat at the resident’s table or was on the tray. During an interview on 5/9/19, at 10:45 A.M., CMT E said they are supposed to pass dietary supplements to residents who have orders for the supplement during medication pass. |
| 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: 265693 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER REDWOOD OF INDEPENDENCE | STREET ADDRESS, CITY, STATE, ZIP 1800 S SWOPE 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) | |
|---|---|---|
| F 0692 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 21) However, the supplement is not always available. During an interview on 5/10/19, at 8:20 A.M., CNA B said hospice staff informed the unit staff that they had placed the resident on comfort care and he/she was not to be fed as he/she was not swallowing. Review of the resident’s dietary intake sheet showed staff recorded the resident received yogurt each morning at breakfast, even the morning of 5/10/19 when he/she was not to be fed. Nursing staff documented he/she received supplements three times a day and ice cream daily from 5/1/19 to the afternoon of 5/10/19. During an interview on 5/14/19, at 8:34 A.M., CMT B said there is suppose to be a nurse at every meal in each dining room to make sure residents do not choke. The nurse comes back to the unit to do the accu-checks (fingerstick blood sugar readings), but then they are busy and leave the unit before the food is served. There is no nurse on the unit during meals and some of the residents are at risk for chocking; just like Resident #70 had been. During an interview on 5/10/19, at 2:15 P.M., Cook B said the resident was supposed 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: 265693 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER REDWOOD OF INDEPENDENCE | STREET ADDRESS, CITY, STATE, ZIP 1800 S SWOPE 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) | |
|---|---|---|
| F 0692 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 22) be juices, milk, meal supplement and finger foods as well as other easy to fix ingredients in the unit refrigerator to allow for staff to offer a variety of drinks and snacks to the residents several times daily (day or night). Residents with dementia are at high risk for weight loss and dehydration. Observation of the unit refrigerator of 5/14/19, at 3:10 P.M., showed three or four glasses of chocolate milk in a 1/2 gallon size container; three or four cups of orange drink and a small carton of yogurt was in the refrigerator. The refrigerator contained no cartons of supplements for staff to serve the residents with physician ordered house supplement(s). 3. Review of the undated facility policy titled Intake and Output Recording showed: – Intake and output (I&O) is documented when indicated by an attending physician order [REDACTED]. – I&O may be instituted per an attending physician’s orders [REDACTED]. – I&O is required for residents with indwelling catheters. – For such residents: A resident will be placed on I&O for 30 days, or as required by state law, until the resident’s output has been deemed stable by a licensed nurse; After 30 days, or as required by state law, the resident must be reevaluated by the licensed nurse to determine further need for the recording of I&O; – Nursing staff will be responsible for completing the I and O record at the end of each shift; – Information obtained from the I and O will be totaled daily and reviewed to ensure that resident’s intake and output are sufficient to meet the resident’s needs; – The licensed nurse conducts and documents a review of the I&O record at least weekly or as specified by state law, to assess the resident’s fluid status and determine if intake and output recording is still required; – I&O recording may be discontinued if either of the criteria below is met: After the licensed nurse’s assessment that indicated that resident is taking adequate intake and has adequate output, if I&O was instituted by nursing department; The attending physician discontinues the monitoring of I&O. Review of Resident #47’s MDS, dated [DATE], showed: – Cognitively intact; – Indwelling catheter; – [DIAGNOSES REDACTED]. Review of the resident’s care plan, dated 5/3/19, showed the resident had a urinary catheter. The intervention included staff to monitor and document I&O as per facility policy. Review of the resident’s medical record showed staff did not complete I&O records for the resident. Observation and interview on 5/8/19, at 1:27 P.M., the resident said it was hard to get ice water at the facility. The resident had no water in his/her room and the resident’s water cup was empty. The resident had fruit punch served with lunch but said the facility staff knew he/she does not drink it. Observation on 5/10/19, at 8:51 A.M., showed: – The resident yelled from his/her room that he/she needed some water; maintenance staff walked by the resident’s door at the time he/she yelled it and did not say anything to the resident; – At 8:55 A.M., the resident yelled again, I need some ice water! An unknown staff member came in to the room and asked if the resident had gotten his/her room tray. The resident said no and that he/she wanted some ice water. Staff took the resident’s cup, got ice 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: 265693 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER REDWOOD OF INDEPENDENCE | STREET ADDRESS, CITY, STATE, ZIP 1800 S SWOPE 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) | |
|---|---|---|
| F 0692 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 23) the storage closet and filled the resident’s cup at his/her sink. During an interview on 5/14/19, at 1:23 P.M., Regional Cooperate staff said the facility did not have any I&O records for the resident and did not know why. 2. Review of the Resident #47’s (MONTH) 2019 Physician order [REDACTED]. – Controlled Carbohydrate diet, regular texture, regular/thin consistency, no added salt. Review of the resident’s care plan, dated 5/3/19, showed the resident: – Has a nutritional problem or potential nutritional problem; diet restrictions; – Is on a controlled carbohydrate, no added salt, regular texture, thin liquid diet. – Interventions included provide, serve diet as ordered, monitor intake and record with meal. Observation and interview on 5/8/19, at 1:19 P.M., showed staff served the resident his/her lunch in his/her room. The resident said he did not get any breakfast that morning. Observation and interview on 5/14/19, at 8:53 A.M., showed: – The resident was sitting in bed; – He/she said he wanted to get up to go down to the kitchen this morning to have breakfast and had been trying to get up since 5:30 A.M. this morning and staff had not assisted him yet. – The resident said he/she wanted over easy eggs but they deliver scrambled to his room. – CNA F came in and offered breakfast that included milk, juice, scrambled egg and bacon, – The resident said he did not want it because the eggs were scrambled; – Staff walked out with the food without offering any other food. During an interview on 5/14/19, at 8:55 A.M., CNA F said: – He/she was not sure what the facility had as an alternative; – He/she was from a staffing agency; – A staff had been in earlier and the resident also refused the food they offered. Review of the resident’s (MONTH) 2019 meal intake record showed staff only recorded two meals for the resident, on 5/4/19 (no supper), 5/5/19 (no supper), and 5/11/19 (no lunch). No meals were recorded on 5/10/19 or 5/12/19. 3. During an interview on 5/14/19, at 4:00 P.M., the Director of Nursing (DON) said: – Staff should provide fresh water/ice as desired at least each shift. – Care plans should have been followed. | |
| F 0695 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | Provide safe and appropriate respiratory care for a resident when needed. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** |
| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265693 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER REDWOOD OF INDEPENDENCE | STREET ADDRESS, CITY, STATE, ZIP 1800 S SWOPE 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) | |
|---|---|---|
| F 0695 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 24) equipment from dust and dirt when not in use. – Administer oxygen at the prescribed rate. – Ensure the oxygen is flowing through the cannula tubing. 1. Review of Resident #28’s admission Minimum Data Set (MDS), a federally mandated assessment instrument completed by facility staff, dated 2/28/19, showed; – Totally dependent on staff for all care; – [DIAGNOSES REDACTED]. – Received oxygen therapy, suctioning and had a [MEDICAL CONDITION] (external opening in the skin to the trachea for breathing) care. Review of the resident’s (MONTH) 2019 physicians’ order sheet (POS) showed; – Order dated 2/21/19, oxygen at two liters per nasal cannula continuously, or to keep oxygen saturation above 90%; – Change oxygen tubing and label each component with date and initials every Wednesday; – Clean oxygen concentrator (machine that delivers oxygen) filter weekly every Wednesday; – [DIAGNOSES REDACTED]. Review of the resident’s (MONTH) 2019 treatment administration record (TAR) showed: – Staff initialed that they cleaned the oxygen concentrator filter on 5/1/19 and 5/8/19. – Staff initialed that they changed and dated the oxygen tubing and each component on 5/2/19 and 5/9/19. Observations on 5/10/19 and 5/14/19, showed: – 5/10/19, at 8:35 A.M.: filters on the oxygen concentrator were covered with fluffy gray lint, the humidifier was dated 5/4/19, and the oxygen tubing had no date on it; – 5/10/19, at 10:45 A.M.: resident in his/her room with oxygen on at 3 liters per nasal cannula; – 5/14/19, at 9:00 A.M.: filters on the oxygen concentrator remained covered in fluffy gray lint, the humidifier was dated 5/4/19, and the oxygen tubing had no date on it. 2. Review of Resident #4’s quarterly MDS, dated [DATE], showed: – [DIAGNOSES REDACTED]. – Received oxygen therapy. Review of the resident’s (MONTH) 2019 TAR showed: – Administer oxygen at 2 liters per nasal cannula continuously for [MEDICAL CONDITION]; – Administer breathing treatments every four hours as needed for shortness of breath; – Change the oxygen tubing weekly every Wednesday and label each component with the date; – Change the [MEDICAL CONDITION]/[MEDICAL CONDITION] (Devices used to treat sleep apnea) tubing every Wednesday; – Clean the oxygen concentrator filter every Wednesday. Observation on 5/7/19, at 3:57 P.M., showed: – The resident’s oxygen concentrator had no filters on either side and was generally dirty, with a brown substance dried on near the handle on top of the machine. – There was no date on the oxygen tubing and the nebulizer cup for his/her breathing treatments was dated 4/18/19. Observation on 5/14/19, at 9:38 A.M., showed there were still no filters on either side of the oxygen concentrator, no date on the oxygen tubing and the nebulizer cup was still dated 4/18/19. 3. Review of Resident #1’s quarterly MDS, dated [DATE], showed the resident received oxygen therapy. Review of the resident’s (MONTH) 2019 TAR showed: – Administer oxygen at three liters per nasal cannula continuously or as needed to maintain oxygen saturation levels greater than 90%. |
| 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: 265693 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER REDWOOD OF INDEPENDENCE | STREET ADDRESS, CITY, STATE, ZIP 1800 S SWOPE 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) | |
|---|---|---|
| F 0695 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 25) – Administer breathing treatments four times a day while awake, for [MEDICAL CONDITION]. – Change oxygen tubing every Wednesday and label each component with the date. – Change the resident’s [MEDICAL CONDITION]/[MEDICAL CONDITION] tubing every Wednesday. During an interview and observation on 5/7/19, at 4:13 P.M., the resident said and observation showed: – The resident said he/she used a [MEDICAL CONDITION] at night. – Staff tried to change oxygen-related tubing every week and the date on the nebulizer tubing was probably when they last changed the oxygen tubing as well. – The oxygen tubing had no date on it and the nebulizer cup had a date of 4/18/19, written on it. Observation on 5/14/19, at 9:36 A.M., showed: – The resident’s nebulizer cup was still dated 4/18/19, and was placed in a zip-lock bag dated 5/10/19. – The oxygen tubing had no date on it. 4. Review of Resident #22’s MDS, dated [DATE], showed: – Unable to make daily decisions; – Used oxygen therapy; – [DIAGNOSES REDACTED]. Review of the resident’s care plan, dated 3/21/19, showed the plan did not address the resident’s oxygen use. Review of the resident’s current, (MONTH) 2019, POS showed- An order of oxygen at 2 liters; – (MONTH) titrate to keep oxygen saturation at 88 %; – Do not titrate oxygen above 4 liters. – Every shift for titrate oxygen. Review of the resident’s current medication and treatment records showed they did not include the order to titrate oxygen saturation levels. Observations showed the resident wore a nasal cannula connected to a portable oxygen tank which showed empty on the following dates and times: – 5/8/19, at 7:08 A.M., and 11:15 A.M.; – 5/9/19, at 11:34 A.M.; – 510/19, at 9:46 A.M.; at 10:41 A.M., Certified Nurse Aide (CNA) E retrieved the portable tank and filled it with liquid oxygen; – 5/14/19, at 10:32 A.M. 5. Review of Resident #57’s MDS, dated [DATE], showed: – Used oxygen therapy. Observation on 5/7/19, at 11:01 A.M., showed the resident had an oxygen concentrator and a portable oxygen tank hooked on his/her wheelchair. The tubings were undated, the plastic bag attached on the concentrator that held the tubing was dated 3/7/19. The concentrator filter was covered with a gray lint. The housekeeping staff had just mopped the floor and the portable tank tubing cannula lay on the wet floor. 6. Review of Resident #38’s MDS, dated [DATE], showed: – Used oxygen therapy. Review of the resident’s current May, 2019 POS showed no order for oxygen use. Review of the resident’s current care plan showed no care plan for oxygen use. Observation on 5/7/19, at 11:32 A.M., showed the resident’s oxygen tubing was undated and the filter on the concentrator was covered in rollable gray lint. Observation on 5/8/19, at 6:10 A.M., showed the resident asleep in bed. His/her oxygen concentrator was running and the nasal cannula lay across the top of the concentrator. 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: 265693 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER REDWOOD OF INDEPENDENCE | STREET ADDRESS, CITY, STATE, ZIP 1800 S SWOPE 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) | |
|---|---|---|
| F 0695 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 26) oxygen tubing was undated and the filter remained covered in gray lint. 7. Review of Resident #43’s MDS, dated [DATE], showed: – Used oxygen therapy. Review of the resident’s current May, 2019 POS showed no order for oxygen use. Review of the resident’s current care plan showed no care plan for oxygen use. Observation on 5/7/19, at 11:45 A.M., showed the resident asleep in bed with an oxygen cannula in his/her nose. The oxygen tubing was not dated and the filter was covered with gray lint. 8. Review of Resident #64’s MDS showed: – Received oxygen therapy; – [DIAGNOSES REDACTED]. Review of the resident’s (MONTH) 2019 POS showed the following order: – Oxygen tubing: change weekly, label each component with date and initials every night shift every Sunday. Review of the resident’s care plan, dated 5/3/19, showed: – The resident has altered respiratory status/difficulty breathing; – Oxygen via nasal cannula per physician order. Humidified. Observation on 5/7/19, at 9:48 A.M., showed: – The resident’s oxygen tubing was not dated and the oxygen concentrator filter was caked with dust. 9. During an interview on 5/14/19, at 4:00 P.M., the Director of Nurses said: – It is documented on the nurse’s treatment administration record to change out and date all oxygen and nebulizer tubings weekly: – Plastic bags attached to the concentrators to hold the tubing should also be changed out and dated weekly; – Staff should also clean the oxygen filters weekly. | |
| F 0725 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | 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: 265693 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER REDWOOD OF INDEPENDENCE | STREET ADDRESS, CITY, STATE, ZIP 1800 S SWOPE 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) | |
|---|---|---|
| F 0725 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 27) He/she had asked and asked for a shower. The facility did away with shower aides. It has been at least two weeks since he/she received a shower. Staff mark baths as given or refused when they do not have time to give us a shower. I am starting to smell, he/she uses the sink and a wash cloth to wash his/her face and arms but he/she is unable to wash the bottom half of his/her body. He/she fell s dirty. He/she often has to take his/her self to the bathroom or empty his/her catheter bag. He/she is unable to clean self up well after using the bathroom. Sometimes it take two hours for staff to respond to the call light so he/she can either poop his/her pants or take his/herself. He/she just needs a good shower so he/she does not stink. 2. Review of Resident #75’s admission (re-admission) MDS, dated [DATE], showed: – Cognitively impaired – Has dementia and a mental health [DIAGNOSES REDACTED]. – Resident requires assistance of one for dressing, hygiene and bathing -Resident uses a wheelchair or walker for mobility. Review of the resident’s bathing follow-up report showed the resident received a bath/shower on: – (MONTH) 1, 15 18, 29. – (MONTH) 2nd. During an interview on 5/7/19 at 11:05 AM., the Guardian/Family Member A said: – He/she had requested that the resident be bathed/showered daily for two weeks. – He/she is in the facility daily and would know when and if the resident received a shower. – The Resident last showers was over two weeks ago. – The resident has an unpleasant body order. – He/she thinks staff mark showers as given when they run out of time and do not get their work done. During an interview on 5/10/19 at 1:50 PM., CNA J said if he/she is the only CNA on unit he/she might get two showers done per day if lucky. He/she can only do them when the CMT is on the floor. He/she tells the charge nurse the showers were not done at the end of the shift but he/she does not document anything in the computer or on paper. During an interview on 05/14/19 at 08:40 AM., CMT E said., when showers are not given staff should mark the shower as not given so the shower will pop up for the next shift to give the shower. Too many times the CNAs mark not available when they (staff) are no available to give the showers and then the showers do not show up for the next shift to give the shower. Too many residents are not getting the showers they need. He/she often worked the floor when they are short handed instead of passing medications or doing his/her paper work. When staff fail (no show) to come to work it make it hard for the good employees; because they have to works doubles and extra hard to cover for the staff that no showed. Observation and interview on 5/14/19 at 2:20 PM., showed CNA G checking off tasks on the computer. He/she said he/she had a long list of showers that were supposed to be given today. He/she did not have time to do shower as he/she was busy helping with meals and resident care. He/she marked the showers as not available. He/she did not know if the shower marked not available would be triggered for someone to give the next shift or the next day. It is impossible to get everything done. During an interview on 5/14/19 at 4:00 P.M., the DON said: -Staff should offer residents at least two baths/showers each week. -Residents have a right to decline baths/showers and staff should care plan a resident’s preference to bathe less than two times a week. |
| 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: 265693 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER REDWOOD OF INDEPENDENCE | STREET ADDRESS, CITY, STATE, ZIP 1800 S SWOPE 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) | |
|---|---|---|
| F 0725 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 28) -Staff were to complete paper bath sheets and document bathing electronically. -She did not know what Not Applicable meant related to electronic documentation of bathing. -Staff run bathing reports each morning, and if a bath is noted as not done, then the resident should be offered one the next day. -The facility currently had an evening staff scheduled to do bathing. -They previously had a staff scheduled to do bathing on days, but not at this time. -The CNA’s should be assigned to do baths/showers if there is no bath aide. -The nurse manager should follow-up if bathing is not documented, and if refused, staff need to find out why the resident is refusing it.- 3. During an interview on 05/08/19 at 5:15 AM., the Administrator said they had been at the facility all night. Only one Certified Nurse Aide show up to work the night shift so she and some of the department heads worked all night. During a group interview with 15 resident on 5/9/19 at 10:05 A.M., the residents said: – The facility makes one meal and if you do not like what they serve then you do not get anything else. – Meals are often late – more than two hours. – There is not enough staff to serve meals timely. – Staff seldom pass ice water. – Bed time snacks are not passed to the residents; they are at the nurses’ station and residents has to help there self and there is not enough to go around. – If you are unable to get your own bed time snack you are out of luck. Observation and interview on 05/14/19 at 08:40 AM., showed the Staffing Coordinator helping care for resident’s on the unit. He/she said he/she is often pulled to work the floor or pass medications when they were short staffed which is almost always. He/she often makes the staffing schedules at night because that is the only time she has to do them. There a lots of no shows and those that are good workers have to stay when no one comes to take their place. At times they just leave without their being staff to cover since it happens so often. During an interview on 05/14/19 at 09:15 AM., CMT E said dietary runs out of food all the time sometimes even run out of cheese for the grilled cheese; it has been so bad that they have even run out of peanut butter so a jelly sandwich was what was served on the hall trays. Residents do not get shower, are not gotten up timely and meals are always late. Often resident’s have accidents because there is not sufficient staff to answer the call lights During an interview on 5/13/19 at 1:18 PM., the Registered Dietitian said: – Staff should always fix enough food for the resident’s to eat a complete meal. – A sandwich is not a complete meal, fruits and vegetables should also be served. – It should never take 3 hours to get resident’s their breakfast after meal service has started. | |
| F 0756 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. **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: 265693 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER REDWOOD OF INDEPENDENCE | STREET ADDRESS, CITY, STATE, ZIP 1800 S SWOPE 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) | |
|---|---|---|
| F 0756 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 29) Based on interview and record review, the facility failed to ensure the physician provided a rationale when the physician did not agree with the pharmacist’s recommendations for gradual dose reductions (GDR)’s-tapering of medication dose in an effort to discontinue or determine the lowest, most effective dose) for two of 24 sampled residents (Residents #4, and #7) who received [MEDICAL CONDITION] (any drug that affects brain activities associated with mental processes and behavior) medications. The facility census was 106. 1. Review of the undated facility policy titled Psychotherapeutic Drug Management showed: Purpose – To implement the most desirable and effective interventions to change, modify, decrease, or eliminate behaviors that are distressing to the resident and/or are decreasing or negatively impacting the resident’s quality of life; – To help promote or maintain the resident’s highest practicable mental, physical, and psychosocial well-being, promote resident safety and security and to enhance the resident’s ability to interact positively with his/her environment; – To ensure the resident receives only those medications, in dosed and for the duration clinically indicated to treat the resident’s assessed condition (s); – To ensure non-pharmacological interventions are considered and utilized when indicated, instead of or in addition to medication; – To ensure clinically significant adverse consequences are minimized; – To ensure that any potential contribution the medication regimen has to an unanticipated decline or newly emerging or worsening symptoms is recognized and evaluated, and the regimen is modified when appropriate. 2. Guidelines for GDR – During the first year if receiving an antipsychotic or other psychopharmacologic medication, at least one attempt at GDR is attempted; – A second attempt, in a subsequent quarter the same 12 month period unless the first attempt demonstrated that GDR was clinically contraindicated. The first attempts should be at least a month apart; – After the first year, GDR should be attempted annually; – GDR may be considered clinically contraindicated if the resident’s targeted symptoms worsened or returned during the reduction. IF this occurs the physician must document the clinical rationale why further GDR attempts should not be done; – All GDR’s will be initiated per pharmacist recommendations as received for all classifications of [MEDICAL CONDITION] medications. 3. Review of Resident #4’s pharmacy progress note, dated 6/12/18 at 1:38 P.M., showed: -Please assess if there is potential for a gradual dose reduction for the resident’s [MEDICATION NAME]. -Resident currently takes 75 milligrams (mg) daily. Consider a trial reduction to 75 mg every other day for four to six weeks, and if no adverse effects/increase in symptoms during this time, then discontinue (if clinically appropriate). -If no reduction is made, please provide a brief rationale as to why and supply this to the facility to aid them in remaining in compliance with state regulations. Review of the resident’s records showed no response to the pharmacy request. Review of the resident’s pharmacy progress note dated 12/19/18, at 11:02 A.M., showed: -Please assess if there is a potential for a gradual dose reduction for the resident’s [MEDICATION NAME]. -He/she currently takes 75 mg daily. Consider a trial reduction to 37.5 mg daily, if clinically appropriate. Review of the resident’s records showed no response to the pharmacy request. |
| 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: 265693 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER REDWOOD OF INDEPENDENCE | STREET ADDRESS, CITY, STATE, ZIP 1800 S SWOPE 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) | |
|---|---|---|
| F 0756 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 30) Review of the resident’s quarterly Minimum Data Set (MDS), a federally mandated assessment instrument completed by facility staff, dated 5/2/19, showed: -[DIAGNOSES REDACTED]. -Received medication for anxiety and depression. Review of the resident’s (MONTH) 2019 physician order [REDACTED]. -4/27/19, [MEDICATION NAME] 75 mg daily. 4. Review of Resident #7’s Minimum Data Set (MDS), a federally mandated assessment completed by facility staff, dated 1/30/19 showed: – Included the following Diagnoses: [REDACTED]. – Used [MEDICAL CONDITION] medications. Review of the resident’s (MONTH) 2019 Physician order [REDACTED]. – [MEDICATION NAME] HCL (used to treat anxiety) 5 milligrams (mg), give two tablets by mouth three times a day for anxiety, order date 9/11/18; – [MEDICATION NAME] (used to treat [MEDICAL CONDITION] disease) delayed release 250 mg, give one tablet by mouth two times a day for depression and behavior, order date 11/9/18; – [MEDICATION NAME] (used to treat anxiety) 0.5mg, give one tablet two times a day for anxiety, order date 9/11/18; – Trazadone (used to treat depression and [MEDICAL CONDITION]) HCL Tablet, give 25 mg by mouth at bedtime for [MEDICAL CONDITION], order date 11/6/18; – [MEDICATION NAME] (used to treat depression) 150 mg, give one tablet by mouth one time a day for depression Review of the pharmacy recommendations dated 1/23/19 showed the following: – Please assess if there is a potential for gradual done reduction for the resident’s [MEDICATION NAME] ([MEDICATION NAME]). He/she currently takes 250 mg twice a day, consider trial reduction to 125 mg twice a day if clinically appropriate; – A form signed by the physician, dated 2/1/19, indicated that he/she disagreed with the recommendations but did not provide any rationale as to why. 5. During an interview on 5/14/19 at 1:50 P.M., Regional Staff A said the administrator told him/her the previous director of nurses employed from (MONTH) 2019 through (MONTH) 2019 was throwing pharmacist’s monthly review recommendations away and the facility could not produce any type of physician rationale for any recommendations. During an interview on 5/14/19 at 4:00 P.M. the Director of Nursing said: – The pharmacist completes the Drug Regimen Reviews (DRR) then sends a report to staff with recommendations. Staff give the report to the DON or Assistant DON, then they give it to the physician for review. The physician usually responds to the recommendations within the same day. If the physician disagrees with the recommendations, there should be a rationale documented and that documentation should be kept in the DON’s office. – If a resident is started on a [MEDICAL CONDITION] medication PRN, it should be re-evaluated within 14 days to determine if it should continue. | |
| F 0759 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | Ensure medication error rates are not 5 percent or greater. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** |
| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265693 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER REDWOOD OF INDEPENDENCE | STREET ADDRESS, CITY, STATE, ZIP 1800 S SWOPE 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) | |
|---|---|---|
| F 0759 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 31) rate of 7.1 %. This affected two of 15 sampled residents (Resident #4 and #86). The facility census was 106. 1. Review of the facility’s Specific Medication dministration procedures, dated 3/18 showed: – A meal tray should be at the resident’s table in dining room or at bedside prior to the licensed nurse administerng rapid acting insulin. 2. Review of Resident #4’s current (MONTH) 2019, physician order [REDACTED]. – [MEDICATION NAME]100 units/milliliters (ml) Inject 10 units before meals. Observation on 5/8/19 at 7:43 A.M., showed Licensed Practical Nurse (LPN) A administered 10 units of [MEDICATION NAME] to the resident. The resident waited in his/her room for breakfast. At 8:44 A.M., the resident had still not been served his/her breakfast. During an interview on 5/8/19 at 10:37 A.M., the resident said staff did not bring his/her breakfast until about 9:25 A.M., just a piece of toast, a piece of bacon and Rice Krispies. During an interview on 5/8/19 at 10:38 A.M., LPN A said: – [MEDICATION NAME] was a rapid acting insulin; – Staff should make sure the resident had a meal within 15 to 20 minutes of the insulin injection; – He/she gave insulin to residents who received hall trays last so they should get their meal on time. 3. Review of the website https://www.[MEDICATION NAME].com/asthma/talking-to-you-doctor/how-to-use-the-inhaler.html showed to take [MEDICATION NAME] exactly as prescribed by the physician. It is important not to miss a dose or take more doses than prescribed. 4. Review of Resident #86’s (MONTH) 2019 physician order [REDACTED].>-[MEDICATION NAME] inhaler 80/4.5 (used to decrease inflammation and dilate air pathways in the lungs) inhale two times a day for breathing, ordered 4/15/19; -[DIAGNOSES REDACTED]. Observation on 5/8/19 at 11:36 A.M. showed LPN B administered one inhalation of [MEDICATION NAME], had the resident rinse his/her mouth with water and spit it out, then returned at 11:50 A.M. and administered a second inhalation of [MEDICATION NAME]. During an interview on 5/8/19 at 12:08 P.M., LPN B said the order directed to give two inhalations a day, so she administered two inhalations. Review of the resident’s (MONTH) 2019 Medication Administration Record [REDACTED] -[MEDICATION NAME] inhaler 80/4.5, inhale two times a day for breathing; -Administer at 8:00 A.M. and 8:00 P.M. -Staff documented that the resident received the inhaler twice a day 5/1/-5/8/19. During an interview on 5/14/19 at 4:00 P.M., the director of nurses said that staff should have clarified the [MEDICATION NAME] order with the physician. | |
| F 0761 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** |
| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265693 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER REDWOOD OF INDEPENDENCE | STREET ADDRESS, CITY, STATE, ZIP 1800 S SWOPE 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) | |
|---|---|---|
| F 0761 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 32) properly dated and discarded resident medications. The facility census was 106. 1. Review of the facility’s Specific Medication Administration Procedures, dated 3/18, did not address dating medications when opened. The procedure guide stated if a label of an insulin pen is illegible or missing, the pen should be discarded and a new pen received from the pharmacy. Observation on 5/14/19 at 9:56 A.M., of the 500 hall nurse’s cart showed: – A container of opened [MEDICATION NAME] powder that had no resident name or date it was opened; – Resident #11’s [MEDICATION NAME] Insulin Pen dated as opened 4/12/19; – Resident #69’s [MEDICATION NAME] Insulin Pen dated as opened 4/9/19 and a [MEDICATION NAME] Pen opened but undated; – Resident #4’s one [MEDICATION NAME] undated when opened and one dated as opened 4/15/19; – Resident #9’s [MEDICATION NAME] opened 4/2/19; – A used [MEDICATION NAME] opened but with no label or date opened. During an interview on 5/14/19 at 9:56 A.M., LPN C said: – Staff should date the insulin when they first opened it for use; – He/she thought insulin could be kept out of the refrigerator for 30 days after it was opened. Observation on 5/14/19 of the 500 hall Medication Cart showed: – Resident’s #11, #4 and #97 had [MEDICATION NAME] Discus inhalers that were all undated when opened; – Resident #38’s [MEDICATION NAME] inhaler undated when opened; – Four resident’s [MEDICATION NAME] nasal spray undated when opened; – Resident #41’s [MEDICATION NAME] eye drops were undated when opened. – Resident #43’s [MEDICATION NAME] and [MEDICATION NAME] B Sulfates eye drops were undated when opened. During an interview on 5/14/19 at 11:00 A.M., Assistant Director of Nursing (ADON) A said: – Staff should date the inhalers, nasal spray and eye drops when opened, otherwise there was no way to prove when it was opened and when it should be discarded. – Staff should discard insulin 28 to 30 days from the date of opening depending on the type of insulin. During an interview on 5/14/19 at 4:00 P.M., the Director of Nurses (DON) said: – Staff should date insulins, inhalers, nasal sprays and eye drops when opened for use. – Opened insulin should be discarded after 28 days. Observation on 5/14/19 at 9:16 A.M. showed Certified Medication Technician (CMT) F administered medications from a 500 hall medication cart and there were no open or discard dates on stock medication containers of acidophilus, iron 325 mg tabs and vitamin D3 1000 mg. During an interview on 5/14/19 at 9:29 A.M., CMT F said he/she tried to look at medication containers this morning to ensure they all had open dates, but may have missed some. During an interview on 5/14/19 at 4:00 P.M., the DON said that staff should date medication containers when they are opened. | |
| F 0800 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | Provide each resident with a nourishing, palatable, well-balanced diet that meets his or her daily nutritional and special dietary 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: 265693 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER REDWOOD OF INDEPENDENCE | STREET ADDRESS, CITY, STATE, ZIP 1800 S SWOPE 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) | |
|---|---|---|
| F 0800 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 33) **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews and record reviews the facility failed to provide residents with a nourishing, palatable, well-balanced diet, taking into consideration the preferences of each resident. This had the potential to affect any resident who received food from the facility’s main kitchen. The facility had a census of 106. 1. During interview on 5/7/19 at 10:27 AM., Resident #300 said the food is cold and not pleasant to taste. He/she does not eat pork. He/she told staff he/she did not eat pork upon admission but he/she received bacon for breakfast again this morning. During interview on 5/7/19 at 10:29 AM., Resident #299 said food is cold and not good, has no flavor and is poor quality. lf you do not like the food served, you can have a ham sandwich, cheese sandwich or canned soup. The substitute menu is always the same. During an interview on 5/7/19 at 10:42 AM., Resident #46 said the food is cold. He/she said staff did not help him/her up for. He/she ahd placed his/her call light over 2 hours before they helped him/her up for breakfast. He/she like to go to the dining room for a hot meal but since staff helped him/her late all he/she got this morning was a bowl of cold cereal. During interview on 5/7/19 at 10:55 AM., Resident #89 said the food is of poor quality, not very good but the worst part is they are always running out. If you are lucky, you will get a grilled cheese or peanut butter and jelly sandwich and nothing else with it besides a cup of punch or tea. During interview on 5/7/19 at 10:57 AM., Resident #51 said food is a major problem. They run out of food and if you are lucky get grilled cheese or peanut butter and jelly sandwich. Cold grilled cheese is not pleasant to eat. During interview on 5/7/19 at 10:29 AM., Resident #66 said said you do not have enough days to listen to the food problems. The kitchen runs out of food almost daily. The food purchased is very poor quality. They do not get not enough to eat, have no fresh fruits and vegetables, and no alternate menu for the whole mea. If you do not go to the main dining room, there are poor choices if you unable to go to the main dining room then you are out of luck getting the main meal at lunch because they run out of food for hall trays. We either get a grilled cheese sandwich and once in a while a ham and cheese sandwich, but mostly they serve a peanut butter and jelly sandwich with a drink on the hall trays. Nothing else comes with the sandwich. They are always running out of food. He/she did not know why they fill out a menu sheet; they do not serve what is asked for. It is limited to only the choice of the main meal or a sandwich. Dietary never supplies condiments; we buy them and share them among ourselves. Ketchup, mayo, mustard are never served with the meal. During interview on 5/7/19 at 12:27 AM., Resident #73 said food is a thumbs down. Sometimes no one will eat the food served. No alternate foods are offered. You just do without. During interview on 5/7/19 at 2:29 AM., Resident #8 said he/she does not eat pork so the kitchen no longer sent it on his/her tray but he/she does not get anything in its place to eat. He/she get hungry often. Observation and interviews on 5/7/19, starting at 11:55 A.M., showed residents on the Special Care Unit unit received fish, orzo (seed shaped pasta), dilled carrots and pineapple cubes. No condiments were served. Observation of the meal showed most of the residents tasted the fish, but at least half of the residents did not eat the fish. The residents told staff the seeds (Orzo pasta) were tasteless, the carrots tasted funny. It was observed that most of the reidents left their carrots uneatten on their plates at the end of the meal service. Most of the residents ate their pineapple. Several residents |
| 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: 265693 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER REDWOOD OF INDEPENDENCE | STREET ADDRESS, CITY, STATE, ZIP 1800 S SWOPE 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) | |
|---|---|---|
| F 0800 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 34) asked for tarter sauce, ketchup and bread. Thirty minutes later the residents had not received slices of bread nor the condiments of tarter sauce and ketchup that they requested and by then most of the residents had left the dining area. Observation and interview on 5/7/19 at 12:36 P.M., showed residents in the main dining starting to receive their meal. Baked fish, sead like pasta, dilled carrots pneapple tibblets were on the trays. Family Member C said his/her loved one does not like and will not eat fish; he/she requested a deli sandwich and strawberry ice cream for the resident’s lunch. He/she asked for mayo but that will probably not happen. The resident does not like the noodles but they serve them anyway or he/she gets nothing. The chicken they fixed the other day was so dry his/her loved one could not chew it. On two different occassions they served pork chops that residents could not chew and looked like thye had been boiled. Yesterday he/she asked for iced tea; dietary had not had time to make it. They often run out of chocolate milk. The resident did not eat breakfast today. They did not get him/her up until late so they gave him/her a bowl of dry rice crispies without milk. It was still in the resident’s room when he/she arrived an hour ago. Dietary staff do not fix enough food for the residents to eat. Observation and interview on 5/7/19, at 1:15 P.M., showed Dietary Staff F serving out lunch trays. He/she said they had 25 more trays to fill. He/she had no clean silverware and not enough prepared food. There was only seven pieces of baked fish left. A couple of the residents had requested chief salads but the morning cook did not make any chief salads. He/she had requests for grilled ham and cheese sandwiches but what they have are grilled cheese that were setting on the counter when he/she arrived at noon. He/she came to work at noon to serve out. We constantly run out of food and all they have time to fix is grilled cheese or peanut butter and jelly sandwiches. They run out of food daily. He/she does not know why the morning cook cannot prepare enough food for all of the residents. He/she was very frustrated. During an interview on 5/8/19, at 12:26 P.M., Resident #59 said the food is always cold. If you do not like the menu, the only alternates are a cheese sandwich or peanut butter and jelly sandwich. Meals are always late. He/she gets served his/her meal two hours after mealtime. During an interview on 5/10/19, at 10:35 A.M., Dietary Staff B said: – He/she was not aware he/she did not prepare enough food for all of the residents. – He/she never fixed the alternate menu on the menu sheets. – They have alternate foods of grilled cheese sandwich, ham and cheese sandwich, deli sandwich, chef salad or peanut butter and jelly sandwich. – They added the deli sandwich and chief salad to the alternate this week. – He/she had never prepared alternate food for vegetables, fruits, starchy foods, etc. – He/she did not know dietary staff needed to offer like nutritional foods for foods residents do not eat or like. During an interview on 5/10/19, at 10:39 A.M., Dietary D said : – He/she was not aware of the facility ever preparing the alternate menu written on the dietary spread sheets. – The menus have a lot of fish one week and lot of chicken next week. – The residents do not like fish. During an interview on 5/10/19, at 1:00 P.M., Family Member B said his/her loved one was served undercooked fish today. His/her loved one could not eat the fish but was hungry. He/she went to the kitchen to see if there was something else for his/her loved one to eat but was told they only had peanut butter and jelly sandwiches which his/her loved one cannot eat. They have talked to administration about the poor quality and lack of food |
| 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: 265693 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER REDWOOD OF INDEPENDENCE | STREET ADDRESS, CITY, STATE, ZIP 1800 S SWOPE 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) | |
|---|---|---|
| F 0800 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 35) served the residents but it continues to happen day after day. During an interview on 5/10/19, at 1:23 P.M., CNA B said the residents on the unit did not eat the fish served. More than half of the residents left their trays uneaten except for the unfrosted cake which most of the residents ate. No alternate foods were offered. The unit residents never have a choice of foods. They just get what is sent. She asked dietary staff for alternate and substitute foods but it does not happen. CNA J said if the residents do not like or eat the food served, nothing else is offered. During an interview on 5/13/19, at 1:18 P.M., the Registered Dietitian (RD) said: – The facility policy is not to prepare the alternate meal listed on the spread sheets. – She was not aware they were running out of food. Staff should be able to prepare sufficient amount of food. – Their always available list was fixed last week; they added deli sandwich and chief salad to go along with the grilled cheese sandwich, ham and cheese sandwich and peanut butter and jelly sandwich. – An alternate food of like nutritional value should be offered to residents who do not eat the food served. During an interview on 5/13/19, at 1:34 P.M., the Administrator said she had intervened a couple of times when she found out the kitchen said they were out of food. She was unaware that they ran out of food daily and some residents only received a grilled cheese or peanut butter and jelly sandwich for their meal. They always have food they can prepare for the residents. There is enough food purchased; dietary staff just need to prepare sufficient amounts of food. She cannot fix things if she is not made aware of the problems. She had been trying to fix dietary issues for some time. The facility hired a new dietary manager who started today. She brought two staff with her today and two more will join her in about a week. Observation and interview on 5/13/19, at 3:34 P.M., of the memory care unit’s refrigerator showed the refrigerator contained no snacks or foods to make a sandwich if residents were hungry. Unit refrigerator contained less than 1/4 gallon of chocolate milk and about three cups of fruit punch and one small container of yogurt. An unidentified staff member said he/she used the yogurt in the refrigerator for medication pass. There is not sufficient staff for a staff member to leave the unit to obtain the supplement or additional foods we know the residents would like to have. Unit residents have no choice of the foods they receive. If they do not eat what is serve they do without and that is just not right. Residents deserve to have foods they like to eat and to feel full after a meal. 2. Review of Resident #1’s quarterly Minimum Data Set (MDS), a federally mandated assessment instrument completed by facility staff, dated 12/31/18, showed: – Cognitively intact; – Very important to receive snacks between meals; – [DIAGNOSES REDACTED]. Observation of the posted meal times in the kitchen said breakfast 7:00 AM. During an interview on 5/7/19, at 4:09 P.M., the resident said he/she did not receive breakfast yesterday until 10:00 A.M., and received breakfast today at 9:30 A.M. Staff did not serve his/her lunch today until 1:50 P.M., and that was after it set in the hall for 15-30 minutes before staff starting passing the trays. 3. Review of Resident #14’s quarterly MDS, dated [DATE], showed: – Cognitively intact; – Somewhat important to receive snacks between meals. During interviews on 5/7/19, at 2:00 P.M. and 3:35 P.M., the resident said he/she: – Did not receive the soup he/she ordered for lunch today; dietary staff do not follow 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: 265693 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER REDWOOD OF INDEPENDENCE | STREET ADDRESS, CITY, STATE, ZIP 1800 S SWOPE 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) | |
|---|---|---|
| F 0800 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 36) menu; – Received two grilled cheese sandwiches for lunch, but no vegetables, fruit or dessert; – Did not receive breakfast on 5/6/19; they sometimes forget to give trays to residents and he/she has to remind staff or go get his/her own meal; – Dietary staff do not follow the menu; – Used his/her monthly $50.00 to buy snacks and other food to store in his/her room since the kitchen does not have enough food for everyone. 4. Review of Resident #49’s quarterly MDS, dated [DATE], showed: – Cognitively intact; – Very important to receive snacks between meals; – [DIAGNOSES REDACTED]. During an interview on 5/7/19, at 11:51 P.M., the resident said dietary: – Often ran out of chocolate milk and other food items; – Often ran out of items on the menu or serve something different than what is on the menu; – Did not provide condiments like pickles or parmesan cheese any more; – Does not serve what residents request, if residents even get a menu to choose from. 5. Review of Resident #62’s quarterly MDS, dated [DATE], showed: – Cognitively intact; – Very important to receive snacks between meals. During an interview on 5/9/19, at 2:54 P.M., the resident said that meals usually run late. Dietary often ran out of food, and some residents did no receive menus to fill out. 6. Review of Resident #47’s comprehensive MDS, dated [DATE], showed: – Coginitively intact; – [DIAGNOSES REDACTED]. Review of the resident’s (MONTH) 2019 physician order [REDACTED]. – Controlled carbohydrate diet, regular texture, regular/thin consistency, no added salt. Review of the resident’s care plan dated 5/3/19, showed the resident: – Has nutritional problem or potential nutritional problem. Diet restrictions; – Is on a controlled carbohydrate, no added salt, regular texture, thin liquid diet. Interventions included provide, serve diet as ordered, monitor intake and record with meal. Observation and interview on 5/14/19, at 8:53 A.M., showed: – The resident was sitting in bed; – He/she said he wanted to get up to go down to the kitchen this morning to have breakfast and had been trying to get up since 5:30 A.M. this morning and staff had not assisted him yet. – The resident said he/she wanted over easy eggs but they deliver scrambled to his room. – CNA F came in and offered breakfast that included milk, juice, scrambled egg and bacon; – The resident said he/she did not want it because the eggs were scrambled; – CNA F walked out with the food without offering any other food. During an interview on 5/14/19, at 8:55 A.M., CNA F said: – He/she was not sure what the facility have as an alternative; – He/she was from a staffing agency; – A staff had been in earlier and the resident also refused the food they offered. 7. During a group interview with 15 residents on 5/9/19, at 10:05 A.M., residents said the facility makes one meal and if you do not like what they serve then you do not get anything else. |
| 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: 265693 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER REDWOOD OF INDEPENDENCE | STREET ADDRESS, CITY, STATE, ZIP 1800 S SWOPE 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) | |
|---|---|---|
| F 0800 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | ||
| 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. Based on observation , record review and interview, the facility failed to prepare pureed |
| 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: 265693 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER REDWOOD OF INDEPENDENCE | STREET ADDRESS, CITY, STATE, ZIP 1800 S SWOPE 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) | |
|---|---|---|
| F 0805 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 38) portion of scrambled eggs and a large portion of sausage (2 1/2 hour after being prepared). The cream of wheat and oatmeal was very dry and sticky. The scrambled eggs were not pureed and the sausage contained small pieces of the sausage. Observation of the test tray at 5/8/19, at 8:41 A.M., showed the pureed sausage had a strong spicy taste and contained pieces of the sausage that would not smooth out in the mouth; the scrambled eggs had no flavor but could be swallowed without chewing. The bland oatmeal was thick and gummy, would not smooth out in the mouth and was hard to swallow. Theoatmeal was unpleasant to taste. A spoon stood upright when placed in the middle of the oatmeal. No cream of wheat was on the test tray. The orange drink did not taste like orange juice but like a powdered drink that was thin and unsweetened. During an interview on 5/8/19, at 9:15 A.M., DS B said they did not have enough staff to prepare pancakes along with sausage and oatmeal. Eggs were easier to prepare for this many residents. It would take one staff all morning to make enough pancakes. That is just not possible with only one person to prepare breakfast. He/she did not know he/she had to have approval to change menus. During an interview on 5/10/19, at 10:35 A.M., DS B and DS D said: – DS B said pureed foods should be smooth but it is hard to get it to the correct texture. – DS D said the Robo Coupe’s blade may be dull preventing the Robo Coupe from grind the | |
| F 0809 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | Ensure meals and snacks are served at times in accordance with resident’s needs, preferences, and requests. Suitable and nourishing alternative meals and snacks must be provided for residents who want to eat at non-traditional times or outside of scheduled meal times. **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: 265693 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER REDWOOD OF INDEPENDENCE | STREET ADDRESS, CITY, STATE, ZIP 1800 S SWOPE 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) | |
|---|---|---|
| F 0809 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 39) kitchen as breakfast 7:00 A.M., lunch 12:30 P.M., dinner at 5:00 P.M. Dietary Staff C said snacks were served after they get all the residents served dinner and get the kitchen cleaned up sometime between 8:00 P.M. and 8:30 P.M. Observation and interview on 5/7/19 at 10:05 A.M. showed dietary staff delivered a bowl of dry cereal to Resident #46 for his/her breakfast. The resident said he/she is unable to get out of bed and staff did not get him/her out of bed in time to go to the main dining room for breakfast. Too often, there is no one to answer his/her call light and get him/her up. He/she had his/her call light on for over two hours this morning before staff came and helped him/her out of bed. He/she was hungry and dry cereal is not breakfast. Supper was a long time ago. He/she did not get an evening snack. Too often by the time he/she gets to the nurses’ station the snacks are all gone. It is to long and he/she gets hungry when he/she had supper about 5:30 P.M. and does not get breakfast till 10:00 A.M. During an interview on 5/8/19, at 10:15 A.M., Dietary Staff (DS) B said they prepare the breakfast menu between 4:00 A.M. and 7:00 A.M., They start serving breakfast at 7:00 A.M. If nursing is late getting the residents up and the hot food is gone, they will send the resident a bowl of dry cereal. They have trouble getting breakfast served timely to the residents because the residents are late getting their menu request to the kitchen. When the hot food is gone, we serve cold cereal as the alternate. Too often they are still serving breakfast tray out mid-morning when they need to be preparing lunch. He/she does not have time to prepare more eggs for residents who get up late when he/she is trying to prepare lunch. We need more staff so one group can fix the next meal while the other meal is still be served out. Observation on 5/8/19, at 10:20 A.M., showed staff continued to pass out breakfast hall trays. 2. Observation on 5/8/19, at 8:10 A.M., showed Resident #8 received a breakfast hall tray containing one piece of toast and a bowl of oatmeal for his/her breakfast. The other residents received hot cereal, toast and sausage. The resident said he/she could not eat pork so he/she got nothing in place of the sausage. It would have been nice to have eggs for breakfast. During the group interview on 5/9/19, at 11:07 A.M., the residents said: – The facility runs out of food daily and there are times they do not get anything to eat. – Usually they get a peanut butter and jelly sandwiches or a grilled cheese sandwich with nothing else. – Meals are always late and sometimes it is mid-morning before they get their breakfast. – There is a small tray of snacks at the nurses’ station but one resident can wipe that out. – Most of the residents do not consistantly get a bedtime snacks since the snack tray will be empty. – Sometimes they sit in the dining room for hours waiting on their meals. – Dietaty substitutes foods without asking what they would like to eat. – We fill out a menu sheet but it is not honored. – Some of the residents said they had missed meals, both supper and breakfas,t because they were alseep and needed staff assistance to obtain their meal or the kitchen ran out of food. – If you miss a meal, you are just out of luck until the next meal and hope they do not run out of food. – Residents were often hungry. – We look forward to a nice warm meal but that does not happen at this facility. During an interview on 5/8/19, at 2:45 P.M., DS B said the afternoon staff prepare 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: 265693 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER REDWOOD OF INDEPENDENCE | STREET ADDRESS, CITY, STATE, ZIP 1800 S SWOPE 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) | |
|---|---|---|
| F 0809 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 40) snacks. They send trays of snacks to the nurses’ station. We have packages of graham crackers, cookies and chips. After they leave the kitchen, we do not know who gets the snacks. During an interview on 5/10/19, at 3:10 P.M., Resident #66 said if he/she is fast enough to the nurses’ station, he/she gets an evening snack. However, often they are all gone by the time he/she gets to the nurses’ station. He/she thinks staff should pass out the snacks with the evening medication. That way it is fair and everyone could have a snack before going to bed. It is a long time between supper and breakfast especially if you have a room tray. You do not receive your breakfast tray until between 9:30 A.M. and 10:30 A.M. He/she would prefer to go to the dining room for meals, but he/she cannot get his/herself out of bed and it takes hours for staff to answer the call lights and have time to help him/her out of bed in the morning. He/she feels sorry for the certified nurses’ aides (CNA), too often they work alone when the other aides just do not show up to work. During an interview on 5/14/19, at 9:57 A.M., Resident #51 said snacks are brought down to the nurses’ station on a couple of trays for all the residents on 300, 500 and the short part of 400 halls. They bring cookies like Oreo packages, chips, graham crackers, and sometimes peanut butter and jelly sandwich halves You have to go get your own snack. If you are unable to get your own snack, you are just out of luck. No one has ever come door to door and asked if he/she would like a snack. Snack trays come down and people help themselves. The biggest problem is a few residents take most of the snacks if they get there first and the rest of us are out of luck. People are hungry so they grab what they can. There are never enough snacks to go around. During an interview on 5/14/19, 1:14 P.M., Liciensed Practicial Nurse (LPN) D said dietary staff bring snack trays to the nurses’ station each evening. Residents help themselves to the snacks. He/she is not sure what happends to residents who cannot come get their snacks. He/she guessed they could ask their CNA for a snack. Nursing does not monitor who gets snacks; there is no way since they help themselves. During an interview on 5/8/19, at 1:30 P.M., CNA I said dietary sends small packages of cookies, graham crackers, cups of applesauce or yogurt and once in a while a banana on the snack tray to the unit. They only send enough for each resident; no extra. They also send a pitcher of juice or a flavored drink. We have asked and asked for small sandwiches, cheese and crackers or other finger foods since some of the residents wander up and down the hallway and do not sit down to eat. We have asked for food to be put in the refrigerator to give to residents who wander at night. We need to be able to feed the residents when they are hungry day or night, but we are not given any extra food to give the residents between meals or at nights. Too often, the residents do not like and will not eat the meal served but we have nothing else to fed them. He/she has asked that the kitchen send a few grilled cheese sandwiches down with the meal trays but it has never happened. The unit residents always receive the regular meal from the kitchen. If a resident is allergic to or cannot eat a food, like pork, it is just omitted from their plate but nothering else is added. No one is listening to staff on the unit when we tell dietary and nursing what the residents need on the memory care unit. We have residents who sleep past meal time; we have no way of heating up a meal tray even if we would keep their meal tray in the refrigerator. Often if a resident sleeps a lot in the day time they just miss out on their meal. During an interview on 5/13/19, at 12:45 P.M., the Registered Dietitian said: – The facility should provide everyone who wants an evening snack at snack of their liking. – Dietary needs to provide finger foods and ingredients for sandwiches on the memory care |
| 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: 265693 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER REDWOOD OF INDEPENDENCE | STREET ADDRESS, CITY, STATE, ZIP 1800 S SWOPE 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) | |
|---|---|---|
| F 0809 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 41) unit for residents who sleep in the day time and wander at night. – Even residents off the unit should be able to have foods at alternate times if that is what they need to obtain their nutritional needs. – It should never take three hours to serve everyone breakfast. | |
| F 0812 Level of harm – Minimal harm or potential for actual harm Residents Affected – Many | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation. record review and interview, the facility failed to prepare, store |
| 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: 265693 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER REDWOOD OF INDEPENDENCE | STREET ADDRESS, CITY, STATE, ZIP 1800 S SWOPE 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) | |
|---|---|---|
| F 0812 Level of harm – Minimal harm or potential for actual harm Residents Affected – Many | (continued… from page 42) holder; – DS B picked up the white cloth from the red roller cart and placed the damp greasy white cloth on the counter; – He/she placed a grease laden sheet pan from the cooked sausage across the red cart and wheeled the cart and pan over to the dirty dish area; – He/she returned from the dirty dish area and tried to open a box, still wearing the same greasy gloves; – He/she removed his/her gloves to tear open the box of plastic wrap; – He/she put on clean gloves without washing hands; – DS B went to the oven, touched the sticky, greasy door handle; checked the sausage in the oven, went into the walk-in cooler and came back with cartons of cholesterol free/fat free egg product; (contained egg whites on carton) placed about 1/4 cup of margarine in the skillet with his/her gloved hands and added the liquid egg mixture into skillet, all while still wearing the same soiled gloves; – Without washing his/her hands, changing gloves or sanitizing the dirty cloth, he/she picked up the white cloth that laid on the whip, wiped off the counter and tossed it back on the end of the counter then picked up the dirty whip and took it to the dishwashing areas; – He/she removed sausage from the steam pan with his/her gloved hands and placed the sausage into the food processor across the room. He/she processed the sausage for about a minute, removed the lid and placed his/her gloved hands into the food processor then using his/her gloved hand, scooped the ground sausage out of Robo Coupe into a steam pan; – DS B went back to work area, covered the pan of ground sausage with plastic wrap and placed the pan into the small steam table; grease from his/her gloved hands stained the plastic wrap package; – He/she returned to the oven/range and stirred the scrambled eggs with a spatula; after finding them cooked, poured the scrambled eggs into a small steam table pan and checked the temperature (172 F); – At 6:07 A.M., DS G entered the kitchen and started pouring milk, juice etc. into small glasses; – At 6:11 A.M., a red substance was noted splattered on the wall and doorway near the small steam table and behind the large floor-standing mixer; the splattered area covered several feet of the wall and doorway; – DS B left the kitchen preparation area and went over to the passed through window, where a resident was requesting a cup of coffee. DS B got a coffee cup and poured coffee into the cup, opened the kitchen door going into the dinning room and gave the resident the cup of coffee, touching the sticky kitchen door with his/her gloved hands; – DS B added more butter, using his/her gloved fingers, into the previously used skillet and added another carton of the egg mixture into the dirty skillet; – DS B, wearing the same gloved hands, picked up 15 sausage links out of a pan of sausage and placed the sausage in the Robo Coupe. He/she ran the Robo Coupe for a minute or so and turned off the Robo Coupe, removed the lid and placed his/her gloved hand into the ground sausageand rubbed the ground sausage between his/her gloved fingers; – He/she left the Robo Coupe area, went to the coffee area at the front side of the kitchen and obtained a Styrofoam cup then went into the dry storage room and dipped the Styrofoam cup into an open box of food thickener, filling the cup about 1/3 full and returned to the Robo Coupe. He/she then added the thickener and processed the mixture for another minute; – DS B placed his/her same gloved hands back into the sausage mixture, rubbing the mixture |
| 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: 265693 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER REDWOOD OF INDEPENDENCE | STREET ADDRESS, CITY, STATE, ZIP 1800 S SWOPE 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) | |
|---|---|---|
| F 0812 Level of harm – Minimal harm or potential for actual harm Residents Affected – Many | (continued… from page 43) with his/her fingers and said the sausage mixture was too thick. He/she went back to the coffee area, obtained a cup of hot water and poured about 1/3 of a cup of hot water into the Robo Coupe with the sausage. He/she ground the sausage mixture a little longer then scooped the mixture out of the Robo Coupe with his/her hands and placed the sausage mixture into small steam table pan. DS B did not change his/her gloves or wash his/her hands during this time. – At 6:11 A.M., without washing his/her hands and changing gloves, DS B placed the sausage mixture on the steam table. – DS B returned to the oven, wearing the same gloves, then went to the stove to stir the scrambled eggs and placed the scrambled egg mixture into steam table pan. The side of the steam table pan shinned from DS B’s greasy gloves; – He/she went into walk-in freezer, touching handles and several boxes, then returned with an unopened box of sausage patties; he/she said he/she did not have enough sausage cooked because he/she used more sausage than he/she thought preparing the pureed and ground sausage; – Still wearing the same soiled gloves, he/she got a sheet pan, placed parchment paper from a box splattered with food and grease and placed the parchment on the pan; went over to the stove area, obtained a bottle of cooking spray and sprayed the parchment then laid sausage patties, touching each patty with his/her same greasy soiled gloved hands. He/she placed the pan of sausage into the oven, leaving grease from his/her gloved hands on the oven handle. – At 6:25 A.M., the filled milk glasses remained sitting on counter. DS G placed small pieces of plastic over the top of each glass. – DS B went back to the walk-in refrigerator, placed the box of sausage into the refrigerator then went back across the room to the roller toaster. He/she used the same gloved hands to pull the slices of bread out of the loaf of bread and placed the bread into the toaster; – He/she went back across the room to get a resident a cup of coffee, again touching the kitchen door with his/her gloved hands. – He/she returned to the skillet, added more butter using his/her fingers and poured egg mixture into the used skillet. – He/she went back to toaster and found it not working; he/she handled multiple parts of the toaster and the outlet and found the toaster was unplugged. He/she plugged the toaster cord into the outlet, and with the same gloved hands, picked up slices of bread and placed the bread into the roller part of toaster, returned to the oven/range to stir the eggs and returned, moving back and forth from the stove to the toaster several times, stopping in between to get residents coffee. – Staff placed a tray of silverware from the dishwasher to counter for dietary staff to roll napkins around the silverwear for meal service. Multiple pieces of food were mixed in with the supposedly cleaned silverware. Pineapple chunks and a small rice like pasta was on the silverware and in the tray. An unknown staff wrapped the silverware for breakfast tray use. – At 6:35 A.M., DS G added a thin layer of ice in a plastic container and sat the glasses of milk on the ice. The ice was about an inch high on the glasses of milk and juice. – DS B checked the temperature of the scrambled eggs in the skilled and said they were 159 degrees F which was close enough to the required 160 degree F. – At 6:38 A.M., DS B removed his/her gloves, took the dirty egg skillet to the dishwashing room; sprayer the skillet with hot water and wiped the skillet dry with the a white cloth. He/she used the same white cloth to clean off the stove and tossed the cloth onto the red |
| 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: 265693 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER REDWOOD OF INDEPENDENCE | STREET ADDRESS, CITY, STATE, ZIP 1800 S SWOPE 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) | |
|---|---|---|
| F 0812 Level of harm – Minimal harm or potential for actual harm Residents Affected – Many | (continued… from page 44) cart. DS B used no soap nor did he/she sanitize the skillet. – Without washing his/her hands, DS B put on new gloves and took sausage out of the oven; placed the cooked sausage into the pan of previously cooked sausage on steam table and returned the dirty pan to dish room. – He/she removed plastic wrap from the food on the steam table and adding serving spoons. – At 6:44 A.M., showed DS D making more toast with his/her greasy gloved hands. – DS B remove his/her gloves and started going through the menu sheet for the day’s breakfast. He/she took the menu sheets to the dining room for residents to fill out. – At 7:08 A.M., DS D brought unpasteurized eggs out of the walk in cooler to the stove. DS D put on gloves without washing his/her hands. – DS B returned to the kitchen and without washing his/her hands or changing gloves, he/she placed his/her hand into the steam table pans and pulled out two links of sausage placed on plate; went into the dry storage room after containers of dry cereal and returned to the tray line; – DS B continued to fill trays touching sausage, toast etc with his/her gloved hands; – DS D told DS B to use tongs when serving food but DS B continued to use his/her gloved hands touching the food. – DS B took the stack of paper menu tickets down off the shelf and placed the paper menus in middle of a plate to find the one he/she wanted; he/she placed the menu sheets back on the shelf; filled the same plate he/she had touched with all of the residents’ menu sheets and served the food to a resident. – DS B removed a piece of sausage off of a resident’s plate that had been prepared, tossed the sausage back into the steam pan and added eggs in place of the sausage to the same plate. Greasy shined on the resident’s plate from DS B’s gloved hand. During an interview on 5/13/19, at 1:18 P.M., the Registered Dietitian said: – Staff should wash their hands and put on clean gloves between tasks. – Staff should not be mopping the floor and cooking at the same time. – Staff should not touch food with gloved hands during meal preparation and service. – Staff are to use tongs during meal service. – Staff should wash their hands and put on clean gloves between tasks and any time their gloves came in contact with a dirty surface. – Doors and boxes are considered unclean surfaces. – Damp used clothes should not be on the counter, carts or work areas and should not be used to clean food preparation surfaces. – Staff should always store their cleaning cloths in a sanitizing solution and sanitize the counter when items were spilled or after food preparation. – Staff should not rinse pans or skillets, dry with a cloth and re-sure. Pan and skillets must be washed, rinsed and sanitized properly or washed in the dishwasher. – Staff are to air dry dishes and pans. – Staff should clean all parts of the kitchen including the elecrical cords, outlets and the walls. During an interview on 5/14/19, at 10:20 A.M., the Administrator said she was aware the dietary department had issues. They hired a new dietary manager who started today and brought trained staff with her. 2. Observation on 5/8/19, at 7:18 A.M., showed DS D fried unpasteurized eggs hard. DS B said he/she needed over easy eggs. DS D said their facility does not serve soft eggs. DS B said he/she was aware some buildings do not serve soft eggs but they do. DS D said the health department said no soft eggs. DS B said he/she knew this, but the residents liked soft eggs and they made and serve easy over eggs. DS D prepared the soft over easy eggs |
| 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: 265693 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER REDWOOD OF INDEPENDENCE | STREET ADDRESS, CITY, STATE, ZIP 1800 S SWOPE 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) | |
|---|---|---|
| F 0812 Level of harm – Minimal harm or potential for actual harm Residents Affected – Many | (continued… from page 45) for DS B to put on the residents’ plates. During an interview on 5/8/19, at 9:50 A,M., the Administrator said: – The facility does not serve unpasteurized soft eggs. – They only use pasteurized eggs. – She called the former dietary manager who still did the ordering for the facility at 9:52 A.M., and found out he/she had never ordered pasteurized eggs. – The Administrator said she would stop the serving of over easy eggs until she can order and the pasteurized eggs were delivered. – She believed they used pasteurized eggs. During an interview on 5/8/19, at 10:10 A.M., the Registered Dietitian said: – The facility does not serve soft eggs. – She told the former dietary manager that he/she could not serve soft eggs unless they were pasteurized. – She instructed the dietary manager to order pasteurized eggs. – She had never been in the facility when a soft unpastured egg was served. During an interview on 5/9/19, at 11:15 A.M., the Administrator said he/she checked the food orders and did not find where staff had ordered pasturized eggs. During an interview on 5/8/19, at 2:59 P.M., Resident #25 said he/she always orders his/her eggs over medium and wanted the yolk runny. He/she received a good runny egg this morning. He/she liked to dip his/her toast in the runny egg yolk. During an interview on 5/9/19, at 9:20 A.M., Resident #66 said he/she was upset because the dietary staff would not prepare easy over eggs this morning. He/she always ate easy over eggs. During an interview on 5/9/19, at 11:21 A.M., DS B said he/she did not know anything about pasteurized eggs. He/she was not to serve any more soft eggs until told otherwise. During an interview on 5/10/19, 10:35 A.M, DS B said he/she cooked about 35 soft easy over eggs daily. He/she was not aware until this week that she could not serve easy over unpasteurized eggs. 3. Observation on 5/8/19, at 8:41 A.M., showed the test tray temperatures’s out of range included a sausage link 117.3 F; milk 55.9 F and orange juice 55.2 F. During an interview on 5/10/19, at 10:15 A.M., DS B said no one monitors the food temperatures once the food leaves the kitchen. He/she was unaware that residents had complained of cold food and lukewarm milk. It take a long time to get all of the residents feed. During an interview on 5/10/19, at 10:35 A.M., DS D said hot food should be at least 135 degrees F when served to the residents and the cold food should be below 42 degrees F. They should have placed the glasses of milk and juice encased in ice, just not sat the glasses of milk on top of a layer of ice. 4. Observation on 5/8/19, at 6:40 A.M., showed a tray of silverware just out of the dishwasher. The silverware contained pieces of pineapple and orzo pasta which stuck onto the silverware. Staff used the silverware during the breakfast meal. Observation and interview on 5/9/19, at 2:15 P.M., showed: – DS D checked the sanitizing solution in the dishwasher more than twice. – He/she said he/she could not get the test strips to register any sanitizing solution. – He/she fiddled with the containers and tubing, trying to make sure the sanitizing solution was going into the machine. – He/she could not get the sanitizing solution to test. – DS B said he/she was unaware how often anyone checked the sanitizing solution in the dishwasher. Staff only record the dishwasher’s temperature daily. |
| 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: 265693 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER REDWOOD OF INDEPENDENCE | STREET ADDRESS, CITY, STATE, ZIP 1800 S SWOPE 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) | |
|---|---|---|
| F 0812 Level of harm – Minimal harm or potential for actual harm Residents Affected – Many | (continued… from page 46) – DS B said the dishwasher was old and sometimes did not clean the the best. During an interview on 5/13/19, at 1:18 P,M., the Registered Dietitian said: – Staff should check and record the sanitizing solution of the dishwasher before or during every meal – Staff should make sure the dishwasher is work correctly. | |
| 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: 265693 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER REDWOOD OF INDEPENDENCE | STREET ADDRESS, CITY, STATE, ZIP 1800 S SWOPE 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) | |
|---|---|---|
| F 0880 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 47) brief and assisted the resident to dress; – Assisted the resident to stand from his/her bed; – He/she touched the handles of the resident’s wheelchair and assisted the resident to sit in the wheelchair; – He/she removed his/her gloves , did not wash his/her hands, gathered trash and soiled clothing in bags and without washing his/her hands, opened the resident’s door, left the resident’s room and walked down the hall to the soiled utility room. 3 Review of Resident #46’s Minimum Data Set (MDS), a federally mandated assessment instrument completed by facility staff, dated 3/9/19, showed: – Difficulty making daily decisions; – Required assistance of staff for toilet use and personal hygiene; – Indwelling catheter and frequently incontinent of bowel; – [DIAGNOSES REDACTED]. Observation and interview on 5/14/19 at 10:11 A.M., showed the resident lay in bed with a supra-pubic catheter (a urinary catheter that is inserted into the abdominal wall and into the bladder). Certified Nurse Aide (CNA) A entered the resident’ room and without washing his/her hands, he/she put on a pair of gloves. CNA A said the insertion site looked infected then he/she provided catheter care in the following way: – Provided catheter care for the resident. changed gloves and washed his/her hands; – Retrieved a graduate (plastic measuring container) from the bathroom, drained urine into the graduate and handled the drain spout, – Without changing gloves or washing hands, CNA A adjusted the resident’s clothing, gathered trash and after removing gloves, without washing hands left the resident’s room. 4. Review of Resident #62’s quarterly MDS, dated [DATE], showed: -Cognitively intact; -Total dependence for toileting; -Extensive assistance required for personal hygiene; -Incontinent of bowel and bladder; -Had moisture-associated skin damage. Review of the resident’s care plan, last revised on 4/2/19, showed: -Required extensive assist with personal hygiene; -Total dependence for toileting; -At risk for skin breakdown; -Peri care after each incontinent episode. Observation on 5/14/19 at 10:24 A.M., showed CNA’s A and D provided care in the following manner as the resident lay in bed: -Both staff washed hands and put on gloves; -CNA A unfastened the resident’s wet brief and cleansed part of the resident’s front genital area, wiping back and forth with the same bunch of moist wipes; -CNA D turned the resident to the resident’s right side; -CNA A cleansed the resident’s backside, wiping back and forth with the same bunch of moist wipes; -CNA D turned the resident onto his/her back; -With the same soiled gloves on, CNA A cleansed the remainder of the front genital skin folds, picked up the resident’s pants, put a stocking on the resident’s left foot, helped CNA D put pants on the resident, picked up the moist wipes container and laid it on the resident’s over-the-bed table, picked up a lift sling and laid it on the bed, helped CNA D place the sling under the resident, adjusted the resident’s top and pants, touched the handle bar of the resident’s electric wheelchair, removed his/her gloves and left 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: 265693 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER REDWOOD OF INDEPENDENCE | STREET ADDRESS, CITY, STATE, ZIP 1800 S SWOPE 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) | |
|---|---|---|
| F 0880 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 48) room, but did not wash his/her hands first. 5. Review of Resident #1’s quarterly MDS, dated [DATE], showed: -Required extensive assistance with toileting and personal hygiene; -Incontinent of urine. Review of the resident’s care plan, last revised on 5/7/19, showed: -Had a urinary catheter (sterile tube inserted into the bladder to drain urine); -At risk for urinary tract infection [MEDICAL CONDITION] due to a history of UTI’s; -Started on an antibiotic for a UTI on 5/6/19. Observation on 5/8/19 at 1:15 P.M. showed Licensed Practical Nurse (LPN) A provided care in the following manner: -Washed his/her hands and put on gloves; -Emptied urine from the resident’s catheter drainage bag and emptied it in the toilet; -Removed his/her gloves, but did not wash or sanitize his/her hands; -Left the resident’s room, took keys from his/her uniform pocket, unlocked the medication cart and removed items from it, then sanitized his/her hands. During an interview on 5/8/19 at 1:34 P.M., LPN A said staff should wash or sanitize their hands after they emptied a catheter drainage bag. He/she did not realize he/she touched multiple items and surfaces before he/she sanitized his/her hands. During an interview on 5/14/19 at 2:40 P.M., CNA A said: – He/she should wash his/her ands when he/she entered a room and before he/she finished resident care; – He/she should wash his her hands after care before putting on clean stuff. 6. Review of Resident #47’s Minimum Data Set (MDS), a federally mandated assessment completed by facility staff, dated 3/18/19 showed: -Cognitively intact. Review of the resident’s Care Plan dated 5/7/19 showed: – The resident was on antibiotic therapy due to [MEDICAL CONDITION]; – Administer antibiotic as per MD orders; – Maintain universal precautions when providing resident care. Review of the (MONTH) 2019 Physician order [REDACTED].>- [MEDICATION NAME] MCL (antibiotic) 125 milligrams (mg), give one capsule by mouth every 6 hours for infection until 5/15/19, start date 5/9/19. During an interview on 5/08/19 at 1:12 P.M. the resident said he/she: – Had [MEDICAL CONDITION]; – Took an antibiotic to treat it 3 times per day; – Had 3 bowel episodes of diarrhea that day, and had been having diarrhea for about week; – Had been hospitalized the last week of April, three days after he/she returned to the facility, the diarrhea returned; – tested positive for [MEDICAL CONDITION] and was kept in bed for three days. Observation at the same time showed there was no signage posted that the resident was on any kind of infection control precautions. Observation on 5/08/19 01:55 P.M. beginning at 1:55 P.M. showed: Regional Human Resources staff entered the resident’s room, spoke briefly with the resident then left. – CNA I entered the resident’s room then left; – CNA H entered the resident’s room, retrieved at room tray, spoke with the resident, then left. The staff then returned to the room then left again – None of the staff washed their hands or took any other precautions after entering or before exiting the 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: 265693 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER REDWOOD OF INDEPENDENCE | STREET ADDRESS, CITY, STATE, ZIP 1800 S SWOPE 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) | |
|---|---|---|
| F 0880 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 49) Observation on 5/10/19 9:09 A.M. showed Housekeeping C (Lisa Carlock) walked in to resident’s room, got a bowl with partially eaten hard boiled egg, walked out of room with it and put it on a food cart. He/she did not his/her wash hands or take any other precautions. During an observation on 5/10/19 at 8:55 A.M. showed an unknown staff member walked in to the room asked if the resident had gotten his/her room tray, the resident said no and the he/she wanted some ice water, staff took the resident’s cup, with ungloved hands, and got ice from the storage closet, walked back in to the resident’s room, filled resident’s water at the sink, and said he/she would be right back, then walked out of the resident’s room and walked in to another resident’s room, spoke with a resident, then walked out, then walked in to another resident’s room, walked out and walked down the hallway. The staff did not wash his/her hands or take any other precautions. During an interview on 5/10/19 at 7:51 A.M. the Administrator said the resident had chronic, colonized [MEDICAL CONDITION]. During an interview on 5/14/19 at 4:00 P.M. the Director of Nursing (DON) said: – Staff should wash their hands before leaving a room of a resident with an infection, such as [MEDICAL CONDITION]. 7. Review of the facility’s undated policy related to blood glucose monitoring showed, in part: -Assemble needed equipment; -Wash hands and put on gloves; -Perform the blood sugar check; -Remove gloves and wash hands; -Put on gloves and clean glucometer (machine used to check blood sugar levels) per manufacturer’s directions; -Remove gloves and wash hands. Review of the facility’s undated medication administration policy showed to wash hands before and after medication administration. 8. Review of Resident #200’s (MONTH) 2019 physician order [REDACTED]. Observation on 5/8/19 at 7:45 A.M., showed LPN B checked blood sugar levels and administered insulin to the resident in the following manner: -Gathered supplies and set them on an aluminum foil barrier at the resident’s bedside; -Washed hands and put on gloves; -Checked the resident’s blood sugar; -Removed gloves, but did not wash or sanitize hands; -Put on new gloves and drew insulin into a syringe; -Removed gloves, did not wash or sanitize hands, and put on new gloves; -Administered the insulin in the resident’s left upper arm; -Removed gloves, but did not wash or sanitize hands; -Touched the computer mouse, touched an ink pen and paper notebook, took keys from his/her uniform pocket and touched the medication cart lock and drawer handle, went to the ERU (express rehabilitation unit) dining room and touched Resident #98’s wheelchair handles, then returned to the medication cart and opened a drawer, removed a piece of aluminum foil and put on gloves, but did not wash or sanitize his/her hands; -Sanitized the glucometer with a sanitizing wipe and set it on the foil to dry, then gathered supplies from the medication cart drawer for Resident #98’s blood sugar check and set them on a piece of aluminum foil on the cart and removed his/her gloves, but did not wash or sanitize his/her hands. 9. Review of Resident #98’s (MONTH) 2019 POS showed he/she received blood sugar level |
| 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: 265693 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER REDWOOD OF INDEPENDENCE | STREET ADDRESS, CITY, STATE, ZIP 1800 S SWOPE 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) | |
|---|---|---|
| F 0880 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 50) checks before meals and at bedtime, and received insulin for diabetes. Observation on 5/8/19 at 7:55 A.M., showed LPN B checked the resident’s blood sugar level and administered insulin in the following manner: -Took supplies to the resident’s room and set them on a piece of aluminum foil; -Put on gloves, but did not wash or sanitize his/her hands first; -Checked the resident’s blood sugar level and set the glucometer on a piece of foil on the medication cart; -Removed his/her gloves, but did not wash or sanitize his/her hands; -Opened the medication cart, touched multiple medication containers, then removed the resident’s insulin bottle from the drawer; -Put on new gloves, but did not wash or sanitize his/her hands; -Drew insulin into a syringe; -Removed his/her gloves, did not wash or sanitize his/her hands, and put on new gloves; -Went to the resident’s room and administered the insulin in the resident’s abdomen; -Removed his/her gloves, but did not wash or sanitize his/her hands. During an interview at 8:03 A.M., LPN B said: -He/she did not know staff should wash or sanitize their hands after each glove removal. -He/she thought it was ok to wash or sanitize hands after every second resident as long as he/she wore gloves. 10. Review of Resident #86’s (MONTH) 2019 POS showed orders for: -[MEDICATION NAME] (water pill) 80 milligrams (mg) daily; -[MEDICATION NAME] (to lower cholesterol) 40 mg daily; -Magnesium Oxide (supplement) 400 mg twice a day; -[MEDICATION NAME] (stimulates gastric movement) 10 mg before meals and at bedtime; -[MEDICATION NAME] (renal supplement) once a day; -[MEDICATION NAME] (for heart arrhythmia) 200 mg daily; -[MEDICATION NAME] (for gastric reflux) 40 mg daily; -[MEDICATION NAME] 8.6 mg daily for constipation; -[MEDICATION NAME] inhaler two times a day for breathing; -[MEDICATION NAME] 0.25 mg twice a day for anxiety; -[MEDICATION NAME]-[MEDICATION NAME] solution 0.5-2.5 mg/3 milliliters per nebulizer (device that disperses medication into a fine mist for inhalation) four times a day for shortness of air. Observation on 5/8/19, between 11:36 A.M. and 11:50 A.M., showed LPN B administered the resident’s medications in the following manner: -Sanitized hands and put on gloves; -Administered one inhalation of [MEDICATION NAME]; -Removed his/her gloves, but did not wash or sanitize his/her hands; -Touched the computer mouse, then opened the medication cart and obtained the resident’s medications from medication cards and stock medication containers and put them in a medication cup; -Put gloves on, but did not wash or sanitize his/her hands; -Returned to the resident’s room and administered a second inhalation of [MEDICATION NAME]; -Removed his/her gloves, did not wash or sanitize his/her hands; -Administered the resident’s oral medications; -Put on new gloves, did not wash or sanitize his/her hands; -Checked the resident’s oxygen saturation level, listened to his/her lung sounds, removed his/her gloves, but did not wash or sanitize his/her 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: 265693 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER REDWOOD OF INDEPENDENCE | STREET ADDRESS, CITY, STATE, ZIP 1800 S SWOPE 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) | |
|---|---|---|
| F 0880 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 51) -Left the room to obtain a new nebulizer face mask; -Returned to the resident’s room, did not wash or sanitize his/her hands; -Administered the resident’s [MEDICATION NAME]-[MEDICATION NAME] nebulizer treatment, removed his/her gloves and sanitized his/her hands. During an interview on 5/8/19 at 12:08 P.M., LPN B said he/she should have washed or sanitized his/her hands before he/she obtained the resident’s medications, after he/she administered the inhaler, after he/she administered the nebulizer treatment and with each glove change. 11. During an interview on 5/14/19 at 4:00 P.M.,the Director of Nurses said: – Staff should wash their hands before and after patient care; – Staff could use hand sanitizer, but should use soap and water if visibly soiled; – Staff should wash their hands between glove changes; – Staff should wash their hands between care provided after the front side of the resident and the back side; – Staff should was their hands after peri care before they touch anything else; – Staff should wash their hands before they left the resident’s room. | |
