| 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: 265797 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER RIDGE CREST NURSING CENTER | STREET ADDRESS, CITY, STATE, ZIP 706 SOUTH MITCHELL | |||||||||
| For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or 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 0610 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | Respond appropriately to all alleged violations. **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: 265797 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER RIDGE CREST NURSING CENTER | STREET ADDRESS, CITY, STATE, ZIP 706 SOUTH MITCHELL | |||||||||
| For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or 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 0610 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 1) medications). Record review of the facility’s Controlled Substances policy dated 12/2012 showed: -Only authorized licensed nursing and/or pharmacy personnel shall have access to Schedule II (an opioid narcotic) controlled drugs maintained on premises; -The DON will identify staff members who are authorized to handle controlled substances; -An individual resident controlled substance record must be made for each resident who will be receiving a controlled substance. Do not enter more than one prescription per page. This record must contain: the name of the resident; the name and strength of the medication; the quantity received; the number on hand; the name of the physician; the prescription number; the name of the issuing pharmacy; the date and time received; the time of administration; the method of administration; the signature of the person receiving the medication; and the signature of the nurse administering the medication; -All keys to controlled substance containers shall be on a single key ring that is different from any other keys; -The charge nurse on duty will maintain the keys to controlled substance containers. The DON will maintain a set of back-up keys for all medication storage areas including keys to controlled substance containers. and -The DON shall investigate any discrepancies in narcotics reconciliation to determine the cause and identify any responsible parties, and shall give the Administrator a written report of such findings. 1. Record review of Resident #36’s Face Sheet showed he/she was admitted to the facility on [DATE] and readmitted on [DATE] with the following Diagnoses: [REDACTED]. -Low back pain; -Other chronic pain; -[MEDICAL CONDITION] (never pain) and -Dorsalgia (spinal pain). Record review of the resident’s (MONTH) (YEAR) physician’s orders [REDACTED]. Record review of the resident’s (MONTH) (YEAR) MAR showed: -[MEDICATION NAME] 5/325 mg, one tablet every four hours prn for pain and -Staff documented [MEDICATION NAME] 5/325 mg administered twice during the month. Record review of the resident’s Controlled Substance Log showed: -[MEDICATION NAME] 5/325 mg, one tablet every four hours prn for pain; -[MEDICATION NAME] 5/325 mg tablet was removed from the resident’s narcotic supply 18 times during the month; –16 tablets of [MEDICATION NAME] 5/325 mg were unaccounted for and –Nine tablets were signed out on the narcotic log and not documented on the resident’s MAR as administered to the resident by CMT C. Record review of the resident’s (MONTH) (YEAR) POS showed [MEDICATION NAME] 5/325 mg, one tablet every four hours prn for pain. Record review of the resident’s (MONTH) (YEAR) MAR showed: -[MEDICATION NAME] 5/325 mg, one tablet every four hours as needed for pain and -Staff documented [MEDICATION NAME] 5/325 mg administered seven times during the month. Record review of the resident’s Controlled Substance Log showed: -[MEDICATION NAME] 5/325 mg, one tablet every four hours as needed for pain; -[MEDICATION NAME] 5/325 mg tablet was removed from the resident’s narcotic supply 19 times during the month; –12 tablets of [MEDICATION NAME] 5/325 mg were unaccounted for and –Ten tablets were signed out on the narcotic log and not documented on the resident’s MAR as administered to the resident by CMT C. |
| 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: 265797 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER RIDGE CREST NURSING CENTER | STREET ADDRESS, CITY, STATE, ZIP 706 SOUTH MITCHELL | |||||||||
| For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or 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 0610 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 2) Record review of the resident’s annual Minimum Data Set (MDS – a federally mandated assessment instrument completed by facility staff for care planning) dated 4/6/18 showed he/she: -Was cognitively intact; -Received scheduled pain medication; -Received as needed pain medication and -Received an opioid during the look-back period seven out of seven days. Record review of the resident’s care plan dated 4/13/18 showed: -He/She had discomfort/pain in he/her back and -He/She is currently on scheduled pain medication and he/she requested as needed pain medication. Record review of the resident’s (MONTH) (YEAR) POS showed [MEDICATION NAME] 5/325 mg, one tablet every four hours as needed for pain. Record review of the resident’s (MONTH) (YEAR) MAR showed: -[MEDICATION NAME] 5/325 mg, one tablet every four hours as needed for pain; -[MEDICATION NAME] 5/325 mg was crossed out on 5/27/18 with a handwritten note On Nurse MAR and -Staff documented [MEDICATION NAME] 5/325 mg administered 13 times during the month. Record review of the resident’s Controlled Substance Log showed: -[MEDICATION NAME] 5/325 mg, one tablet every four hours as needed for pain; -[MEDICATION NAME] 5/325 mg tablet was removed from the resident’s narcotic supply 49 times during the month; –36 tablets of [MEDICATION NAME] 5/325 mg were unaccounted for; –15 tablets were signed out of the narcotic log and not documented on the resident’s MAR as administered to the resident between 5/1/18 – 5/27/18 when the MAR was crossed out on 5/27/18 with a handwritten On Nurse MAR by CMT C and –Six tablets were signed out of the narcotic log and not documented on the resident’s MAR as administered to the resident between 5/28/17-5/31/18 by CMT C. Record review of the resident’s (MONTH) (YEAR) POS showed [MEDICATION NAME] 5/325 mg, one tablet every four hours as needed for pain. Record review of the resident’s (MONTH) (YEAR) MAR showed: -[MEDICATION NAME] 5/325 mg, one tablet every four hours as needed for pain was crossed out on the CMT MAR with a handwritten note On Nurse MAR; -[MEDICATION NAME] 5/325 mg, one tablet every four hours as needed for pain was handwritten on the Nurse’s MAR and -Staff documented [MEDICATION NAME] 5/325 mg administered twice during the month. Record review of the resident’s Controlled Substance Log showed: -[MEDICATION NAME] 5/325 mg, one tablet every four hours as needed for pain; -[MEDICATION NAME] 5/325 mg tablet was removed from the resident’s narcotic supply three times between 6/1/18 – 6/6/18 and –One tablet of [MEDICATION NAME] 5/325 mg was unaccounted for. During an interview on 6/5/18 at 9:17 A.M., an anonymous resident said: -He/She believed CMT C was taking Resident #36’s as needed narcotics; -He/She reported this to the DON a week or two ago; -The as needed narcotics were pulled from the CMT’s carts and given to the licensed nursing staff to administer; -The alleged perpetrator still worked at the facility and was still administering some as needed narcotics; -He/She felt the DON and Administrator did not investigate his/her complaint 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: 265797 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER RIDGE CREST NURSING CENTER | STREET ADDRESS, CITY, STATE, ZIP 706 SOUTH MITCHELL | |||||||||
| For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or 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 0610 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 3) -Resident #36 had told the DON he/she was not getting his/her as needed narcotics. During an interview on 6/5/18 at 9:55 A.M., the resident said: -He/She did not usually take as needed pain medication since his/her pain is controlled with a [MEDICATION NAME] (a narcotic); -He/She had not requested an as needed pain medication for quite some time before the previous night; -Last week a staff member asked him/her if he had been taking two to three as needed [MEDICATION NAME] 5/325 mg tablets a day and -He/She told the staff member he had not taken any as needed [MEDICATION NAME] 5/325 mg for a while and could not remember the last time he/she had requested to take one. 2. Record review of Resident #19’s Face Sheet showed he/she was admitted to the facility on [DATE] and readmitted on [DATE] with the [DIAGNOSES REDACTED]. Record review of the resident’s care plan dated 10/13/17 showed: -He/She had expressed pain in his/her knee and back at times; -Had no scheduled pain medication at that time and -Staff should administer pain medication as ordered. Record review of the resident’s quarterly MDS dated [DATE] showed he/she: -Was cognitively intact; -Received as needed pain medication and -Received an opioid seven out of seven days during the look-back period. Record review of the resident’s (MONTH) (YEAR) POS showed [MEDICATION NAME] 5/325 mg; two tablets every six hours as needed for pain. Record review of the resident’s (MONTH) (YEAR) MAR showed: -[MEDICATION NAME] 5/325 mg, take two tablets every six hours as needed for pain and -[MEDICATION NAME] 5/325 mg was documented as administered to the resident 12 times during the month for a total of 24 tablets. Record review of the resident’s [MEDICATION NAME] 5/325 mg Controlled Substance Log showed: -[MEDICATION NAME] 5/325 mg, take two tablets every six hours as needed for pain; -[MEDICATION NAME] 5/325 mg, two tables per dose, was removed from the resident’s narcotic supply 55 times during the month for a total of 110 tablets; -Forty-three doses, for a total of 86 [MEDICATION NAME] 5/325 mg were unaccounted for during the month and -Seventeen doses, for a total of 34 tablets were signed out of the narcotic log and not documented on the resident’s MAR as administered to the resident by CMT C. Record review of the resident’s quarterly MDS date 3/27/18, MAR and Controlled Substance Log showed the resident: -Had moderate cognitive impairment; -Received as needed pain medication; -Received an opioid three out of seven days during the look-back period; –During the look-back period the resident’s MAR showed [MEDICATION NAME] 5/325 two tablets every six hours as needed for pain was administered three out of the seven days and –During the look-back period the resident’s Controlled Substance Log showed [MEDICATION NAME] 5/325 mg take two tablets every six hours as needed for pain was removed seven out of seven days. Record review of the resident’s (MONTH) (YEAR) POS showed: -[MEDICATION NAME] 5/325 mg, take two tablets every six hours as needed for pain; -Discontinue [MEDICATION NAME] 5/325 mg, two tablets every six hours as needed for pain on |
| 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: 265797 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER RIDGE CREST NURSING CENTER | STREET ADDRESS, CITY, STATE, ZIP 706 SOUTH MITCHELL | |||||||||
| For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or 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 0610 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 4) 4/19/18 and -Start [MEDICATION NAME] 10/325 mg, take one tablet every six hours as needed for pain on 4/19/18. Record review of the resident’s (MONTH) (YEAR) MAR showed: -[MEDICATION NAME] 5/325 mg, take two tablets every six hours as needed for pain; –Eleven doses were documented as administered between 4/1/18 – 4/19/18, for a total of 22 tablets; –The rest of the month was crossed out with a handwritten notation the order was changed on 4/19/18; -Handwritten [MEDICATION NAME] 10/325 mg take one tablet every six hours as needed for pain dated 4/19/18 and –One dose was documented between 4/19/18 – 4/30/18. Record review of the resident’s [MEDICATION NAME] 5/325 mg Control Substance Log showed: -[MEDICATION NAME] 5/325 mg, take two tablets every six hours as needed for pain; -A handwritten note on the second Control Substance Log received by the facility on 4/10/18 noting the order changed on 4/19/18 and nurse needs notified when this card runs out on the Control Substance Log; -[MEDICATION NAME] 5/325 mg, two tablets per dose, was removed from the resident’s narcotic supply 52 times between 4/1/18 – 4/23/18 for a total of 101 tablets; -Twenty doses for a total of 40 tablets were signed out on the resident’s narcotic log and not documented as administered on the resident’s MAR by CMT C; –The resident’s order for [MEDICATION NAME] 5/325 mg was discontinued on 4/19/18; –Thirteen tablets were removed from the resident’s [MEDICATION NAME] 5/325 mg narcotic supply after the resident’s order was discontinued; -Forty-one doses, for a total of 82 [MEDICATION NAME] 5/325 mg were unaccounted for during the month; -[MEDICATION NAME] 10/325 mg, take one tablet every six hours for pain was removed from the resident’s narcotic supply nine times between 4/24/18 – 4/29/18; –Eight doses of [MEDICATION NAME] 10/325 mg for a total of eight tablets were unaccounted for between 4/24/18 – 4/30/18 and –Three tablets were signed out on the resident’s narcotic log and not documented as being administered to the resident by CMT C. Record review of the resident’s (MONTH) (YEAR) POS showed [MEDICATION NAME] 10/325 mg, take one tablet every six hours as needed for pain. Record review of the resident’s (MONTH) (YEAR) MAR showed: -[MEDICATION NAME] 10/325 mg, take one tablet every six hours as needed for pain; -Eight doses were documented as administered during the month for total of eight tablets; -The order was crossed out with a hand-written note after 5/26/18 the medication was on the nurse’s MAR; -A handwritten [MEDICATION NAME] 10/325 mg, take one tablet every six hours as needed for pain on the nurse’s MAR and -No documented doses on the nurse’s MAR during the month. Record review of the resident’s [MEDICATION NAME] 10/325 mg Control Substance Log showed: -[MEDICATION NAME] 10/325 mg, take one tablet every six hours as needed for pain; -[MEDICATION NAME] 10/325 mg, one tablet per dose, was removed from the resident’s narcotic supply 44 times during the month for a total of 44 tablets; -Thirty-six doses, for a total of 36 [MEDICATION NAME] 10/325 mg were unaccounted for during the month; -Twelve tablets were signed out on the resident’s narcotic log and not documented as |
| 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: 265797 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER RIDGE CREST NURSING CENTER | STREET ADDRESS, CITY, STATE, ZIP 706 SOUTH MITCHELL | |||||||||
| For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or 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 0610 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 5) administered to the resident on the resident’s MAR by CMT C between 5/1/18 – 5/26/18 and -Six tablets were signed out on the resident’s narcotic log and not documented as administered to the resident on the resident’s MAR after the MAR was marked through on 5/27/18 with a handwritten note On Nurse MAR by CMT C. Record review of the resident’s (MONTH) (YEAR) POS showed [MEDICATION NAME] 10/325 mg, take one tablet every six hours as needed for pain. Record review of the resident’s (MONTH) (YEAR) MAR showed: -[MEDICATION NAME] 10/325 mg, take one tablet every six hours as needed for pain was crossed out with a handwritten note On Nurses MAR; -A handwritten [MEDICATION NAME] 10/325 mg, take one tablet every six hours as needed for pain on the nurse’s MAR; -Three doses were documented as administered between 6/1/18 – 6/6/18 for a total of three tablets and -No documented doses on the CMT MAR during the month. Record review of the resident’s [MEDICATION NAME] 10/325 mg Control Substance Log showed: -[MEDICATION NAME] 10/325 mg, take one tablet every six hours as needed for pain and -[MEDICATION NAME] 10/325 mg, one tablet per dose, was removed from the resident’s narcotic supply three times during the month for a total of three tablets. During an interview on 6/7/18 at 2:53 P.M., the resident said: -He/She takes his/her pain medication one time a day and -He/She denied taking more than one pain medication a day. 3. Record review of Resident #22’s Face Sheet showed he/she was admitted to the facility on [DATE] and readmitted on [DATE]. Record review of the resident’s (MONTH) (YEAR) POS showed [MEDICATION NAME] 5/325 mg one tablet every six hours for pain dated 3/12/18. Record review of the resident’s (MONTH) (YEAR) MAR showed: -[MEDICATION NAME] 5/325 mg one tablet every six hours for pain and -[MEDICATION NAME] 5/325 mg was documented as administered by the staff two times during the month. Record review of the resident’s medical record showed a Controlled Substance Log could not be found for 3/12/18 – 3/31/18. Record review of the resident’s significant change MDS dated [DATE] showed he/she: -Was severely cognitively impaired; -Did not receive as needed pain medication and -Did not receive an opioid during the seven day look-back period. Record review of the resident’s care plan dated 3/23/18 showed: -The resident had the potential for pain related to a [MEDICAL CONDITION] and -Coordinate with his/her physician to manage his/her pain medication for optimum control of his/her pain. Record review of the resident’s (MONTH) (YEAR) POS showed [MEDICATION NAME] 5/325 mg one tablet every six hours for pain dated 3/12/18. Record review of the resident’s (MONTH) (YEAR) MAR showed: -[MEDICATION NAME] 5/325 mg one tablet every six hours for pain and -[MEDICATION NAME] 5/325 mg was documented as administered by the staff two times during the month. Record review of the resident’s medical record showed no documentation of the resident’s Controlled Substance Log from 4/1/18 – 4/30/18. Record review of the resident’s (MONTH) (YEAR) POS showed [MEDICATION NAME] 5/325 mg one tablet every six hours for pain dated 3/12/18 with a handwritten RN to the side of 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: 265797 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER RIDGE CREST NURSING CENTER | STREET ADDRESS, CITY, STATE, ZIP 706 SOUTH MITCHELL | |||||||||
| For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or 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 0610 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 6) order. Record review of the resident’s (MONTH) (YEAR) MAR showed: -[MEDICATION NAME] 5/325 mg one tablet every six hours for pain; –The order was crossed out with a handwritten On Nurse MAR on 5/27/18 and -[MEDICATION NAME] 5/325 mg was documented as administered by the staff two times during the month. Record review of the resident’s medical record showed no documentation of the resident’s Controlled Substance Log between 5/1/18 – 5/26/18. Record review of the resident’s Controlled Substance Log showed: -[MEDICATION NAME] 5/325 mg, take one tablet four times a day as needed; -Thirty tablets were delivered on 4/30/18; -Eight tablets were removed from the resident’s narcotic supply between 5/27/18 – 5/29/18; –Six [MEDICATION NAME] 5/325 mg were unaccounted for and –Six tablets were signed out on the resident’s narcotic log and not documented on the resident’s MAR as administered between 5/27/18-5/31/18 by CMT C. The resident’s MAR was crossed out on 5/27/18 with a handwritten On Nurse MAR. Record review of the resident’s (MONTH) (YEAR) POS showed [MEDICATION NAME] 5/325 mg one tablet every six hours for pain dated 3/12/18 with a handwritten RN to the side of the order. Record review of the resident’s (MONTH) (YEAR) MAR showed: -[MEDICATION NAME] 5/325 mg one tablet every six hours for pain; –The order was crossed out with a handwritten On Nurse MAR on 5/27/18 and -[MEDICATION NAME] 5/325 mg was documented as administered by the staff zero times during the month. Record review of the resident’s Controlled Substance Log showed: -[MEDICATION NAME] 5/325 mg, take one tablet four times a day as needed; -Thirty tablets were delivered on 4/30/18; -One tablet was removed from the resident’s narcotic supply between 6/1/18 – 6/6/18 and –One [MEDICATION NAME] 5/325 mg was unaccounted for. Record review of the resident’s medical record showed no additional Controlled Substance Logs for the resident’s [MEDICATION NAME] 5/325 mg were located by the facility staff prior to 4/30/18. During an interview on 6/15/18 at 2:30 P.M., the resident’s pharmacy said: -On 3/14/18, 30 [MEDICATION NAME] 5/325 mg tablets were delivered to the facility; -On 4/30/18, 30 [MEDICATION NAME] 5/325 mg tablets were delivered to the facility; –Per the resident’s pharmacy interview, a total of 60 tablets were delivered to the facility; –Six tablets have been documented on the resident MAR as administered between 3/12/18 – 6/6/18; –Nine tablets have been signed out on the resident’s Controlled Substance Log with 21 tablets remaining and –A total of 54 [MEDICATION NAME] 5/325 mg tablets are unaccounted for. 4. During an interview on 6/7/18 at 2:56 P.M., the Administrator said: -He/She recalled the DON calling him/her a week or so ago, he/she couldn’t remember the exact date, regarding a concern about possible narcotic diversion by CMT C; -The DON was supposed to call the Regional Nurse to help him/her with the investigation; -The DON should have the results of the investigation and -To his/her knowledge, the investigation was completed and unsubstantiated. During an interview on 6/7/18 at 3:24 P.M., the DON said: |
| 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: 265797 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER RIDGE CREST NURSING CENTER | STREET ADDRESS, CITY, STATE, ZIP 706 SOUTH MITCHELL | |||||||||
| For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or 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 0610 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 7) -He/She expected staff to document on the resident’s MAR each time an as needed medication is administered; -If staff remove a medication from the resident’s Controlled Substance Log, that medication should be documented on the resident’s MAR as well; -He/She does not compare the Controlled Substance Log with the MAR to ensure accuracy of the medication count; -He/She was made aware by a staff member and by a resident of a concern that Resident #36 was not receiving all of the narcotics that were being signed out as administered on 5/25/18 or 5/26/18; -He/She did not compare the resident’s Controlled Substance Log to the resident’s MAR to determine if there were any unaccounted for narcotics; -He/She did not compare any other resident’s Controlled Substance Log to the resident’s MAR to determine if any other residents had narcotics that were unaccounted for; -He/She did not have record of his/her investigation; -He/She did not think CMT C had diverted narcotics, thought it was a documentation issue; -He/She had been aware there was an issue with medication documentation in the past; -He/She had not been auditing medication administration documentation after being aware of the documentation issue; -He/She did not notify the State Agency regarding the alleged diversion; -The alleged perpetrator was not suspended because he/she was not on the schedule to work during the time he/she was investigating the diversion allegation; -He/She removed the as needed narcotics for residents who were not alert and oriented from the CMT’s cart and gave the narcotics to the licensed nurses on 5/27/18 due to this allegation and the CMT’s lack of documentation; -He/She did not have record of interviewing the resident who allegedly had missing narcotics and -He/She did not interview other staff regarding narcotic administration or documentation. During an interview on 6/7/18 at 5:36 P.M., CMT C said: -He/She had been in-serviced at some time about how to document administration of narcotics; -Staff should document on the resident’s narcotic Controlled Substance Log when a dose is removed for administration; -He/She would document on the front of the resident’s MAR when he/she administered a medication, including an as needed narcotic; -He/She would assess the resident’s pain prior to administering an as needed narcotic pain medication and document it on the back of the resident’s MAR; -The licensed nurse were to follow-up on the effectiveness of the resident’s as needed narcotic pain medication; -He/She could not explain why an as needed narcotic would be documented as removed from the resident’s narcotic supply and not documented as administered on the resident’s MAR and -He/She denied diverting narcotic pain medication for his/her personal use. Complaint #MO 471 | |
| 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. |
| 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: 265797 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER RIDGE CREST NURSING CENTER | STREET ADDRESS, CITY, STATE, ZIP 706 SOUTH MITCHELL | |||||||||
| For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or 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 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure residents who required staff assistance with bathing were offered and/or received at least two baths or showers per week for five sampled residents (Resident #19, #33, #96, #4, and #17) out of 13 sampled residents. The Facility Assessment Tool showed the facility had 40 residents which required staff assistance for bathing. The facility census was 46 residents. Record review of the facility’s Shower/Tub Bath policy dated 10/2010 showed: -The following information should be recorded on the resident’s Activity of Daily Living (ADL) record and/or in the resident’s medical record: –The date and time the shower/tub bath was performed. –The name and title of the individual(s) who assisted the resident with the shower/tub bath. –All assessment data, such as any reddened areas or sores on the resident’s skin, obtained during the resident’s shower/tub bath. –How the resident tolerated the shower/tub bath. –If the resident refused the shower/tub bath, the reason(s) why, and the interventions taken. –The signature and title of the person recording the data. -Notify the supervisor if the resident refused the shower/tub bath. 1. Record review of Resident #19’s Face Sheet showed he/she was admitted to the facility on [DATE] and readmitted on [DATE]. Record review of the resident’s Care Plan dated 10/13/17 showed the resident: -Had been discharged to the hospital on [DATE] and returned on 5/8/18; -He/She required staff assistance to complete ADL’s; -Staff should provide assistance with bathing and -He/She should be bathed per his/her schedule. Record review of the resident’s quarterly Minimum Data Set (MDS – a federally mandated assessment instrument completed by facility staff for care planning) dated 12/28/17 showed he/she: -Was cognitively intact and -Required extensive staff assistance for bathing. Record review of the resident’s quarterly MDS dated [DATE] showed he/she: -Had moderate cognitive impairment and -Required extensive staff assistance for bathing. Record review of the resident’s Shower Log dated (MONTH) (YEAR) – (MONTH) (YEAR) showed: -The resident received a shower on 5/3/18, 5/9/18, 5/14/18, 5/24/18 and 5/26/18; -The resident was in the hospital on [DATE]; -The resident had no documented showers or baths from 6/1/18 – 6/7/18; –No documentation by the facility staff the resident received at least two showers per week and –No documentation the resident received a shower between 5/26/18 – 6/7/18. Record review of the resident’s Shower Sheet/Skin Assessment showed: -The resident received a shower on 5/1/18, 5/14/18, and 5/24/18 and -No documented showers after 5/24/18 – 6/7/18. During an interview on 6/5/18 at 11:01 A.M. the resident said: -He/She would like to have a bath or shower at least twice a week; -Staff did not have time to give him/her a bath or shower twice a week and -He/She was not sure how long it had been since he/she had a bath or shower. |
| 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: 265797 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER RIDGE CREST NURSING CENTER | STREET ADDRESS, CITY, STATE, ZIP 706 SOUTH MITCHELL | |||||||||
| For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. | ||||||||||
| (X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
|---|---|---|
| F 0677 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 9) Observation on 6/6/18 at 6:00 A.M. showed the resident was sitting in his/her recliner with his/her eyes closed. His/her hair was oily and slicked down to his/her scalp. During an interview and observation on 6/6/18 at 7:19 A.M. showed the resident was in his/her wheelchair propelling themselves down the hall. His/her hair was unclean, oily, and slicked down to his/her scalp. The resident said it had been a while since he/she had a bath. During an interview and observation on 6/6/18 at 9:50 A.M. showed: -The resident’s hair was oily and slicked down to his/her scalp; -Certified Nursing Assistant (CNA) A and Registered Nurse (RN) A assisted the resident to the toilet. -CNA A said: –RN A or Certified Medication Technician (CMT) A would be able to watch the resident’s on the 300 and 400 hall if he/she had to stop answering call lights to give a resident a shower; –He/She could ask the charge nurse to watch call lights on the 300 and 400 hall, but sometimes there is only one CMT for 100, 200, 300, and 400 halls, so the CMT may not be available to help watch call lights; –The facility had a shower book with a resident shower schedule, but he/she did not know what happened to it; –He/She did not know what days the residents were supposed to get baths; –He/She will give a resident a shower if he/she thinks the resident needs one; –He/She would document the resident’s shower in the shower book after it had been completed and -It was difficult to get showers done for the 300 and 400 hall when he/she is the only CNA for 23 residents. During an observation and interview on 6/7/18 at 8:55 A.M. the resident: -Had oily hair slicked down to his/her scalp; -Had a small, quarter-sized reddened area on his/her right chest, visible above the neckline of his/her shirt; -Was in his/her wheelchair in front of the nurse’s station with two unidentified staff in the area. -Said I hope I get a shower today and -Reported he/she had not received a shower since before the survey started on 6/4/18 and was not certain when his/her last shower was. During an interview and observation on 6/7/18 at 7:00 P.M., the resident: -Had oily hair slicked down to his/her scalp and -Said he/she still had not received a shower. During an interview on 6/7/18 at 9:39 A.M., CNA B said: -Normally the facility has a dedicated shower aide, but does not currently have one; -He/She tries to work resident showers in when he/she can and ask the charge nurse and CMT to watch the unit and answer call lights while he/she give the residents showers; -There is a shower book the staff are supposed to sign when a resident’s shower has been completed; -Staff is also supposed to complete a Shower Sheet that shows a skin assessment has been completed with the resident’s shower; -The Shower Sheet is turned in to the Director of Nursing (DON) for review and -He/She has not been able to get resident showers done because there is not enough staff to help watch the floor, toilet residents, and answer call lights while he/she is assisting the resident’s in the shower. |
| 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: 265797 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER RIDGE CREST NURSING CENTER | STREET ADDRESS, CITY, STATE, ZIP 706 SOUTH MITCHELL | |||||||||
| For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. | ||||||||||
| (X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
|---|---|---|
| F 0677 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 10) During an interview on 6/8/18 at 10:40 A.M., Licensed Practical Nurse (LPN) A said: -All staff were responsible to ensure residents received baths; -There is a bathing schedule for the staff to refer to know when a resident’s bath or shower is due; -He/She could not locate a resident bathing schedule in the Shower Book for the 300 and 400 halls; -Staff should go through the Shower Book to see who has had an shower and to ask the resident’s who have not had a shower that week if they want one; -Staff should document in the Shower Book if a resident refused a shower; -Staff should also complete a skin sheet when a resident’s bath is completed for the nurse to review. This form is then turned into the DON to review; -Nursing staff should also document in the resident’s Nurse’s Notes if the resident refused a shower; -Residents should be offered two showers a week; -The charge nurse and the DON should follow up to ensure showers are at least offered twice weekly and -The last documented shower for Resident #19 was 5/26/18. During an interview on 6/8/18 at 10:42 A.M., CMT A said: -Residents should have at least two showers per week; -Staff should write down on the Shower Log in the Shower Book if a resident refused his/her shower, but sometimes staff forget to document when a resident refuses; -Residents have assigned shower days, which should be located on the front of the Shower Book and -He/She could not locate the resident shower schedule for the 300 and 400 halls. 2. Record review of Resident #33’s Face Sheet showed he/she was admitted to the facility on [DATE], and most recently readmitted on [DATE]. Record review of the resident’s Annual MDS, dated [DATE], showed he/she: -Was cognitively intact; -Had no behaviors and did not exhibit rejection of cares; -Needed extensive assistance with bed mobility and toileting; -Needed limited assistance with personal hygiene and dressing and -Did not participate or have staff participation with bathing, walking or transfer during the 7-day assessment look back period. Record review of the resident’s Care Plan reviewed and updated 4/30/18, showed: -The resident often refused cares and -Staff should provide assistance with ADL’s. Record review of the resident’s Shower Log for (MONTH) (YEAR) showed: -The resident did not receive a shower or bed bath during the month of May; -There was no documentation to show the resident was offered a shower or bath, or refusal of a shower or bath and -The shower log was blank. Record review of the resident’s Shower Log for (MONTH) (YEAR) showed: -The resident had not received a shower or bed bath and -There was no documentation to show the resident refused a shower or bath. -The shower log was blank. 3. Record review of Resident #96’s Face Sheet showed he/she was admitted to the facility on [DATE], and most recently readmitted on [DATE]. Record review of the resident’s Annual MDS, dated [DATE], showed he/she: -Was moderately cognitively impaired; |
| 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: 265797 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER RIDGE CREST NURSING CENTER | STREET ADDRESS, CITY, STATE, ZIP 706 SOUTH MITCHELL | |||||||||
| For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or 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) -Had no behaviors and did not exhibit rejection of cares; -Needed extensive assistance with transfers, walking, toileting, and bathing and -Needed limited assistance with bed mobility, dressing, and personal hygiene. Record review of the resident’s Care Plan reviewed and updated 4/30/18, showed staff should provide assistance with ADL’s. Record review of the resident’s Shower Log for (MONTH) (YEAR) showed he/she received four showers during the month of (MONTH) (on 5/3, 5/7, 5/14, 5/26). Record review of the resident’s Shower Log for (MONTH) (YEAR) showed the resident had a shower on 6/7. (Note: The resident did not have a shower for 11 days prior to (MONTH) 7.) Observation of the resident on 6/5/18 at 9:31 A.M. showed the resident in his/her wheelchair outside his/her room. The resident had an odor. Observation and interview of the resident on 6/5/18 at 10:00 A.M., during Resident Council, showed the resident in his/her wheelchair. Another resident attending the meeting would not sit by the resident because of the resident’s odor. During an interview on 6/8/18 at 1:46 P.M., CNA A said: -Residents should be getting showers every two or three days. It does happen sometimes; -Showers should be documented in the shower book and -There is a shower book at each nurses’ station. During an interview on 6/8/18 at 2:13 P.M., the DON said -Residents should be getting showers or baths twice weekly; -We had a shower aide, but she has been working on the floor; -He/she knew that some residents were not getting their baths; -Showers should be documented on the shower sheet and the shower sheet should be given to the charge nurse; -The charge nurse should look at anything noted on the shower sheet and document anything in reference to skin issues; -The nurse should monitor shower sheets; -Staff mentioned they did not have time to do baths/showers; -The nurse should take initiative to help the CNAs by watching the floor while the CNAs give showers; -There have been audits and the audits show that more CNAs are needed; -Even if a resident refuses their shower, it should be documented on the shower sheet and -Showers should be offered and given to residents on halls 100 and 300 on Mondays and Thursdays; and to residents on halls 200 and 400 on Tuesdays and Fridays. 4. Record review of Resident # 4’s Face Sheet showed he/she was admitted to the facility on [DATE] with the following [DIAGNOSES REDACTED]. Record review of the resident’s quarterly MDS dated [DATE] showed he/she: -Was cognitively intact and -Required limited staff assistance for bathing. Record Review of the resident’s Care Plan dated 9/7/17 showed: -He/she required staff assistance to complete ADL’s and -Staff should provide assistance with bathing. Record review of the resident’s Shower Log dated (MONTH) (YEAR) and (MONTH) (YEAR) showed the resident: -Received a shower on 5/3/18, and 5/20/18; -Had no documented showers or baths from 5/20/18 through 6/7/18 and -Had no documentation, by facility staff, that showed the resident had received at least two shower/baths per week. Record review of the resident’s Shower Sheet/Skin Assessment for (MONTH) (YEAR) 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: 265797 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER RIDGE CREST NURSING CENTER | STREET ADDRESS, CITY, STATE, ZIP 706 SOUTH MITCHELL | |||||||||
| For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or 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) (MONTH) (YEAR) showed he/she received a shower on 5/3/18. Observation on 6/4/18 at 8:00 P.M. of the resident’s room showed: -The room had a very strong odor; -Flies flying around in room; -Resident was sitting in his/her wheelchair watching TV and -His/her hair slicked back. Observation on 6/5/18 at 1:00 P.M. of the resident’s room showed: The room had a very strong odor; -Flies flying around in room; -Resident was sitting in his/her wheelchair, TV on, and lunch tray in front of him/her and -His/her hair slicked back. During an interview on 6/5/18 at 1:00 P.M. the resident said: -He/she would like to have a bath/shower more often; -There wasn’t enough staff to give him/her a bath/shower; -He/she was not sure how long it had been since he/she had a bath/shower and -He/she don’t ask any more for a bath/shower because he/she won’t get one. Observation on 6/6/18 at 7:00 A.M. showed of the resident’s room showed: -The room had a very strong odor; -Resident was sitting in his/her wheelchair with TV on and -His/her hair slicked back. Observation on 6/7/18 at 8:00 A.M. of the resident’s room showed: -The room had a very strong odor; -Resident was sitting in his/her wheelchair with TV on and -His/her hair slicked back. 5. Record review of Resident # 17’s Face Sheet showed that he/she was admitted to the facility on [DATE], readmitted on ,[DATE] and 3/17/18. Record review of the resident’s Medical Record showed the following [DIAGNOSES REDACTED]. Record review of the resident’s quarterly MDS dated [DATE] showed he/she: -Was severely cognitively impaired and -Required total staff assistance for bathing. Record Review of the resident’s Care Plan dated 2/20/18 showed: -He/she was dependent on staff for daily hygiene/grooming; -He/she to be showered/bathed per schedule and -Staff should provide assistance with bathing. Record review of the resident’s Shower Log dated (MONTH) (YEAR) and (MONTH) (YEAR) showed the resident: -Received a shower on 5/3/18; -Had no documented showers or baths from 5/3/18 through 6/7/18 and -Had no documentation, by facility staff, that showed the resident received at least two shower/baths per week. Record review of the resident’s Shower Sheet/Skin Assessment for (MONTH) (YEAR) and (MONTH) (YEAR) showed he/she received a shower on 5/3/18. Observation on 6/4/18 at 7:49 P.M., showed: -The resident lying in bed on right side in fetal position and – His/her hair looked oily and uncombed. Observation on 6/5/18 at 12:48 P.M. showed: -The resident sitting up in wheelchair and -His/her hair looked oily and uncombed. Observation on 6/6/18 at 6:20 A.M. 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: 265797 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER RIDGE CREST NURSING CENTER | STREET ADDRESS, CITY, STATE, ZIP 706 SOUTH MITCHELL | |||||||||
| For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or 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) -The resident lying in bed on left side in fetal position and -His/her hair looked oily and uncombed. 6. During an interview on 6/8/18 at 2:13 P.M., the DON said: -Residents should be getting showers or baths twice weekly; -We had a shower aide, but she has been working on the floor; -He/she knew that some residents were not getting their baths; -Showers should be documented on the shower sheet and the shower sheet should be given to the charge nurse; -The charge nurse should look at anything noted on the shower sheet and document anything in reference to skin issues; -The nurse should monitor shower sheets; -Staff mentioned they did not have time to do baths/showers; -The nurse should take initiative to help the CNAs by watching the floor while the CNAs give showers; -There have been audits and the audits show that more CNAs are needed; -Even if a resident refuses their shower, it should be documented on the shower sheet and -Showers should be offered and given to residents on halls 100 and 300 on Mondays and Thursdays; and to residents on halls 200 and 400 on Tuesdays and Fridays. | |
| F 0684 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | Provide appropriate treatment and care according to orders, resident’s preferences and goals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** |
| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265797 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER RIDGE CREST NURSING CENTER | STREET ADDRESS, CITY, STATE, ZIP 706 SOUTH MITCHELL | |||||||||
| For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or 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 0684 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 14) Record review of the resident’s annual Minimum Data Set (MDS – a federally mandated assessment instrument completed by facility staff for care planning) dated 4/6/18 showed he/she was cognitively intact. Record review of the resident’s (MONTH) (YEAR) physician’s orders [REDACTED]. Notify the resident’s physician for blood sugar results below 60 or above 400. Record review of the resident’s (MONTH) (YEAR) Medication Administration Record [REDACTED] -Accuchecks three times daily before meals. Notify the resident’s physician for blood sugar results below 60 or above 400. -5/3/18 evening blood sugar was 57; -5/4/18 morning blood sugar was 53; -5/9/18 morning blood sugar was 48; -5/19/18 morning blood sugar was 50; -5/25/18 evening blood sugar was 56; -5/26/18 morning blood sugar was 49 and -No documentation on the back of the MAR indicated [REDACTED]. Record review of the resident’s Accucheck Record showed: -On 5/10/18 the facility faxed the resident’s blood sugar results from 5/3/18 – 5/9/18 to the resident’s physician; -On 5/17 the facility faxed the resident’s blood sugar results from 5/10/18 – 5/16/18 to the resident’s physician; -On 5/24/18 the facility faxed the resident’s blood sugar results from 5/17/18 – 5/23/18 to the resident’s physician and -On 5/31/18 the facility faxed the resident’s blood sugar results from 5/24/18 – 5/30/18 to the resident’s physician. Record review of the resident’s Nurse’s Notes from 5/1/18 – 5/31/18 showed no documentation the resident’s physician was notified of the resident’s low blood sugar results, any interventions done by the staff, or any repeat blood sugar testing results when the resident’s blood sugar was below 60. Record review of the resident’s (MONTH) (YEAR) POS showed Accuchecks (blood sugar monitoring) three times daily before meals. Notify the resident’s physician for blood sugar results below 60 or above 400. Record review of the resident’s (MONTH) (YEAR) MAR indicated [REDACTED] -Accuchecks three times daily before meals. Notify the resident’s physician for blood sugar results below 60 or above 400; -6/2/18 morning blood sugar was 51 and -No documentation on the back of the MAR indicated [REDACTED]. Record review of the resident’s Nurse’s Notes from 6/1/18 – 6/6/18 showed no documentation the resident’s physician was notified of the resident’s low blood sugar results, any interventions done by the staff, or any repeat blood sugar testing results when the resident’s blood sugar was below 60. During an interview on 6/5/18 at 10:45 A.M. the resident said: -He/She has had a few times when his/her blood sugar was low and -He/She thinks the fall he/she had last month may have been due to low blood sugar. During an interview on 6/8/18 at 10:42 A.M., Certified Medication Technician (CMT) A said: -He/She performs the resident’s blood glucose monitoring and -He/She would report to the charge nurse if the resident’s blood sugar level was less than the physician’s parameters or greater than the physician’s parameters. During an interview on 6/8/18 at 10:45 A.M., Licensed Practical Nurse (LPN) A said: -The CMT’s performs the resident’s blood glucose monitoring; |
| 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: 265797 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER RIDGE CREST NURSING CENTER | STREET ADDRESS, CITY, STATE, ZIP 706 SOUTH MITCHELL | |||||||||
| For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or 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 0684 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 15) -He/She would expect the CMT to report to him/her when a resident’s blood sugar level was less than or greater than the physician’s parameters; -The nurse should document on the back of the resident’s MAR indicated [REDACTED] -The nurse should document on the back of the resident’s MAR indicated [REDACTED] -The nurse should document in the resident’s Nurse’s Note the date and time of the resident’s physician’s notification; -If the resident’s order was to notify the resident’s physician for a blood sugar less than 60, the nurse should have called the resident’s physician and documented it in the resident’s medical record and -Notifying the resident’s physician several days later by fax with the resident’s weekly blood sugar notification would not be appropriate notification. During an interview on 6/8/18 at 2:03 P.M., the Director of Nursing (DON) said: -He/She expected the staff to follow the resident’s physician’s orders [REDACTED].>-If a resident has an order to notify the resident’s physician for blood sugar levels less than 60, he/she expected the staff to notify the resident’s physician and to document the notification in the resident’s Nurse’s Notes and/or on the back of the resident’s MAR; -The CMT’s usually obtain the resident’s blood sugars; -The CMT should notify the charge nurse if a resident’s blood sugar level is out of the physician ordered parameters and -The resident’s physician should be notified before the weekly fax reporting the resident’s blood sugar levels. | |
| F 0697 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | Provide safe, appropriate pain management for a resident who requires such services. **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: 265797 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER RIDGE CREST NURSING CENTER | STREET ADDRESS, CITY, STATE, ZIP 706 SOUTH MITCHELL | |||||||||
| For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or 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 0697 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 16) 1. Record review of Resident #36’s Face Sheet showed he/she was admitted to the facility on [DATE] and readmitted on [DATE] with the following Diagnoses: [REDACTED]. -Low back pain; -Other chronic pain; -[MEDICAL CONDITION] (never pain) and -Dorsalgia (spinal pain). Record review of the resident’s (MONTH) (YEAR) physician’s orders [REDACTED]. Record review of the resident’s (MONTH) (YEAR) MAR showed: -[MEDICATION NAME] 5/325 mg, one tablet every four hours as needed for pain; -Staff documented [MEDICATION NAME] 5/325 mg was administered twice during the month; -No documentation on the back of the resident’s MAR the resident’s pain was assessed prior to or after the administration of [MEDICATION NAME] 5/325 mg and -No documentation the staff attempted non-pharmacological interventions prior to administering an as needed narcotic pain medication. Record review of the resident’s (MONTH) (YEAR) POS showed [MEDICATION NAME] 5/325 mg, one tablet every four hours as needed for pain. Record review of the resident’s (MONTH) (YEAR) MAR showed: -[MEDICATION NAME] 5/325 mg, one tablet every four hours as needed for pain; -Staff documented [MEDICATION NAME] 5/325 mg administered seven times during the month; -The CMT assessed the resident’s pain prior to administering an as needed [MEDICATION NAME] 5/325 mg tablet five times. Three of the five assessments did not include a pain scale rating; -The licensed nurse assessed the resident’s pain prior to administering an as needed [MEDICATION NAME] 5/325 mg tablet one time; -The licensed nurse assessed the effectiveness of the resident’s as needed pain medication my documenting a down arrow pain without a pain scale rating six times and -No documentation staff attempted non-pharmacological interventions prior to administering as needed narcotic pain medication. Record review of the resident’s annual Minimum Data Set (MDS – a federally mandated assessment instrument completed by facility staff for care planning) dated 4/6/18 showed he/she: -Was cognitively intact; -Received scheduled pain medication; -Received as needed pain medication and -Received an opioid during the look-back period seven out of seven days. Record review of the resident’s care plan dated 4/13/18 showed: -He/She had discomfort/pain in his/her back and -He/She is currently on scheduled pain medication and has requested as needed pain medication. Record review of the resident’s (MONTH) (YEAR) POS showed [MEDICATION NAME] 5/325 mg, one tablet every four hours as needed for pain. Record review of the resident’s (MONTH) (YEAR) MAR showed: -[MEDICATION NAME] 5/325 mg, one tablet every four hours as needed for pain; -[MEDICATION NAME] 5/325 mg was crossed out on 5/27/18 with a handwritten note On Nurse MAR; –Staff documented [MEDICATION NAME] 5/325 mg administered 13 times during the month; –The CMT documented the resident’s pain assessment prior to the administration of an as needed [MEDICATION NAME] 5/325 mg five times; –The licensed nurse reassess the resident’s pain after the administration of an as needed |
| 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: 265797 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER RIDGE CREST NURSING CENTER | STREET ADDRESS, CITY, STATE, ZIP 706 SOUTH MITCHELL | |||||||||
| For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or 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 0697 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 17) [MEDICATION NAME] 5/325 mg four times. Three of the four times did not include a pain scale rating; -Non-pharmacological interventions every shift; –Staff documented nothing for non-pharmacological interventions 92 out of 93 shifts and –No documentation of a non-pharmacological intervention prior to each documented as needed [MEDICATION NAME] administration. Record review of the resident’s (MONTH) (YEAR) POS showed [MEDICATION NAME] 5/325 mg, one tablet every four hours as needed for pain. Record review of the resident’s (MONTH) (YEAR) MAR showed: -[MEDICATION NAME] 5/325 mg, one tablet every four hours as needed for pain was crossed out on the CMT MAR with a handwritten note On Nurse MAR; -[MEDICATION NAME] 5/325 mg, one tablet every four hours as needed for pain was handwritten on the Nurse’s MAR; –Staff documented [MEDICATION NAME] 5/325 mg administered twice during the month; -Non-pharmacological intervention prior to giving pain medications and chart result every shift and –Staff documented nothing for non-pharmacological interventions 16 out of 16 shifts. 2. Record review of Resident #19’s Face Sheet showed he/she was admitted to the facility on [DATE] and readmitted on [DATE] with the [DIAGNOSES REDACTED]. Record review of the resident’s care plan dated 10/13/17 showed: -He/She had expressed pain in his/her knee and back at times; -Had no scheduled pain medication at that time and -Staff should administer pain medication as ordered. Record review of the resident’s quarterly MDS dated [DATE] showed he/she: -Was cognitively intact; -Received as needed pain medication and -Received an opioid seven out of seven days during the look-back period. Record review of the resident’s (MONTH) (YEAR) POS showed [MEDICATION NAME] 5/325 mg; two tablets every six hours as needed for pain. Record review of the resident’s (MONTH) (YEAR) MAR showed: -[MEDICATION NAME] 5/325 mg, take two tablets every six hours as needed for pain; -[MEDICATION NAME] 5/325 mg was documented as administered to the resident 12 times during the month for a total of 24 tablets; –Staff documented the resident’s pain assessment prior to and after the administration of as needed [MEDICATION NAME] three times; –Two of the three times the resident’s pain was assessed prior to the administration of an as needed [MEDICATION NAME] was completed by the CMT and -No documentation the staff attempted non-pharmacological interventions prior to administering an as needed narcotic pain medication. Record review of the resident’s quarterly MDS dated [DATE], MAR and Controlled Substance Log showed he/she: -Had moderate cognitive impairment; -Received as needed pain medication and -Received an opioid three out of seven days during the look-back period. –During the look-back period the resident’s MAR showed [MEDICATION NAME] 5/325 two tablets every six hours as needed for pain was administered three out of the seven days and –During the look-back period the resident’s Controlled Substance Log showed [MEDICATION NAME] 5/325 mg take two tablets every six hours as needed for pain was removed seven out |
| 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: 265797 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER RIDGE CREST NURSING CENTER | STREET ADDRESS, CITY, STATE, ZIP 706 SOUTH MITCHELL | |||||||||
| For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or 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 0697 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 18) of seven days. Record review of the resident’s (MONTH) (YEAR) POS showed: -[MEDICATION NAME] 5/325 mg, take two tablets every six hours as needed for pain; -Discontinue [MEDICATION NAME] 5/325 mg, two tablets every six hours as needed for pain on 4/19/18 and -Start [MEDICATION NAME] 10/325 mg, take one tablet every six hours as needed for pain on 4/19/18. Record review of the resident’s (MONTH) (YEAR) MAR showed: -[MEDICATION NAME] 5/325 mg, take two tablets every six hours as needed for pain; –Eleven doses were documented as administered between 4/1/18 – 4/19/18, for a total of 22 tablets; –The rest of the month was crossed out with a handwritten notation the order was changed on 4/19/18; –The CMT documented the resident’s pain assessment prior to the administration of an as needed [MEDICATION NAME] 5/325 mg 9 times; -Handwritten [MEDICATION NAME] 10/325 mg take one tablet every six hours as needed for pain dated 4/19/18; –One dose was documented between 4/19/18 – 4/30/18; –The CMT documented the resident’s pain assessment prior to the administration of an as needed [MEDICATION NAME] 10/325 mg one time and -No non-pharmacological interventions were documented as attempted prior to the intervention of an as needed narcotic pain medication. Record review of the resident’s (MONTH) (YEAR) POS showed [MEDICATION NAME] 10/325 mg, take one tablet every six hours as needed for pain. Record review of the resident’s (MONTH) (YEAR) MAR showed: -[MEDICATION NAME] 10/325 mg, take one tablet every six hours as needed for pain; -Eight doses were documented as administered during the month for total of eight tablets; -The order was crossed out with a hand-written note after 5/26/18 the medication was on the nurse’s MAR; -A handwritten [MEDICATION NAME] 10/325 mg, take one tablet every six hours as needed for pain on the nurse’s MAR; -No documented doses on the nurse’s MAR during the month; -The resident’s pain was assessed prior to the administration of as needed [MEDICATION NAME] 10/325 mg seven times. The CMT assessed the resident’s pain prior to administering as needed [MEDICATION NAME] 10/325 mg four times; -The effectiveness of the as needed [MEDICATION NAME] was assessed four out of seven times the medication documented as assessed prior to administration and -Non-pharmacological interventions prior to giving pain medications every shift. –Staff documented nothing as the non-pharmacological intervention 50 out of 85 shifts; –Staff documented relaxation as the non-pharmacological intervention 26 out of 85 shifts and –Staff documented music as the non-pharmacological intervention eight out of 85 shifts. Record review of the resident’s (MONTH) (YEAR) POS showed [MEDICATION NAME] 10/325 mg, take one tablet every six hours as needed for pain. Record review of the resident’s (MONTH) (YEAR) MAR showed: -[MEDICATION NAME] 10/325 mg, take one tablet every six hours as needed for pain was crossed out with a handwritten note On Nurses MAR; -A handwritten [MEDICATION NAME] 10/325 mg, take one tablet every six hours as needed for pain on the nurse’s MAR; |
| 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: 265797 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER RIDGE CREST NURSING CENTER | STREET ADDRESS, CITY, STATE, ZIP 706 SOUTH MITCHELL | |||||||||
| For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or 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 0697 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 19) -Three doses were documented as administered between 6/1/18 – 6/6/18 for a total of three tablets and -No documented doses on the CMT MAR during the month. 3. Record review of Resident #22’s Face Sheet showed he/she was admitted to the facility on [DATE] and readmitted on [DATE]. Record review of the resident’s (MONTH) (YEAR) POS showed [MEDICATION NAME] 5/325 mg one tablet every six hours for pain dated 3/12/18. Record review of the resident’s (MONTH) (YEAR) MAR showed: -[MEDICATION NAME] 5/325 mg one tablet every six hours for pain; -[MEDICATION NAME] 5/325 mg was documented as administered by the staff two times during the month; -No documentation the staff assessed the resident’s pain prior to or after the administration of an as needed [MEDICATION NAME] 5/325 mg tablet and -No documentation the staff utilized non-pharmacological interventions prior to administering an as needed [MEDICATION NAME] 5/325 mg tablet. Record review of the resident’s significant change MDS dated [DATE] showed he/she: -Was severely cognitively impaired; -Did not receive as needed pain medication and -Did not receive an opioid during the seven day look-back period. Record review of the resident’s care plan dated 3/23/18 showed: -The resident had the potential for pain related to a [MEDICAL CONDITION] and -Coordinate with his/her physician to manage his/her pain medication for optimum control of his/her pain. Record review of the resident’s (MONTH) (YEAR) POS showed [MEDICATION NAME] 5/325 mg one tablet every six hours for pain dated 3/12/18. Record review of the resident’s (MONTH) (YEAR) MAR showed: -[MEDICATION NAME] 5/325 mg one tablet every six hours for pain; -[MEDICATION NAME] 5/325 mg was documented as administered by the staff two times during the month; -The CMT assessed the resident’s pain prior to administering an as needed [MEDICATION NAME] 5/325 mg two times; -The resident’s pain was not reassessed after the administration of an as needed [MEDICATION NAME] 5/325 mg two out of two times and -No documentation by the facility staff a non-pharmacological intervention was attempted prior to administering an as needed [MEDICATION NAME] 5/325 mg tablet. Record review of the resident’s (MONTH) (YEAR) POS showed [MEDICATION NAME] 5/325 mg one tablet every six hours for pain dated 3/12/18 with a handwritten RN to the side of the order. Record review of the resident’s (MONTH) (YEAR) MAR showed: -[MEDICATION NAME] 5/325 mg one tablet every six hours for pain; –The order was crossed out with a handwritten On Nurse MAR on 5/27/18; -[MEDICATION NAME] 5/325 mg was documented as administered by the staff two times during the month; -The CMT assessed the resident’s pain prior to administering an as needed [MEDICATION NAME] 5/325 mg tablet two times; -The CMT assessed the resident’s effectiveness of the resident’s pain medication and documented the assessment with a down arrow pain one time; -The resident’s pain was not reassessed after an as needed [MEDICATION NAME] 5/325 mg tablet one out of two times 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: 265797 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER RIDGE CREST NURSING CENTER | STREET ADDRESS, CITY, STATE, ZIP 706 SOUTH MITCHELL | |||||||||
| For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or 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 0697 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 20) -Non-pharmacological interventions prior to giving pain medications per shift. -Staff documented nothing as the non-pharmacological intervention 93 out of 93 shifts. Record review of the resident’s (MONTH) (YEAR) POS showed [MEDICATION NAME] 5/325 mg one tablet every six hours for pain dated 3/12/18 with a handwritten RN to the side of the order. Record review of the resident’s (MONTH) (YEAR) MAR showed: -[MEDICATION NAME] 5/325 mg one tablet every six hours for pain; –The order was crossed out with a handwritten On Nurse MAR on 5/27/18; -[MEDICATION NAME] 5/325 mg was documented as administered by the staff zero times during the month; -Non-pharmacological interventions prior to giving pain medications and chart each shift and -Staff documented nothing as the non-pharmacological intervention 20 out of 20 shifts. 4. During an interview on 6/7/18 at 3:24 P.M., the Director of Nursing (DON) said: -He/She expected staff to document on the resident’s MAR each time an as needed medication is administered;. During an interview on 6/7/18 at 5:36 P.M., CMT C said: -He/She had been in-serviced at some time about how to document administration of narcotics; -He/She would document on the front of the resident’s MAR when he/she administered a medication, including an as needed narcotic; -He/She would assess the resident’s pain prior to administering an as needed narcotic pain medication and document it on the back of the resident’s MAR and -The licensed nurse was responsible to follow-up on the effectiveness of the resident’s as needed narcotic pain medication. During an interview on 6/8/18 at 10:44 A.M., Licensed Practical Nurse (LPN) A said: -The CMT and the nurse can administer an as needed narcotic to a resident; -The licensed nurse should assess the resident’s pain with a pain scale prior to the resident being administered an as needed pain medication; -Staff should document as needed medication administration on the front of the resident’s MAR; -The back of the resident’s MAR should have the resident’s pain assessment before and after an as needed medication is administered; -If the CMT gives him/her the resident’s MAR to show an as needed medication was administered, he/she will reassess the resident and document the reassessment on the back of the resident’s MAR; -If the CMT does not give him/her the resident’s MAR, he/she would not know an as needed narcotic was administered to the resident; -Non-pharmacological interventions should be attempted before an as needed pain medications is administered unless the resident refused the non-pharmacological intervention and -If the resident refused a non-pharmacological intervention, it should be documented on the resident’s MAR. During an interview on 6/8/18 at 10:50 A.M., CMT A said: -He/She would assess a resident’s pain and report to the charge nurse what the resident’s pain was and where it was; -It depends on who the charge nurse is if he/she would report the resident’s pain report before giving the as needed pain medication and depending on the resident; -Staff should document as needed medication administration on the front of the resident’s |
| 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: 265797 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER RIDGE CREST NURSING CENTER | STREET ADDRESS, CITY, STATE, ZIP 706 SOUTH MITCHELL | |||||||||
| For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or 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 0697 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 21) MAR; -The back of the resident’s MAR should have the resident’s pain assessment before and after an as needed medication is administered. 5. Record review of Resident #33’s Face Sheet showed he/she was admitted to the facility on [DATE], and most recently readmitted on [DATE]. Record review of the resident’s annual MDS, dated [DATE], showed he/she: -Was cognitively intact; -Had no behaviors; -Needed extensive assistance with bed mobility and toileting; -Needed limited assistance with personal hygiene and dressing; -Experienced frequent pain; -Had pain that made it hard to sleep and -Received Opioid pain medication 7 out of 7 days during the assessment period. Record review of the resident’s Care Plan reviewed and updated 4/30/18, showed: -The resident verbalized discomfort/pain freely and talked to his/her Primary Care Physician (PCP) about his/her pain on visits. -Interventions included: –Provide comfort measures as needed. –Comfort measures included back rubs, lotion to the resident’s body, sponge baths, and repositioning. –Pain medication was to be administered as needed. Record review of the resident’s current POS showed a physician’s orders [REDACTED]. -Two tablets were to be administered by mouth every four hours PRN for pain; -The order was originally dated 8/25/17 and -The order was renewed 5/26/18. Record review of the resident’s MAR showed the resident received [MEDICATION NAME] 50 mg tablets on the following dates: -On 5/1/18 at 11:45 A.M. for general pain all over; –No non-pharmacological interventions were documented; -On 5/1/18 at 9:30 P.M. for general pain at 9, on a scale of 1 to 10; –No non-pharmacological interventions were documented; –The effectiveness of the medication was not evaluated; -On 5/2/18 at 7:00 P.M. for general pain at 6 on a scale of 1 to 10; –No non-pharmacological interventions were documented; -On 5/3/18 at 10:00 A.M. for general pain at 6 on a scale of 1 to 10; –No non-pharmacological interventions were documented; –The effectiveness of the medication was not evaluated; -On 5/4/18 at 4:45 A.M. for general pain at 9 on a scale of 1 to 10; –No non-pharmacological interventions were documented; -On 5/4/18 at 10:00 A.M. for general pain at 8 on a scale of 1 to 10; –No non-pharmacological interventions were documented; –The effectiveness of the medication was not evaluated; -On 5/5/18 at 10:00 A.M. for general pain all over; –No non-pharmacological interventions were documented; –The effectiveness of the medication was not evaluated; -On 5/6/18 at 10:00 A.M. for general pain all over; –No non-pharmacological interventions were documented; -On 5/6/18 at 9:00 P.M. for general pain at 9 on a scale of 1 to 10; –No non-pharmacological interventions were documented; |
| 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: 265797 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER RIDGE CREST NURSING CENTER | STREET ADDRESS, CITY, STATE, ZIP 706 SOUTH MITCHELL | |||||||||
| For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or 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 0697 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 22) –The effectiveness of the medication was not evaluated; -On 5/7/18 at 9:30 P.M. for general pain all over; –No non-pharmacological interventions were documented; -On 5/10/18 at 10:00 P.M. for general pain all over at 9 on a scale of 1 to 10; –No non-pharmacological interventions were documented; -On 5/10/18 at 5:00 P.M. for general pain at 7 on a scale of 1 to 10; –No non-pharmacological interventions were documented; –The effectiveness of the medication was not evaluated; -On 5/12/18 at 1:45 A.M. for general pain all over; –No non-pharmacological interventions were documented; -On 5/12/18 at 1:40 P.M. for general pain all over. –No non-pharmacological interventions were documented. -On 5/12/18 at 5:40 P.M. for general pain all over; –No non-pharmacological interventions were documented; -On 5/13/18 at 4:00 P.M. for general pain; –No non-pharmacological interventions were documented; –The effectiveness of the medication was not evaluated; -On 5/13/18 at 8:00 P.M. for general pain; –No non-pharmacological interventions were documented; –The effectiveness of the medication was not evaluated; -On 5/14/18 at 11:30 A.M. for general pain all over; –No non-pharmacological interventions were documented; –The effectiveness of the medication was not evaluated; -On 5/15/18 at 11:30 A.M. for general pain at 8 on a scale of 1 to 10; –No non-pharmacological interventions were documented; -On 5/16/18 at 11:00 A.M. for general pain at 9 on a scale of 1 to 10; –No non-pharmacological interventions were documented; -On 5/27/18 at 5:00 P.M. for general pain at 7 on a scale of 1 to 10. –No non-pharmacological interventions were documented. -On 5/28/18 at 5:30 A.M. for general pain at 6 on a scale of 1 to 10; –No non-pharmacological interventions were documented; -On 5/30/18 at 11:40 A.M. for general pain at 8 on a scale of 1 to 10; –No non-pharmacological interventions were documented; -On 5/30/18 at 11:30 A.M. for general pain at 8 on a scale of 1 to 10 and –No non-pharmacological interventions were documented. During observation and interview of the resident on 6/6/18 at 6:09 A.M., showed: -The resident was in bed watching television; -He/she was lying on his/her back with his/her upper body leaning toward the right side of the bed and -He/she said the pain had been terrible before going into the hospital (the resident was hospitalized ,[DATE] – 5/26), but has gotten better. During an interview on 6/8/18 at 1:18 P.M., Registered Nurse (RN) B said: -Non-pharmacological interventions should be tried before administering pain medication; -Non-pharmacological interventions such as back rubs and music could be attempted and -Nurses should assess the resident prior to and after administering pain medication. During an interview on 6/8/18 at 2:13 P.M., the DON said he/she would expect: -Nurses to assess the resident and attempt non-pharmacological interventions prior to administering medication; -Non-pharmacological interventions and the reason for giving medication should be |
| 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: 265797 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER RIDGE CREST NURSING CENTER | STREET ADDRESS, CITY, STATE, ZIP 706 SOUTH MITCHELL | |||||||||
| For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or 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 0697 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 23) documented and -Nurses should also assess and document the results after a resident receives the medication. #MO 471 | |
| 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: 265797 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER RIDGE CREST NURSING CENTER | STREET ADDRESS, CITY, STATE, ZIP 706 SOUTH MITCHELL | |||||||||
| For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or 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 24) -Resident was sitting in his/her wheelchair with TV on; and -His/her hair slicked back. Observation on 6/7/18 at 8:00 A.M. of the resident showed: -Room had a very strong odor; -Resident was sitting in his/her wheelchair with TV on and -His/her hair slicked back. During an interview on 6/5/18 at 1:00 P.M. the resident said: -He/she would like to have a bath/shower more often; -There wasn’t enough staff to give him/her a bath/shower; -He/she was not sure how long it had been since he/she had a bath/shower; and – He/she don’t ask any more for a bath/shower because he/she won’t get one. 2. Record review of Resident # 17’s Face Sheet showed he/she was admitted to the facility on [DATE], readmitted on ,[DATE] and 3/17/18 with the following [DIAGNOSES REDACTED]. Record review of the resident’s quarterly MDS dated [DATE] showed he/she: -Was severely cognitively impaired and -Required total staff assistance for bathing. Record Review of the resident’s Care Plan dated 2/20/18 showed: -He/she was dependent on staff for daily hygiene/grooming; -He/she to be showered/bathed per schedule and -Staff should provide assistance with bathing. Record review of the resident’s Shower Log dated (MONTH) (YEAR) and (MONTH) (YEAR) showed the resident: -Received a shower on 5/3/18; -Had no documented showers or baths from 5/3/1 through 6/7/18 and -Had no documentation, by facility staff, that showed the resident received at least two shower/baths per week. Record review of the resident’s Shower Sheet/Skin Assessment for (MONTH) (YEAR) and (MONTH) (YEAR) showed, he /she received a shower on 5/3/18. Observation on 6/4/18 at 7:49 P.M. of the resident showed: – The resident lying in bed on right side in fetal position and -His/her hair was oily and uncombed. Observation on 6/5/18 at 12:48 P.M. of the resident showed: -The resident sitting up in wheelchair; and -His/her hair was oily and uncombed. Observation on 6/6/18 at 6:20 A.M. of the resident showed: -The resident sitting up in wheelchair and -His/her hair was oily and uncombed. During an interview on 6/6/18 at 6:22 A.M., Certified Nursing Assistant (CNA) C said: -It is impossible for one aide to be on a hall and they’re are multiple lights going off and -It is hard to meet to everyone’s needs without him/her being too late to get to them. During an interview on 6/6/18 at 9:50 A.M. CNA A said: -He/She could ask the charge nurse to watch call lights on the 300 and 400 hall, but sometimes there is only one Certified Medication Technician (CMT) for 100, 200, 300, and 400 halls, so the CMT may not be available to help watch call lights; and -It was difficult to get showers done for the 300 and 400 hall when he/she is the only CNA for 23 residents. During an interview on 6/7/18 at 9:39 A.M., CNA B said: -Normally the facility has a dedicated shower aide, but does not currently have one 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: 265797 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER RIDGE CREST NURSING CENTER | STREET ADDRESS, CITY, STATE, ZIP 706 SOUTH MITCHELL | |||||||||
| For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or 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 25) -He/She has not been able to get resident showers done because there is not enough staff to help watch the floor, toilet residents, and answer call lights while he/she is assisting the resident’s in the shower. During an interview on 6/8/18 at 10:40 A.M., Licensed Practical Nurse (LPN) A said all staff were responsible to ensure residents received baths. During an interview on 6/8/18 at 2:03 P.M., the Director of Nursing (DON) said: -Residents should get showers or baths at least twice weekly; -The facility used to have a dedicated shower aide, but that staff member is working the floor now; -The facility does not have a dedicated shower aide at this time; -The facility bath schedule is the 100 and 300 halls receive baths on Monday and Thursday and residents on the 200 and 400 halls receive baths on Tuesday and Friday; -He/She does not think there is not enough staff to do resident baths but that it is a time management issue; -Staff have not mentioned to him/her they have not had time to give resident baths; -The facility is currently working on getting more staff hired and -It was not acceptable for residents to go 12 days without a bath. | |
| F 0755 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **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: 265797 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER RIDGE CREST NURSING CENTER | STREET ADDRESS, CITY, STATE, ZIP 706 SOUTH MITCHELL | |||||||||
| For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or 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 0755 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 26) medication; the quantity received; the number on hand; the name of the physician; the prescription number; the name of the issuing pharmacy; the date and time received; the time of administration; the method of administration; the signature of the person receiving the medication; and the signature of the nurse administering the medication; -All keys to controlled substance containers shall be on a single key ring that is different from any other keys; -The charge nurse on duty will maintain the keys to controlled substance containers. The DON will maintain a set of back-up keys for all medication storage areas including keys to controlled substance containers and -The DON shall investigate any discrepancies in narcotics reconciliation to determine the cause and identify any responsible parties, and shall give the Administrator a written report of such findings. 1. Record review of Resident #36’s Face Sheet showed he/she was admitted to the facility on [DATE] and readmitted on [DATE] with the following Diagnoses: [REDACTED]. -Low back pain; -Other chronic pain; -[MEDICAL CONDITION] (never pain) and -Dorsalgia (spinal pain). Record review of the resident’s (MONTH) (YEAR) physician’s orders [REDACTED]. Record review of the resident’s (MONTH) (YEAR) MAR showed: -[MEDICATION NAME] 5/325 milligram (mg), one tablet every four hours as needed for pain and -Staff documented [MEDICATION NAME] 5/325 mg administered twice during the month. Record review of the resident’s Controlled Substance Log showed: -[MEDICATION NAME] 5/325 mg, one tablet every four hours as needed for pain; -[MEDICATION NAME] 5/325 mg tablet was removed from the resident’s narcotic supply 18 times during the month and –16 tablets of [MEDICATION NAME] 5/325 mg were unaccounted for. Record review of the resident’s Pharmacy Consulting Services record dated 3/6/18 showed no documentation by the pharmacy consultant of any discrepancies between the Controlled Substance Log and the resident’s MAR. Record review of the resident’s (MONTH) (YEAR) POS showed [MEDICATION NAME] 5/325 mg, one tablet every four hours as needed for pain. Record review of the resident’s (MONTH) (YEAR) MAR showed: -[MEDICATION NAME] 5/325 mg, one tablet every four hours as needed for pain and -Staff documented [MEDICATION NAME] 5/325 mg administered seven times during the month. Record review of the resident’s Controlled Substance Log showed: -[MEDICATION NAME] 5/325 mg, one tablet every four hours as needed for pain; -[MEDICATION NAME] 5/325 mg tablet was removed from the resident’s narcotic supply 19 times during the month and –12 tablets of [MEDICATION NAME] 5/325 mg were unaccounted for. Record review of the resident’s Pharmacy Consulting Services record dated 4/4/18 showed no documentation by the pharmacy consultant of any discrepancies between the Controlled Substance Log and the resident’s MAR. Record review of the resident’s annual Minimum Data Set (MDS – a federally mandated assessment instrument completed by facility staff for care planning) dated 4/6/18 showed he/she: -Was cognitively intact; -Received scheduled pain 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: 265797 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER RIDGE CREST NURSING CENTER | STREET ADDRESS, CITY, STATE, ZIP 706 SOUTH MITCHELL | |||||||||
| For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or 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 0755 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 27) -Received as needed pain medication and -Received an opioid during the look-back period seven out of seven days. Record review of the resident’s care plan dated 4/13/18 showed: -He/She had discomfort/pain in he/her back and -He/She is currently on scheduled pain medication and he/she requested as needed pain medication. Record review of the resident’s (MONTH) (YEAR) POS showed [MEDICATION NAME] 5/325 mg, one tablet every four hours as needed for pain. Record review of the resident’s (MONTH) (YEAR) MAR showed: -[MEDICATION NAME] 5/325 mg, one tablet every four hours as needed for pain; -[MEDICATION NAME] 5/325 mg was crossed out on 5/27/18 with a handwritten note On Nurse MAR and -Staff documented [MEDICATION NAME] 5/325 mg administered 13 times during the month. Record review of the resident’s Controlled Substance Log showed: -[MEDICATION NAME] 5/325 mg, one tablet every four hours as needed for pain; -[MEDICATION NAME] 5/325 mg tablet was removed from the resident’s narcotic supply 49 times during the month and –36 tablets of [MEDICATION NAME] 5/325 mg were unaccounted for. Record review of the resident’s Pharmacy Consulting Services record dated 5/1/18 showed no documentation by the pharmacy consultant of any discrepancies between the Controlled Substance Log and the resident’s MAR. Record review of the resident’s (MONTH) (YEAR) POS showed [MEDICATION NAME] 5/325 mg, one tablet every four hours as needed for pain. Record review of the resident’s (MONTH) (YEAR) MAR showed: -[MEDICATION NAME] 5/325 mg, one tablet every four hours as needed for pain was crossed out on the CMT MAR with a handwritten note On Nurse MAR; -[MEDICATION NAME] 5/325 mg, one tablet every four hours as needed for pain was handwritten on the Nurse’s MAR and -Staff documented [MEDICATION NAME] 5/325 mg administered twice during the month. Record review of the resident’s Controlled Substance Log showed: -[MEDICATION NAME] 5/325 mg, one tablet every four hours as needed for pain; -[MEDICATION NAME] 5/325 mg tablet was removed from the resident’s narcotic supply three times between 6/1/18 – 6/6/18 and –One tablet of [MEDICATION NAME] 5/325 mg was unaccounted for. Record review of the resident’s Pharmacy Consulting Services record dated 6/5/18 showed no documentation by the pharmacy consultant of any discrepancies between the Controlled Substance Log and the resident’s MAR. 2. Record review of Resident #19’s Face Sheet showed he/she was admitted to the facility on [DATE] and readmitted on [DATE] with the [DIAGNOSES REDACTED]. Record review of the resident’s care plan dated 10/13/17 showed: -He/She had expressed pain in his/her knee and back at times; -Had no scheduled pain medication at that time and -Staff should administer pain medication as ordered. Record review of the resident’s quarterly MDS dated [DATE] showed he/she: -Was cognitively intact; -Received as needed pain medication and -Received an opioid seven out of seven days during the look-back period. Record review of the resident’s (MONTH) (YEAR) POS showed [MEDICATION NAME] 5/325 mg; two tablets every six hours as needed for pain. |
| 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: 265797 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER RIDGE CREST NURSING CENTER | STREET ADDRESS, CITY, STATE, ZIP 706 SOUTH MITCHELL | |||||||||
| For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or 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 0755 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 28) Record review of the resident’s (MONTH) (YEAR) MAR showed: -[MEDICATION NAME] 5/325 mg, take two tablets every six hours as needed for pain and -[MEDICATION NAME] 5/325 mg was documented as administered to the resident 12 times during the month for a total of 24 tablets. Record review of the resident’s [MEDICATION NAME] 5/325 mg Controlled Substance Log showed: -[MEDICATION NAME] 5/325 mg, take two tablets every six hours as needed for pain; -[MEDICATION NAME] 5/325 mg, two tables per dose, was removed from the resident’s narcotic supply 55 times during the month for a total of 110 tablets and -Forty-three doses, for a total of 86 [MEDICATION NAME] 5/325 mg were unaccounted for during the month. Record review of the resident’s Pharmacy Consulting Services record dated 3/6/18 showed no documentation by the pharmacy consultant of any discrepancies between the Controlled Substance Log and the resident’s MAR. Record review of the resident’s quarterly MDS dated [DATE], MAR and Controlled Substance Log showed he/she: -Had moderate cognitive impairment; -Received as needed pain medication; -Received an opioid three out of seven days during the look-back period. –During the look-back period the resident’s MAR showed [MEDICATION NAME] 5/325 two tablets every six hours as needed for pain was administered three out of the seven days. –During the look-back period the resident’s Controlled Substance Log showed [MEDICATION NAME] 5/325 mg take two tablets every six hours as needed for pain was removed seven out of seven days. Record review of the resident’s (MONTH) (YEAR) POS showed: -[MEDICATION NAME] 5/325 mg, take two tablets every six hours as needed for pain; -Discontinue [MEDICATION NAME] 5/325 mg, two tablets every six hours as needed for pain on 4/19/18 and -Start [MEDICATION NAME] 10/325 mg, take one tablet every six hours as needed for pain on 4/19/18. Record review of the resident’s (MONTH) (YEAR) MAR showed: -[MEDICATION NAME] 5/325 mg, take two tablets every six hours as needed for pain; –Eleven doses were documented as administered between 4/1/18 – 4/19/18, for a total of 22 tablets; –The rest of the month was crossed out with a handwritten notation the order was changed on 4/19/18; -Handwritten [MEDICATION NAME] 10/325 mg take one tablet every six hours as needed for pain dated 4/19/18 and –One dose was documented between 4/19/18 – 4/30/18. Record review of the resident’s [MEDICATION NAME] 5/325 mg Control Substance Log showed: -[MEDICATION NAME] 5/325 mg, take two tablets every six hours as needed for pain; -A handwritten note on the second Control Substance Log received by the facility on 4/10/18 noting the order changed on 4/19/18 and nurse needs notified when this card runs out on the Control Substance Log; -[MEDICATION NAME] 5/325 mg, two tablets per dose, was removed from the resident’s narcotic supply 52 times between 4/1/18 – 4/23/18 for a total of 101 tablets; –The resident’s order for [MEDICATION NAME] 5/325 mg was discontinued on 4/19/18; –Thirteen tablets were removed from the resident’s [MEDICATION NAME] 5/325 mg narcotic supply after the resident’s order was discontinued; |
| 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: 265797 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER RIDGE CREST NURSING CENTER | STREET ADDRESS, CITY, STATE, ZIP 706 SOUTH MITCHELL | |||||||||
| For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or 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 0755 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 29) -Forty-one doses, for a total of 82 [MEDICATION NAME] 5/325 mg were unaccounted for during the month; -[MEDICATION NAME] 10/325 mg, take one tablet every six hours for pain was removed from the resident’s narcotic supply nine times between 4/24/18 – 4/29/18 and –Eight doses of [MEDICATION NAME] 10/325 mg for a total of eight tablets were unaccounted for between 4/24/18 – 4/30/18. Record review of the resident’s Pharmacy Consulting Services record dated 4/4/18 showed no documentation by the pharmacy consultant of any discrepancies between the Controlled Substance Log and the resident’s MAR. Record review of the resident’s (MONTH) (YEAR) POS showed [MEDICATION NAME] 10/325 mg, take one tablet every six hours as needed for pain. Record review of the resident’s (MONTH) (YEAR) MAR showed: -[MEDICATION NAME] 10/325 mg, take one tablet every six hours as needed for pain; -Eight doses were documented as administered during the month for total of eight tablets; -The order was crossed out with a hand-written note after 5/26/18 the medication was on the nurse’s MAR; -A handwritten [MEDICATION NAME] 10/325 mg, take one tablet every six hours as needed for pain on the nurse’s MAR and -No documented doses on the nurse’s MAR during the month. Record review of the resident’s [MEDICATION NAME] 10/325 mg Control Substance Log showed: -[MEDICATION NAME] 10/325 mg, take one tablet every six hours as needed for pain; -[MEDICATION NAME] 10/325 mg, one tablet per dose, was removed from the resident’s narcotic supply 44 times during the month for a total of 44 tablets and -Thirty six doses, for a total of 36 [MEDICATION NAME] 10/325 mg were unaccounted for during the month. Record review of the resident’s Pharmacy Consulting Services record dated 5/1/18 showed no documentation by the pharmacy consultant of any discrepancies between the Controlled Substance Log and the resident’s MAR. Record review of the resident’s (MONTH) (YEAR) POS showed [MEDICATION NAME] 10/325 mg, take one tablet every six hours as needed for pain. Record review of the resident’s (MONTH) (YEAR) MAR showed: -[MEDICATION NAME] 10/325 mg, take one tablet every six hours as needed for pain was crossed out with a handwritten note On Nurses MAR; -A handwritten [MEDICATION NAME] 10/325 mg, take one tablet every six hours as needed for pain on the nurse’s MAR; -Three doses were documented as administered between 6/1/18 – 6/6/18 for a total of three tablets and -No documented doses on the CMT MAR during the month. Record review of the resident’s [MEDICATION NAME] 10/325 mg Control Substance Log showed: -[MEDICATION NAME] 10/325 mg, take one tablet every six hours as needed for pain and -[MEDICATION NAME] 10/325 mg, one tablet per dose, was removed from the resident’s narcotic supply three times during the month for a total of three tablets. Record review of the resident’s Pharmacy Consulting Services record dated 6/5/18 showed no documentation by the pharmacy consultant of any discrepancies between the Controlled Substance Log and the resident’s MAR. 3. Record review of Resident #22’s Face Sheet showed he/she was admitted to the facility on [DATE] and readmitted on [DATE]. Record review of the resident’s (MONTH) (YEAR) POS showed [MEDICATION NAME] 5/325 mg one tablet every six hours for pain dated 3/12/18. |
| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265797 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER RIDGE CREST NURSING CENTER | STREET ADDRESS, CITY, STATE, ZIP 706 SOUTH MITCHELL | |||||||||
| For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or 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 0755 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 30) Record review of the resident’s (MONTH) (YEAR) MAR showed: -[MEDICATION NAME] 5/325 mg one tablet every six hours for pain and -[MEDICATION NAME] 5/325 mg was documented as administered by the staff two times during the month. Record review of the resident’s significant change MDS dated [DATE] showed he/she: -Was severely cognitively impaired; -Did not receive as needed pain medication and -Did not receive an opioid during the seven day look-back period. Record review of the resident’s care plan dated 3/23/18 showed: -The resident had the potential for pain related to a [MEDICAL CONDITION] and -Coordinate with his/her physician to manage his/her pain medication for optimum control of his/her pain. Record review of the resident’s (MONTH) (YEAR) POS showed [MEDICATION NAME] 5/325 mg one tablet every six ours for pain dated 3/12/18. Record review of the resident’s (MONTH) (YEAR) MAR showed: -[MEDICATION NAME] 5/325 mg one tablet every six hours for pain and -[MEDICATION NAME] 5/325 mg was documented as administered by the staff two times during the month. Record review of the resident’s Pharmacy Consulting Services record dated 4/4/18 showed no documentation by the pharmacy consultant of any discrepancies between the Controlled Substance Log and the resident’s MAR. Record review of the resident’s (MONTH) (YEAR) POS showed [MEDICATION NAME] 5/325 mg one tablet every six hours for pain dated 3/12/18 with a handwritten RN to the side of the order. Record review of the resident’s (MONTH) (YEAR) MAR showed: -[MEDICATION NAME] 5/325 mg one tablet every six hours for pain and –The order was crossed out with a handwritten On Nurse MAR on 5/27/18. -[MEDICATION NAME] 5/325 mg was documented as administered by the staff two times during the month. Record review of the resident’s Controlled Substance Log showed: -[MEDICATION NAME] 5/325 mg, take one tablet four times a day as needed; -Thirty tablets were delivered on 4/30/18; -Eight tablets were removed from the resident’s narcotic supply between 5/27/18 – 5/29/18 and –Six [MEDICATION NAME] 5/325 mg were unaccounted for. Record review of the resident’s Pharmacy Consulting Services record dated 5/1/18 showed no documentation by the pharmacy consultant of any discrepancies between the Controlled Substance Log and the resident’s MAR. Record review of the resident’s (MONTH) (YEAR) POS showed [MEDICATION NAME] 5/325 mg one tablet every six hours for pain dated 3/12/18 with a handwritten RN to the side of the order. Record review of the resident’s (MONTH) (YEAR) MAR showed: -[MEDICATION NAME] 5/325 mg one tablet every six hours for pain; –The order was crossed out with a handwritten On Nurse MAR on 5/27/18 and -[MEDICATION NAME] 5/325 mg was documented as administered by the staff zero times during the month. Record review of the resident’s Controlled Substance Log showed: -[MEDICATION NAME] 5/325 mg, take one tablet four times a day as needed; |
| 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: 265797 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER RIDGE CREST NURSING CENTER | STREET ADDRESS, CITY, STATE, ZIP 706 SOUTH MITCHELL | |||||||||
| For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or 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 0755 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 31) -Thirty tablets were delivered on 4/30/18; -One tablet was removed from the resident’s narcotic supply between 6/1/18 – 6/6/18 and –One [MEDICATION NAME] 5/325 mg were unaccounted for. Record review of the resident’s Pharmacy Consulting Services record dated 6/5/18 showed no documentation by the pharmacy consultant of any discrepancies between the Controlled Substance Log and the resident’s MAR. Record review of the resident’s medical record showed no additional Controlled Substance Logs for the resident’s [MEDICATION NAME] 5/325 mg were located by the facility staff prior to 4/30/18. During an interview on 6/15/18 at 2:30 P.M., the resident’s pharmacy said: -On 3/14/18, 30 [MEDICATION NAME] 5/325 mg tablets were delivered to the facility; -On 4/30/18, 30 [MEDICATION NAME] 5/325 mg tablets were delivered to the facility; –Per the resident’s pharmacy interview, a total of 60 tablets were delivered to the facility; –Six tablets have been documented on the resident MAR as administered between 3/12/18 – 6/6/18; –Nine tablets have been signed out on the resident’s Controlled Substance Log with 21 tablets remaining and –A total of 54 [MEDICATION NAME] 5/325 mg tablets are unaccounted for. 4. During an interview on 6/7/18 at 3:24 P.M., the DON said: -He/She expected staff to document on the resident’s MAR each time an as needed medication is administered; -If staff remove a medication from the resident’s Controlled Substance Log, that medication should be documented on the resident’s MAR as well; -He/She does not compare the Controlled Substance Log with the MAR to ensure accuracy of the medication count; -He/She thought the Pharmacy Consultant would compare the Controlled Substance Log with the resident’s MAR during the monthly Drug Regimen Reviews; -He/She was made aware by a staff member and by a resident of a concern that Resident #36 was not receiving all of the narcotics that were being signed out as administered on 5/25/18 or 5/26/18; -He/She did not compare the resident’s Controlled Substance Log to the resident’s MAR to determine if there were any unaccounted for narcotics and -He/She did not compare any other resident’s Controlled Substance Log to the resident’s MAR to determine if any other residents had narcotics that were unaccounted for. During an interview on 6/11/18 at 10:40 A.M., the Pharmacy Consultant said: -He/She reviews the resident’s MAR to determine how many as needed pain medications the resident received per month; -He/She does not compare the resident’s MAR with the resident’s narcotic Controlled Substance Log to determine if there are any discrepancies in the narcotic counts and -He/She will listen to the staff while they are doing the end of shift narcotic count for any discrepancies during the shift count, but does not review the narcotic logs. Complaint #MO 471 | |
| F 0758 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; 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: 265797 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER RIDGE CREST NURSING CENTER | STREET ADDRESS, CITY, STATE, ZIP 706 SOUTH MITCHELL | |||||||||
| For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or 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 0758 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 32) PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. **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: 265797 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER RIDGE CREST NURSING CENTER | STREET ADDRESS, CITY, STATE, ZIP 706 SOUTH MITCHELL | |||||||||
| For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or 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 0758 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 33) -On 5/26/18 at 5:40 P.M. –No non-pharmacological interventions were documented. –Results were not assessed and documented after administering the medication. -On 5/27/18 at 5:00 P.M. –No non-pharmacological interventions were documented. -On 5/30/18 at 8:45 P.M. –No non-pharmacological interventions were documented. During an interview on 6/8/18 at 1:18 P.M., Registered Nurse (RN) B said: -Nonpharmacological interventions should be attempted prior to administering PRN antianxiety medications and -The nurse administering the medication should go back about 45 minutes after administering the PRN medication to the resident to check for results. During an interview on 6/8/18 at 2:13 P.M., the Director of Nursing (DON) said he/she would expect: -Nurses to assess the resident and attempt non-pharmacological interventions prior to administering PRN medication; -Non-pharmacological interventions and the reason for giving medication should be documented and -Nurses should also assess and document the results after a resident receives the PRN medication. | |
| F 0759 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | 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: 265797 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER RIDGE CREST NURSING CENTER | STREET ADDRESS, CITY, STATE, ZIP 706 SOUTH MITCHELL | |||||||||
| For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or 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 – Some | (continued… from page 34) -[MEDICAL CONDITION] (Is a condition in which your [MEDICAL CONDITION] doesn’t produce enough of certain important hormones.) Record review of the resident’s Quarterly Minimum Data Set (MDS-a federally mandated assessment tool completed by facility staff for care planning) dated 3/23/18 showed he/she: -Was severely cognitively impaired; -Had a [DIAGNOSES REDACTED].>–[MEDICAL CONDITION]; –Dysphasia (difficulty swallowing food and liquids) with Gastrostomy Tube ([DEVICE]-a tube surgically placed through the skin into the stomach that delivers food, liquids and medications) and –[MEDICAL CONDITION] Reflux Disease (GERD). Record review of the resident’s [MEDICAL CONDITION] Stimulating Hormone (TSH-a test that measures the amount of stimulating hormone in your blood) lab results showed: -12/8/17 the TSH was 4,820 IU (International Units)/milliliters (ml); -3/19/18 the TSH was 33,520 IU/ml and –Normal value range was 0.270 to 4,200 IU/ml Record review of the resident’s physician’s orders [REDACTED]. -[MEDICATION NAME] Sodium 125 micrograms (mcg) one tablet per [DEVICE] at 6:00 A.M. for [MEDICAL CONDITION] and -[MEDICATION NAME] (a medication to treat GERD) 20 milligrams (mg) every 12 hours. Observation on 6/6/18 at 6:25 A.M. showed Licensed Practical Nurse (LPN) B removed, crushed and administered through his/her [DEVICE], in the following order: -[MEDICATION NAME] 125 mcg, put it in 15 ml of Sterile Normal Saline (NS); -30 ml of water; -[MEDICATION NAME] 20 mg, put it in 15 ml of NS and -100 ml of water by gravity; During an interview on 6/6/18 at 6:45, LPN B said: -The Physician ordered both medications to be given at 6 A.M.; and -The Director of Nursing (DON) approved it this way. 2. Record review of Resident #3’s Face Sheet and Quarterly MDS dated [DATE] showed he/she |
| 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: 265797 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER RIDGE CREST NURSING CENTER | STREET ADDRESS, CITY, STATE, ZIP 706 SOUTH MITCHELL | |||||||||
| For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or 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 – Some | (continued… from page 35) heart rate is < 50; -[MEDICATION NAME] (medicine to treat nerve pain) 300 mg two times a day; -[MEDICATION NAME] (medicine to treat GERD) 10 mg to be given at 6:00 A.M.; -[MEDICATION NAME] (medicine to treat diabetes) 500 mg after meals or with snack; -[MEDICATION NAME] (medicine to treat high blood pressure) 100 mg daily; -[MEDICATION NAME] (medicine to treat depression and anxiety) 60 mg daily; -[MEDICATION NAME] acid (ASA-aspirin) 81 mg daily; -[MEDICATION NAME] (medicine to treat excessive gas/bloating in the stomach) 80 mg daily; -Multi vitamin one tablet two times a day and Record review of lab results showed: -Record review of the residents TSH levels showed: –On 2/3/16 the TSH was 1,740 IU/ml; –On 2/1/17 the TSH was 1950 IU/ml and –On 3/28/18 the TSH was 2090 IU/ml. Observation on 6/6/18 at 7:29 A.M. showed Certified Medication Technician (CMT) B: -Removed the following medications placed them into a medicine cup: — [MEDICATION NAME]; — [MEDICATION NAME]; — [MEDICATION NAME]; — [MEDICATION NAME]; — [MEDICATION NAME]; — [MEDICATION NAME]; — [MEDICATION NAME]; — ASA; — [MEDICATION NAME] — Multi vitamin and -Gave the medication cup to the resident to take. Observation on 6/6/18 at 7:54 A.M. showed CMT B administered: -Dorzol/Timol in the resident’s left eye at 7:54 A.M.; -Dorzol/Timol in the resident’s right eye at 7:55 A.M.; -[MEDICATION NAME] in the resident’s left eye at 7:56 A.M.; and -[MEDICATION NAME] in the resident’s right eye at 7:57 A.M. During an interview on 6/6/18 at 8:00 A.M. CMT B said: -He/she has to wait one minute between medications for the eye drops and -The resident prefers to take his/her medicines all at one time. During an interview on 6/7/18 at 12:00 P.M. Registered Nurse (RN) B, said: -[MEDICATION NAME] should be given about one hour before the resident eats or drinks and -It should not be given with any other medications. During an interview on 6/8/18 at 2:30 P.M. the DON said: -[MEDICATION NAME] should be given by itself; -He/she has told the nurses that; -He/she will have to tell them again and -The nurses should look at the lab values and notify the resident’s physician. | |
| 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: 265797 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER RIDGE CREST NURSING CENTER | STREET ADDRESS, CITY, STATE, ZIP 706 SOUTH MITCHELL | |||||||||
| For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or 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 | Based on observation, interview and record review, the facility failed to ensure the | |
| F 0802 Level of harm – Minimal harm or potential for actual harm Residents Affected – Many | Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service. |
| 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: 265797 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER RIDGE CREST NURSING CENTER | STREET ADDRESS, CITY, STATE, ZIP 706 SOUTH MITCHELL | |||||||||
| For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or 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 0802 Level of harm – Minimal harm or potential for actual harm Residents Affected – Many | Based on observation, interview and record review, the facility failed to adequately staff |
| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265797 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER RIDGE CREST NURSING CENTER | STREET ADDRESS, CITY, STATE, ZIP 706 SOUTH MITCHELL | |||||||||
| For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or 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 0802 Level of harm – Minimal harm or potential for actual harm Residents Affected – Many | (continued… from page 38) – On 5/27/18, two people worked the morning shift, and two people worked the afternoon/evening shift; – On 5/28/18, four people worked the morning shift, and two people worked the afternoon/evening shift; – On 5/29/18, one person worked the morning shift and two people worked the afternoon/evening shift; – On 5/30/18, two people worked the morning shift, and two people worked the afternoon/evening shift and – On 5/31/18, two people worked the morning shift, and two people worked the afternoon/evening shift. In summary, two people worked the morning shift on 5 days and one person worked on two days and two people worked the afternoon/evening shift for all 10 days listed. Only on four of ten days did three or more dietary staff work the morning shift. During an interview on 6/6/18 at 8:56 A.M., Dietary Cook (DC) B said the following: – A dishwasher, a Dietary Cook, a Dietary Aide and the DM was needed and – They cannot always get clean the way they need to because they have to be off the clock a certain time usually at 2:00 P.M., if he/she started his/her shift at 5:30 a.m., To get the cleaning done that was needed, he/she would have to work over time. During an interview on 6/6/18 at 9:02 A.M., the DM said the following: – There used to be two people that came in with the DM but in the present there was only one person; -That got changed about 7-8 months ago; – If there was an extra person, someone from the dietary staff would be able to take temperatures and – When he/she had meetings such as leadership meetings or care planning meetings, DC B got stuck with all the dietary tasks. During an interview on 6/6/18 at 9:23 A.M., the Administrator said if there was not enough dietary staff, the DM did not let him know there was not enough staff. | |
| F 0804 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. Based on observation and interview, the facility failed to ensure breakfast foods were at |
| 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: 265797 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER RIDGE CREST NURSING CENTER | STREET ADDRESS, CITY, STATE, ZIP 706 SOUTH MITCHELL | |||||||||
| For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or 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 0804 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 39) book open; – DC B did not warm the milk before adding it; – DC B placed the pureed sausage in a metal pan and placed the pan on the steam table without checking the temperature and – The temperature of the pureed sausage after it was placed in the steam table was 83 ºF. 3. Observation of the room trays on 6/6/18, showed the following: – At 7:58 A.M., the temperature of the regular sausage that was going to be served to Resident #35, was 107 ºF, with Certified Nurse’s Aide (CNA) A, observing; – At 8:02 A.M., the temperature of the bacon and toast that was going to be served to Resident #14, was 80-82 ºF, with Registered Nurse (RN) A observing; – At 8:06 A.M., the temperature of the eggs that was going to be served to Resident #28, was 115.5 ºF, with (RN) A observing and – At 8:10 A.M., the temperature of the pureed sausage that was going to be served to Resident #19 was 97.1 ºF, with Certified Medication Technician (CMT) A observing. 4. During an interview on 6/6/18 at 8:14 A.M., CNA A said he/she served breakfast on that side of the facility regularly and has not seen anyone from dietary check temperatures of room trays. 5. During an interview on 6/6/18 at 8:34 A.M., the DM said they do not check temperatures of room trays, because they do not have the time. Just having a manager and 2 people makes things difficult, and he/she did not know the temperature that hot foods should be, when it was delivered to the residents. | |
| F 0812 Level of harm – Minimal harm or potential for actual harm Residents Affected – Many | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview and record review, the facility failed to do 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: 265797 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER RIDGE CREST NURSING CENTER | STREET ADDRESS, CITY, STATE, ZIP 706 SOUTH MITCHELL | |||||||||
| For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or 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 40) – At 6:55 P.M., the Dietary Manager (DM) said he/she was not sure how long the fan has been like that, but it may have been like that for a month or so, – The hairnet for DC A, did not completely covered his/her hair; – At 6:57 P.M., the DM said he/she has not found a hair net big enough for the hair of DC A – DA C’s hair was not completely covered; – At 6:58 PM DC A said that he/she usually has to place two hair nets on but realized there was hair hanging out from between the hairnets; – At 7:00 P.M., the DM said it is hard to get behind the ice machine because it cannot be pulled out, and hard to get behind the pipes on the floor because he/she did not want to break anything, he/she could speak with the maintenance guy about getting something to go behind the ice machine; – A soy sauce bottle and debris behind six burner stove; – At 7:07 P.M., the DM said he/she tried to pull out the stove every two weeks but because there are only two people they do not get a chance to do the cleaning they want to do; -Two bins with cups and lids with debris inside of those bins; – At 7:23 P.M., the DM said he/she and the dietary staff did not check the bins too often; – A red cutting board with numerous indentations making it not easily cleanable; – A delivery cart with a 7 inch (in.) crack; – At 7:31 P.M., the DM said he/she was only employed as the DM for 4 months and – At 7:32 P.M., the DM said the maintenance man was usually the one that handles the fan vent cover in the walk-in refrigerator. 2. Observation during the breakfast meal preparation on 6/6/18 from 6:15 A.M., through 8:20 A.M., showed the following: – Four mittens that were torn and not in an easily cleanable condition; – At 6:15 A.M., DC B said the mittens have been torn up for about six months; – At 6:31 A.M., DC B used the facility’s thermometer to measure the temperature of hot cereal and the temperature was between 140 to 145 ºF (degrees Fahrenheit); the surveyor’s thermometer measured the temperature of the hot cereal between 183-188 ºF; – At 6:32 A.M., DC B said he/she did not know the last time she calibrated that thermometer; – The presence of debris inside the inner part of the food processor blade just before she pureed sausage; -At 7:09 A.M., DC B said he/she was rushed that day and did not check the inner part of the food processor blade and – The sanitizing solution was too weak for 3 compartment sink, when measured with a test strip, Further observation showed the pump was not pulling the sanitizing solution all the way through to the sink marked sanitization Record review of the 1999 and 2009 Food and Drug Administration (FDA) Food Code and Missouri Food Codes, showed: – In Chapter 2-402.11 (A) Except as provided in (B) of this section, FOOD EMPLOYEES shall wear hair restraints such as hats, hair coverings or nets, beard restraints, and clothing that covers body hair, that are designed and worn to effectively keep their hair from contacting exposed FOOD. – In Chapter 3-305.14, During preparation, unPACKAGED FOOD shall be protected from environmental sources of contamination. – In Chapter 4-202.11, regarding Food-Contact Surfaces; Multi-use FOOD-CONTACT SURFACES shall be: (1) SMOOTH; (2) Free of breaks, open seams, cracks, chips, inclusions, pits, and similar imperfections; (3) Free of sharp internal angles, corners, and crevices; and 4) |
| 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: 265797 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER RIDGE CREST NURSING CENTER | STREET ADDRESS, CITY, STATE, ZIP 706 SOUTH MITCHELL | |||||||||
| For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or 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 41) Finished to have SMOOTH welds and joints; -In 4-203.11 B) Temperature Measuring Devices, Food. Food temperature measuring devices that are scaled only in Fahrenheit shall be accurate to ±2 °F in the intended range of use. – In Chapter 4-501.12, Surfaces such as cutting blocks and boards that are subject to scratching and scoring shall be resurfaced if they can no longer be effectively cleaned and SANITIZED, or discarded if they are not capable of being resurfaced. Surfaces such as cutting blocks and boards that are subject to scratching and scoring shall be resurfaced if they can no longer be effectively cleaned and SANITIZED, or discarded if they are not capable of being resurfaced. – In Chapter 4-601.11, EQUIPMENT FOOD-CONTACT SURFACES and UTENSILS shall be clean to sight and touch. – In Chapter 4-602.13, nonFOOD-CONTACT SURFACES of EQUIPMENT shall be cleaned at a frequency necessary to preclude accumulation of soil residues; – In Chapter 6-501.12, paragraph A, The physical facilities shall be cleaned as often as necessary to keep them clean. | |
| 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: 265797 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER RIDGE CREST NURSING CENTER | STREET ADDRESS, CITY, STATE, ZIP 706 SOUTH MITCHELL | |||||||||
| For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or 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 42) Infectious Agents in Healthcare Settings provided by the Centers for Disease Control and Prevention (CDC) showed: -Transmission-Based Precautions were for patients who were known or suspected to be infected or colonized (organism present without signs or symptoms of infection) with infectious agents, including certain epidemiologically (branch of medicine that deals with the incidence of disease and epidemics of infections) important pathogens, which require additional control measures to effectively prevent transmission. One of the three categories of Transmission-Based Precautions included Contact Precautions (methods used to prevent the spread of infectious organisms by direct or indirect contact with the patient or his/her environment): -Contact Precautions also applied where the presence of excessive wound drainage, fecal incontinence, urine or other discharges from the body suggested an increased potential for extensive environmental contamination and risk of transmission; -Healthcare personnel caring for patients on Contact Precautions were to wear a gown and gloves for all interactions that may involve contact with the patient or potentially contaminated areas in the patient’s environment; -Donning personal protective equipment (PPE) upon room entry and discarding before exiting the patient room was done to contain pathogens, especially those that have been implicated in transmission through environmental contamination. Record review of National Library of Medicine, a branch of the National Institute of Health showed: -Most Extended Spectrum Beta-Lactamasw (ESBL-an infectious bacteria) infections are spread by direct contact with an infected person’s bodily fluids (blood, drainage from a wound, urine, stool, or sputum); and -ESBL infections are spread by contact with equipment or surfaces that have been contaminated with the germ. Record review of the facility’s [MEDICAL CONDITION] (MDRO) Policy dated (MONTH) (YEAR), showed: -Appropriate precautions will be taken when caring for individuals known or suspected to have infection with a MDRO. (Note: Infection means that the organism is present and is causing illness. Colonization means that the organism is present in or on the body but is not causing illness.); -MDRO are bacteria and other microorganisms that have developed resistance to one or more classes of antimicrobial drugs, common examples of MDRO in long-term care facilities include aram-negative bacilli (like E Coli ESBL producing) have been identified as emerging MDRO threats in long-term care. -The staff and practitioner will evaluate each individual known or suspected to have infection with a MDRO for room placement and initiation of Contact Precautions on a case-by-case basis, Standard Precautions will be adequate for some; -The infection prevention and control committee or medical director may implement of consider the following to determine the need for Contact Precautions and/or room placement. Record review of the facility’s Handwashing/Hand Hygiene Policy, dated (MONTH) (YEAR) showed: -This facility considers hand hygiene the primary means to prevent the spread of infections; -All personnel shall follow the Handwashing/Hand Hygiene procedures to help prevent the spread of infections to other personnel, residents, and visitors; -Wash hands with soap (antimicrobial or non-antimicrobial) and water for the following situations: |
| 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: 265797 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER RIDGE CREST NURSING CENTER | STREET ADDRESS, CITY, STATE, ZIP 706 SOUTH MITCHELL | |||||||||
| For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or 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 43) –When hands are visibly soiled; and -Use an alcohol-base hand rub containing at least 62% alcohol; or, alternatively, soap (antimicrobial or non-antimicrobial) and water for the following situations: –Before and after direct with residents; –Before and after handling an invasive device (e.g. urinary catheters); –After contact with a resident’s intact skin; –After contact with bloody or bodily fluids; -After contact with objects in the immediate vicinity of the resident; –After removing gloves; –Before and after entering isolation precaution settings. Record review of the facility’s Catheter (a tube inserted in the bladder to drain urine) Care, Urinary Policy, dated (MONTH) 2014 showed: -The purpose of this procedure is to prevent catheter-associated urinary infections: -Use standard precautions when handling or manipulating the drainage system; -Maintain clean technique when handling or manipulating the catheter, tubing, or drainage bag; –Do not clean the per urethral area with antiseptics to prevent catheter-associated urinary catheter infection (UTI’s) while the catheter is in place; –Empty the drainage bag regularly using a separate, clean collection container for each resident. Avoid splashing, and prevent contact of the drainage spigot with the non-sterile container; -Wash the resident’s genitalia and perineum thoroughly with soap and water. Rinse the area well and towel dry; -Place soiled linen into designated container; -Put on clean gloves; -Remove gloves and discard into the designated container. Wash and dry your hands thoroughly; -Use a clean washcloth with warm water and soap to cleanse and rinse the catheter from insertion site to approximately four inches outward. 1. Record review of Resident #25’s Face Sheet showed he/she was admitted to the facility on [DATE] with a [DIAGNOSES REDACTED]. Record review of the resident’s (MONTH) (YEAR) physician’s orders [REDACTED]. 2. Record review of Resident #28’s Face Sheet showed he/she was admitted to the facility on [DATE] with a [DIAGNOSES REDACTED]. Record review of the resident’s (MONTH) (YEAR) POS and MAR indicated [REDACTED]. 3. Observation and interview on 6/6/18 at 7:45 A.M., Certified Medication Technician (CMT) A showed: -He/She was waiting to get aluminum foil for a barrier; -He/She could probably use paper towels for a barrier, but thinks the policy is for the staff to use aluminum foil, so he/she will wait for the foil; -He/She put two pieces of aluminum foil on top of his/her medication cart and said one piece was for clean barrier and one piece was for dirty barrier; -He/She said each resident had their own glucometer to use for blood sugar monitoring; -He/She placed an alcohol wipe, lancet, and meter strip on the clean barrier; -He/She removed a glucometer for Resident #25 from the medication cart drawer and cleaned the strip insertion port with an alcohol wipe and placed the contaminated glucometer on the clean barrier; –He/She did not sanitize the glucometer after removing the meter from the medication cart drawer; |
| 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: 265797 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER RIDGE CREST NURSING CENTER | STREET ADDRESS, CITY, STATE, ZIP 706 SOUTH MITCHELL | |||||||||
| For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or 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 44) -He/She entered Resident #25’s room and discovered the resident’s glucometer battery was dead causing the meter to not turn on; -He/She exited the resident’s room, sanitized his/her hands, and removed the glucometer for Resident #28 out of the medication cart drawer; -He/She cleaned the strip insertion port of Resident #28’s meter with an alcohol wipe, and without sanitizing the meter, placed the contaminated glucometer on a clear barrier and entered Resident #25’s room; -He/She performed the resident’s accucheck with the contaminated glucometer belonging to Resident #28; -He/She then placed the contaminated meter on the resident’s bedside table without a barrier, removed his/her gloves and washed his/her hands; -Without gloved hands, he/she removed the contaminated meter, placed it on top of the medication cart without a barrier and -Without sanitizing the contaminated meter, he/she placed the contaminated meter in the medication cart drawer with the other residents’ glucometers. 4. Record review of Resident #31’s Face Sheet showed he/she was admitted to the facility on [DATE] with a [DIAGNOSES REDACTED]. Record review of the resident’s (MONTH) (YEAR) POS and MAR indicated [REDACTED] Observation on 6/6/18 at 7:57 A.M. showed CMT A: -Removed the contaminated glucometer for Resident #31 from the medication cart drawer and placed the contaminated meter on top of the contaminated medication cart without a barrier; -He/She cleaned the meter strip insertion port with an alcohol wipe and placed the contaminated meter with the lancet, alcohol wipe, and sample strip on a clean barrier; -He/She placed the contaminated meter with supplies on the clean barrier and a separate dirty barrier on the resident’s table in his/her room and obtained the resident’s blood sample; -CMT A placed the contaminated meter on the resident’s table where the resident was eating breakfast without a barrier, removed his/her gloves, and removed the contaminated barrier from the resident’s room and -CMT A placed the contaminated meter on top of the contaminated medication cart, and without sanitizing the contaminated meter, placed the contaminated meter in the medication drawer with the other residents’ meters. 5. During an interview on 6/6/18 at 8:22 A.M., CMT A said: -He/She cleaned the glucometer port with alcohol wipes; -He/She thought alcohol wipes to clean the glucometer ports were according to the facility policy; -He/She thought he/she only needed to clean the glucometer ports with alcohol since that was closest to where the blood sample was obtained; -He/She should have used the dirty barrier to place the contaminated meters and did not realize he/she did not use the dirty barriers he/she brought into the resident room when performing Accuchecks; -He/She should have had gloves on when handling the contaminated meter and -It was not appropriate to place the contaminated meter on the resident’s table, bedside table, or on top of the medication cart without a barrier. During an interview on 6/8/18 at 11:08 A.M., Licensed Practical Nurse (LPN) A said: -Staff should use a dirty barrier for contaminated meters; -Staff should wear gloves when handling contaminated meters; -Staff should sanitize meters with bleach wipes before and after each resident use; |
| 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: 265797 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER RIDGE CREST NURSING CENTER | STREET ADDRESS, CITY, STATE, ZIP 706 SOUTH MITCHELL | |||||||||
| For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or 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 45) -Each resident has a dedicated meter just for that resident. -Staff should not use another resident’s meter to perform an blood sugar test for a different resident and -If a resident’s meter had a dead battery, staff should get a new battery for the meter to use for the resident. During an interview on 6/8/18 at 2:03 P.M., the Director of Nursing (DON) said: -He/She expected staff to sanitize meters with bleach wipes before and after resident use; -It was not appropriate to clean the meter with only an alcohol wipe before resident use; -He/She expected staff to place contaminated meters on a barrier; -It was not appropriate to place contaminated meters on a resident table, bedside table, or on top of the medication cart without a barrier; -He/She expected staff to sanitize a contaminated meter with a bleach wipe before placing the meter back into the medication drawer with other residents’ meters; -Staff should wear gloves when handling contaminated meters; -He/She expected staff to replace the batteries in a meter if the batteries were dead before using the meter on a resident; -Each resident had a dedicated meter to be used only for that resident and -It was not appropriate to use one resident’s meter for another resident’s blood sugar testing. 6. Record review of Resident # 5’s face sheet showed that he/she was admitted to the facility on [DATE] with the following Diagnoses: [REDACTED]. -Foley catheter was placed to aid in the healing of coccyx wounds. Observation on 6/4/18 at 7:40 A.M. showed a urine graduate was in the bathroom setting on top of the toilet tank. It as not placed in a plastic bag. The date on the urine graduate was 4/20/18 and it did not have a resident’s name on it. Observation on 6/6/18 at 9:53 A.M. of the resident’s peri care performed by CNA C and CNA D showed: -CNA D washed hands, donned gloves and assisted to hold the resident on his/her side; -CNA C washed hands, donned gloves then removed a wet coccyx (tail bone) dressing; -With contaminated gloves, CNA C removed wipes out of the container with his/her right hand and wiped around the resident’s coccyx wounds; -CNA C removed his/her gloves an immediately donned on clean gloves; -CNA D removed his/her gloves and donned clean gloves; -CNA C with contaminated gloves applied A&D Ointment (a skin protectant) to the resident’s buttocks; -CNA C removed is/her gloves and immediately donned on clean gloves; -CNA C & CNA D repositioned the resident with pillow support, and pulled up the cover over the resident; -CNA C & CNA D removed their gloves and -CNA C with contaminated hands, put the oxygen on the resident. Observation on 6/07/18 at 10:42 A.M., CNA C and CNA D performed catheter care on the resident: -CNA C and CNA D wash their hands, donned gloves; -CNA D removed the resident’s oxygen, and pulled back the resident’s covers, removed the resident’s mechanical lift sling by rolling the resident side to side and pulled the resident’s pants down to to the ankles; -CNA C removed wipes from the container with his/her contaminated right hand, wiped the resident’s bottom from bottom up with his/her right hand and grabbed the trash can with his/he right hand; |
| 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: 265797 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER RIDGE CREST NURSING CENTER | STREET ADDRESS, CITY, STATE, ZIP 706 SOUTH MITCHELL | |||||||||
| For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or 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 46) -CNA C removed his/her gloves and donned on clean gloves; -CNA D used both hands to remove the dirty/contaminated linens; -CNA D with contaminated hands grabbed wipes from the container and wiped the resident’s bottom; -CNA D rolled the soiled linens handed them to CNA C; -CNA D removed his/her gloves and donned on new gloves; -CNA D with contaminated hands grabbed the wipes out of the container; -CNA C using both hands to grab the wipes, wiped oozing feces from the resident’s bottom; -CNA C removed gloves, washed hands with sanitizing gel, donned on clean gloves and removed the resident’s pants; -CNA D washed his/her hands with sanitizing gel, donned on clean gloves with wipes and wiped the resident’s both groins from top to bottom and -CNA D with contaminated hands cleaned the resident’s catheter with the contaminated wipes and applied clean briefs. During an interview on 6/6/18 at 10:15 A.M. CNA D said he/she should have washed hands between each glove change During an interview on 6/6/18 at 10:18 A.M. CNA C said, the resident’s coccyx wound was his/her only concern during the peri care. 7. Record review of Resident #17’s Face Sheet showed he/she was admitted to the facility on [DATE], readmitted on ,[DATE] and 3/17/18 with the following Diagnoses: [REDACTED].>-Stroke with [MEDICAL CONDITION] (muscle weakness or [DIAGNOSES REDACTED] on one side of the body); -Pneumonia/Pneumonitis and -All three times he/she also had an urinary tract infection [MEDICAL CONDITION]. Record review of the resident’s quarterly MDS dated [DATE] showed he/she: -Was severely cognitively impaired and -Required total staff assistance for bathing. Record Review of the resident’s Care Plan dated 2/20/18 showed: -He/she was dependent on staff for daily hygiene/grooming; -He/she to be showered/bathed per schedule and -Staff should provide assistance with bathing Observation on 6/4/18 at 7:49 A.M. showed a urine graduate was in the bathroom sitting on the toilet tank, was not bagged, the date written on the graduate was 3/18/18. Record review on 6/6/18 11:08 A.M. of the resident’s urine analysis (UA) results showed on 5/23/18 it was confirmed the resident has ESBL in his/her urine and was placed on an antibiotic. During an interview on 6/7/18 at 2:00 P.M. Registered Nurse (RN) B said: -I’ve asked a doctor, he/she said it was just harder to get rid of; -I don’t really know much about it and -The resident has a Foley catheter so he/she doesn’t think he/she needs to be in isolation or have any other precautions. During an interview on 6/8/18 at 2:03 P.M. the DON said: -Urine graduates should be changed monthly; -It will be changed to weekly; -The resident had a Foley catheter so the urine was contained; -Since the urine was contained isolation was not necessary; -Didn’t think of emptying the Foley and the potential contamination; -Contaminated gloves should be changed; and -He/she did not expect staff to pull wipes out of the container with contaminated gloved |
| 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: 265797 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER RIDGE CREST NURSING CENTER | STREET ADDRESS, CITY, STATE, ZIP 706 SOUTH MITCHELL | |||||||||
| For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or 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) hands. | |
| F 0925 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. **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: 265797 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER RIDGE CREST NURSING CENTER | STREET ADDRESS, CITY, STATE, ZIP 706 SOUTH MITCHELL | |||||||||
| For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or 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 0925 Level of harm – Minimal harm or potential for actual harm Residents Affected – Some | (continued… from page 48) C) Using methods, if pests are found, such as trapping devices or other means of pest control as specified under; and D) Eliminating harborage conditions. 6-501.112 Removing Dead or Trapped Birds, Insects, Rodents, and Other Pests. Dead or trapped birds, insects, rodents, and other pests shall be removed from control devices and the premises at a frequency that prevents their accumulation, decomposition, or the attraction of pests. | |
