DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES |
PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 |
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STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION |
(X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265832 |
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(X3) DATE SURVEY COMPLETED
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NAME OF PROVIDER OF SUPPLIER
SENATH SOUTH HEALTH CARE CENTER |
STREET ADDRESS, CITY, STATE, ZIP
300 EAST HORNBECK STREET, PO BOX 940 |
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For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) |
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F 0607
Level of harm – Minimal harm or potential for actual harm Residents Affected – Some |
Develop and implement policies and procedures to prevent abuse, neglect, and theft.
Based on record review and interview the facility staff failed to check the Certified |
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F 0623
Level of harm – Potential for minimal harm Residents Affected – Many |
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES |
PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 |
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STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION |
(X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265832 |
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(X3) DATE SURVEY COMPLETED
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NAME OF PROVIDER OF SUPPLIER
SENATH SOUTH HEALTH CARE CENTER |
STREET ADDRESS, CITY, STATE, ZIP
300 EAST HORNBECK STREET, PO BOX 940 |
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For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) |
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F 0623
Level of harm – Potential for minimal harm Residents Affected – Many |
(continued… from page 1) [DATE]. Review of the resident’s record showed no documentation of a letter notifying the resident or the resident’s representative in writing of the reason for transfer nor notification of the state Long-Term Care Ombudsman. 2. Record review of Resident #17’s nurses notes showed the resident transferred to the hospital on [DATE] and returned to the facility on [DATE]. Review of the resident’s record showed no documentation of a letter notifying the resident or the resident’s representative in writing of the reason for transfer nor notification of the state Long-Term Care Ombudsman. 3. Record review of Resident #19’s nurses notes showed the resident transferred to the hospital on [DATE] and returned to the facility on [DATE]. Review of the resident’s record showed no documentation of a letter notifying the resident or the resident’s representative in writing of the reason for transfer nor notification of the state Long-Term Care Ombudsman. 4. Record review of Resident #79’s nurses notes showed the resident transferred to the hospital on [DATE] and did not return to the facility. Review of the resident’s record showed no documentation of a letter notifying the resident or the resident’s representative in writing of the reason for transfer nor notification of the state Long-Term Care Ombudsman. During an interview on 12/12/18 at 11:32 P.M., the Administrator said the facility has not been notifying the resident or the resident’s representative in writing of the reason for transfer and was not aware that they were supposed to notify the ombudsman. Record review of the Transfer to Hospital Policy, dated (MONTH) 6, (YEAR), showed: – Prior to discharge/transfer, the Social Service Director will notify the resident’s family, next of kin or legal representative regarding transfer/discharge; – Location of the transfer/discharge; – Reason for the transfer discharge. |
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F 0625
Level of harm – Potential for minimal harm Residents Affected – Many |
Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave. **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 |
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STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION |
(X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265832 |
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(X3) DATE SURVEY COMPLETED
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NAME OF PROVIDER OF SUPPLIER
SENATH SOUTH HEALTH CARE CENTER |
STREET ADDRESS, CITY, STATE, ZIP
300 EAST HORNBECK STREET, PO BOX 940 |
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For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) |
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F 0625
Level of harm – Potential for minimal harm Residents Affected – Many |
(continued… from page 2) transfer on 11/15/18. 3. Record review of Resident #19’s nurse’s notes showed the resident transferred to the hospital on [DATE] and readmitted to the facility on [DATE]. Review of the resident’s record showed no documentation the resident or the resident’s representative was informed in writing of the facility’s bed hold policy at the time of transfer on 10/21/18. 4. Record review of Resident #79’s nurse’s notes showed the resident transferred to the hospital on [DATE] and did not return to the facility. Review of the resident’s record showed no documentation the resident or the resident’s representative was informed in writing of the facility’s bed hold policy at the time of transfer on 9/12/18. During an interview on 12/12/18 at 11:00 A.M., the Administrator said the facility gives the bed hold policy on admission, and management has been working on implementing this but they just didn’t have it in place yet. Record review of the Bed Hold Policy, dated (MONTH) 10, (YEAR) (Revised (MONTH) 27, (YEAR)), showed: – When a resident is admitted to the facility, they receive a copy of the bed hold policy; – When a resident is discharged to the hospital, the facility will provide to the resident or their legal representative, a copy of the bed hold policy. |
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F 0645
Level of harm – Minimal harm or potential for actual harm Residents Affected – Few |
PASARR screening for Mental disorders or Intellectual Disabilities
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES |
PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 |
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STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION |
(X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265832 |
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(X3) DATE SURVEY COMPLETED
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NAME OF PROVIDER OF SUPPLIER
SENATH SOUTH HEALTH CARE CENTER |
STREET ADDRESS, CITY, STATE, ZIP
300 EAST HORNBECK STREET, PO BOX 940 |
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For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) |
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F 0645
Level of harm – Minimal harm or potential for actual harm Residents Affected – Few |
(continued… from page 3) During an interview on 12/12/18 at 9:46 A.M., the Administrator said she would expect the assessments to be completed on all residents. The facility does not have the Level I PASARR documentation available for these residents and is trying to obtain copies. Record review of the facility’s policy on PASARR assessments and DA-124 A & B showed: – The purpose of this policy is to utilize the PASARR to develop a plan of care that shows continuity from previous history of behaviors and placement. This policy is to ensure that a procedure is set up that communicates to the Social Services Director, MDS/Care Plan Coordinator Case Manage and Director of Nursing issues and concerns that need to be addressed in the plan of care for the resident to reach and maintain the resident’s highest level of mental and psychosocial functioning; – The PASSAR will be utilized as an instrument to assist the facility in maintaining as much as possible, previous treatment modalities that were effective in the resident’s life prior to placement at this facility; – The PASARR will be a guide in developing an assessment that will assist in the continuity of care and services in the best interest of the resident. |
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F 0656
Level of harm – Minimal harm or potential for actual harm Residents Affected – Few |
Develop and implement a complete care plan that meets all the resident’s needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES |
PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 |
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STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION |
(X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265832 |
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(X3) DATE SURVEY COMPLETED
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NAME OF PROVIDER OF SUPPLIER
SENATH SOUTH HEALTH CARE CENTER |
STREET ADDRESS, CITY, STATE, ZIP
300 EAST HORNBECK STREET, PO BOX 940 |
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For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) |
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F 0656
Level of harm – Minimal harm or potential for actual harm Residents Affected – Few |
(continued… from page 4) smoke breaks with supervision. During an interview on 12/12/18 at 9:20 A.M. LPN K said the care plans should reflect the residents smoking. During an interview on 12/12/18 2:45 P.M. the Administrator said she was completing care plans until the first part of (MONTH) (YEAR) and just missed putting the smoking on the residents’ care plans. Record review of the facility’s policy (not dated) on Comprehensive Care Plans showed: – The purpose of this policy is ensure the facility must develop comprehensive care plan for each resident that includes measurable objectives and timetables to meet a resident’s medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment; – A Registered Nurse that has been designated by the facility administration will coordinate each assessment with the appropriate participation of health professionals otherwise known for the purposes of the MDS/care planning process; – The care plan will be updated toward preventing declines in functioning, will reflect on managing risk factors and building on resident’s strengths; – All treatment objectives will be measurable and corroborate with the resident’s own goals and wishes when appropriate. |
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F 0657
Level of harm – Minimal harm or potential for actual harm Residents Affected – Few |
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. Based on interview and record review, the facility failed to update and revise care plans |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES |
PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 |
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STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION |
(X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265832 |
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(X3) DATE SURVEY COMPLETED
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NAME OF PROVIDER OF SUPPLIER
SENATH SOUTH HEALTH CARE CENTER |
STREET ADDRESS, CITY, STATE, ZIP
300 EAST HORNBECK STREET, PO BOX 940 |
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For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) |
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F 0657
Level of harm – Minimal harm or potential for actual harm Residents Affected – Few |
(continued… from page 5) of care within 24 hours during the week and within 72 hours after the weekend. |
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F 0688
Level of harm – Minimal harm or potential for actual harm Residents Affected – Few |
Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** |
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES |
PRINTED: 9/3/2019 FORM APPROVED OMB NO. 0938-0391 |
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STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION |
(X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265832 |
|
(X3) DATE SURVEY COMPLETED
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NAME OF PROVIDER OF SUPPLIER
SENATH SOUTH HEALTH CARE CENTER |
STREET ADDRESS, CITY, STATE, ZIP
300 EAST HORNBECK STREET, PO BOX 940 |
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For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. |
(X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) |
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F 0688
Level of harm – Minimal harm or potential for actual harm Residents Affected – Few |
(continued… from page 6) – Use of a wheelchair for mobility; – Impairment on one side to upper and lower extremities. Record review of Physical Therapy documentation, dated 5/24/18, showed: – [DIAGNOSES REDACTED]. – discharged from physical therapy on 5/24/18 with goal met; – Recommend discharge from skilled services with restorative program. Record review of Restorative Care Program documentation, showed: – Restorative to maintain trunk control, posture, position and wheelchair management; – No frequency or duration documented; – Restorative sheet dated (MONTH) (YEAR), showed restorative services received seven times. During an interview on 12/12/18 at 11:19 A.M., the Administrator said: – Residents should receive restorative services to improve and/or maintain range of motion. – The restorative program should have the frequency and duration of the planned treatments. – It should be documented when the residents receive it and if the they refuse it. – The most common duration is 12 weeks, it depends on the problem and the resident’s cooperation. – If a resident is discharged from the restorative program there should be a discharge order written. During an interview on 12/12/18 at 2:10 P.M., LPN K said they have had some problems with the restorative program and the staff member doing it just took a leave of absence. The facility did not provide a policy on restorative services. |
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