| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/25/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265762 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER ST JOSEPH SENIOR LIVING | STREET ADDRESS, CITY, STATE, ZIP 1317 NORTH 36TH STREET | |||||||||
| 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 0640 Level of harm – Potential for minimal harm Residents Affected – Some | Encode each resident’s assessment data and transmit these data to the State within 7 days of assessment. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** |
| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/25/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265762 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER ST JOSEPH SENIOR LIVING | STREET ADDRESS, CITY, STATE, ZIP 1317 NORTH 36TH STREET | |||||||||
| 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 0640 Level of harm – Potential for minimal harm Residents Affected – Some | (continued… from page 1) During an interview on 2/11/19 at 3:35 P.M., the administrator said that the resident was discharged on [DATE], so there should be a discharge subset transmission. 5. Resident #24’s CMS MDS entries showed: -A quarterly MDS, dated [DATE]; -A discharge subset with return anticipated, dated 9/26/18; -A reentry subset, dated 9/29/18; -A 5-day PPS subset, dated 10/5/18; -A 14-day PPS, dated 10/12/18; -A return entry, dated 10/23/18 (no discharge subset between 10/12/18 and 10/23/18); -No quarterly MDS, due 11/3/18. Review of the facility’s MatrixCare (an electronic health record computer program) Report for 8/1/18-2/11/19, showed: -A quarterly MDS, dated [DATE], which showed production accepted; -A discharge subset with return anticipated, dated 9/26/18, which showed production accepted; -An entry subset, dated 9/29/18, which showed production accepted; -A 5-day PPS, dated 10/5/18, which showed production accepted; -A 14-day PPS, dated 10/12/818, which showed production accepted; -A discharge with return anticipated, dated 10/18/18, which showed production accepted; -An entry subset, dated 10/23/18, which showed production accepted; -A quarterly MDS, dated [DATE], which showed production accepted. During an interview on 2/11/19 at 3:36 P.M., the administrator said: -Their computer system showed the MDS’s for Residents #1, #2, and #4 to be current and all submitted and accepted. -Their computer system also showed Resident #4’s discharge subset was completed and accepted. -The only MDS not current and accepted was for Resident #3, which was completed but not transmitted. -He/she did not know why the CMS system did not show them as up-to-date. During a phone interview on 2/13/19, at 3:05 P.M., the MDS state automation coordinator said: -None of the missing MDS’s for Residents #1, #2, #3, #4 and #24 were transmitted through the CMS system. -It can be deceiving if MDS’s are only transmitted through a facility’s electronic healthcare system, such as Matrix, as it might show it was accepted, but was actually not accepted into the CMS system. -Facility’s need to pull the final validation of transmitted MDS’s from CMS CASPER (Certification and Survey Provider Enhanced Reports). | |
| F 0658 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | Ensure services provided by the nursing facility meet professional standards of quality. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** |
| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/25/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265762 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER ST JOSEPH SENIOR LIVING | STREET ADDRESS, CITY, STATE, ZIP 1317 NORTH 36TH STREET | |||||||||
| For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. | ||||||||||
| (X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
|---|---|---|
| F 0658 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 2) Review of the facility’s policy related to medication administration, revised (MONTH) 2012, showed: -Medications shall be administered in a safe and timely manner, and as prescribed. -Medications must be administered in accordance with the orders. -If a dose is believed to be inappropriate or excessive for a resident, the person preparing or administering the medication shall contact the resident’s attending physician or the facility’s medical director to discuss the concerns. -The individual administering the medication must check the label to verify the right resident, right medication, right dosage, right time and right route of administration before giving the medication. 1. Review of Resident #5’s MatrixCare (a specific electronic health record system) (MONTH) 2019 e-POS showed an order, dated 6/21/16, for [MEDICATION NAME] ([MEDICATION NAME]-[MEDICATION NAME], a medication used to treat body odors) 0.6-3 milligrams (mg), take one tablet with meals AM (morning), midday and PM (evening) for malodorous urine. Review of the resident’s MatrixCare (MONTH) 2019 e-MAR showed the resident received the Cholorphyll as prescribed 1/1/19-1/16/19. Review of the resident’s AHT (a specific electronic health record system) (MONTH) 2019 e-POS showed an order, dated 1/7/19, for [MEDICATION NAME] 20 mg, take three times a day with meals for malodorous urine. Review of the resident’s (MONTH) 2019 AHT e-MAR showed the resident received [MEDICATION NAME] 20 mg three times a day with meals 1/17/19-1/31/19. Review of the resident’s (MONTH) 2019 AHT e-POS showed an order, dated 1/7/19, for [MEDICATION NAME] 20 mg three times a day. Observation and interview on 2/8/19 at 12:16 P.M., showed Certified Medication Technician (CMT) did and said: -Checked the e-MAR; -Removed the resident’s bottle of [MEDICATION NAME], with a label that indicated it contained [MEDICATION NAME]-[MEDICATION NAME] 0.6 mg-3 mg per tablet, from the medication cart and placed one tablet in a medication cup and prepared to administer the medication to the resident; -When questioned about the dose, he/she said he/she had not previously noticed there was a different dose on the medication bottle compared to the dose on the e-MAR. -He/she reported the issue to the assistant director of nurses (ADON). Review of the resident’s (MONTH) 2019 AHT e-MAR showed staff documented they administered [MEDICATION NAME] 20 mg three times a day 2/1/19 through the noon dose on 2/8/19. During an interview on 2/8/19 at 12:33 P.M., the ADON said: -He/she spoke with the resident’s physician who clarified that the [MEDICATION NAME] dose should be 3 mg. -The original order for the medication was for 3 mg, but staff incorrectly entered the order into the new computer system when they changed systems. During a phone interview on 2/11/19 at 3:47 P.M., the Director of Nurses (DON) said: -Three nurses entered and checked orders when the facility changed computer systems and he/she was still reviewing orders for accuracy. -Physicians should also look at physician orders [REDACTED]. -He/she did not catch the incorrect dose entered into the new e-POS/e-MAR system for the resident’s [MEDICATION NAME]. -Staff should check the medication container dose with the dose on the e-MAR and clarify with the resident’s physician if they do not match. |
| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/25/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265762 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER ST JOSEPH SENIOR LIVING | STREET ADDRESS, CITY, STATE, ZIP 1317 NORTH 36TH STREET | |||||||||
| For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. | ||||||||||
| (X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
|---|---|---|
| F 0658 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | ||
| F 0686 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | Provide appropriate pressure ulcer care and prevent new ulcers from developing. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** |
| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/25/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265762 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER ST JOSEPH SENIOR LIVING | STREET ADDRESS, CITY, STATE, ZIP 1317 NORTH 36TH STREET | |||||||||
| 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 0686 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 4) -A pea-sized open area with a pink center was located on the resident’s sacrum; -There was no type of dressing over the open area; -CNA A said the resident had an open area on his/her backside for a while and that hospice nurses and facility nurses provided wound care, but was not sure what the treatment was; -CNA A said that the CNA’s turned the resident when he/she was in bed and they did not leave him/her up in a chair very long. Review of the resident’s (MONTH) 2019 electronic treatment administration record (e-TAR) showed weekly skin assessments done on 2/3/19 and 2/10/19 with skin documented as intact. During an interview on 2/11/19 at 12:35 P.M., LPN A said: -The resident had a pressure ulcer on his/her backside recently, but he/she thought it was healed. -LPN A showed the (MONTH) skin inspection report which showed non-intact skin with an existing skin issue for 1/7/19 and 1/15/19, and entries for 1/21/19 and 1/27/19 that showed intact skin. -LPN A said the resident’s wound treatment was discontinued. -He/she knew of no current open areas on the resident, but would assess the resident’s skin when staff put him/her back to bed after lunch. During an interview on 2/11/19 at 2:20 P.M., the assistant director of nurses (ADON) said that the CNA’s do not document any skin issues, they should tell the nurse and the nurse should document any skin issues. During an interview on 2/11/19 at 2:25 P.M., LPN A said: -He/she assessed the resident’s skin this afternoon and found a 0.5 centimeter (cm) by 0.5 cm open area on the resident’s coccyx that had no measurable depth. -He/she obtained a treatment order and contacted hospice. -He/she did not know why the nurse documented that the resident’s skin was intact during the weekly skin assessment on 2/10/19 when the surveyor saw the open area on 2/8/19 and it was still currently open. -LPN A thought the open area was possibly covered with barrier cream when the night nurse did the weekly skin assessment, so he/she did not see it. -Staff should include the presence of a pressure ulcer in the care plan and in the nurses’ shift report to let staff know it was there. During a phone interview on 2/11/19 at 3:47 P.M., the director of nurses (DON) said: -Nurses do weekly skin assessments. -CNA’s should report any skin issues to the nurse and the nurse should document the issue in the progress notes or on the weekly skin audit sheet. -Staff should document he size and character of the open area. -Staff should also care plan for current pressure ulcers or for residents with a history of past pressure ulcers. | |
| F 0689 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** |
| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/25/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265762 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER ST JOSEPH SENIOR LIVING | STREET ADDRESS, CITY, STATE, ZIP 1317 NORTH 36TH STREET | |||||||||
| For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. | ||||||||||
| (X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
|---|---|---|
| F 0689 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 5) stand, transfer and walk) transfers for two out of 15 sampled residents (Residents #27 and #17). The facility census was 58. Review of the facility’s policy, entitled Safe Lifting and Movement of Residents, dated (MONTH) (YEAR), showed: -In order to protect the safety and well-being of staff and residents, and to promote quality care, this facility uses appropriate techniques and devices to lift and move residents. -Staff responsible for direct resident care will be trained in the use of manual (to include gait belts) and mechanical lifting devices. 1. Review of Resident #27’s quarterly Minimum Data Set (MDS), a federally mandated assessment instrument completed by facility staff, dated 1/23/19, showed; -Required limited assistance for transfers; -Had one non-injury fall since the last MDS assessment. Review of the resident’s care plan, last revised 2/5/19, showed: -Required assistance of one for transfers; -At risk for falls due to muscle weakness; -Had non-injury falls on 1/23/19 and 2/4/19. Observation on 2/8/19 at 9:58 A.M. showed Certified Nurse Assistant (CNA) A and CNA B transferred the resident from a wheelchair to bed in the following manner: -CNA A applied a gait belt around the resident’s upper chest, above the breasts, with the gait belt against the resident’s arm pits. -A CNA stood on each of the resident’s sides. -CNA A grasped the gait belt in the front and back of the resident. -CNA B grasped the gait belt in the back of the resident and placed his/her arm under the resident’s arm pit. -The resident’s shoulders raised upward as staff lifted the resident to stand. -Both staff assisted the resident to pivot and sat him/her on the bed, removed the gait belt and laid the resident in bed. During an interview on 2/8/19 at 12:09 A.M., CNA B said: -Staff should place the gait belt around the resident’s waist or above the breasts, according to the resident’s choice. -Staff should never lift under the resident’s arms. 2. Review of Resident #17’s care plan, last revised on 12/11/18, showed: -Had altered activities of daily living related to dementia; -Required assistance of two staff for transfers; -Had a past history of falls. Review of the resident’s quarterly MDS, dated [DATE], showed: -Total dependence on staff for transfers; -Had two non-injury falls and on fall with injury since the last MDS assessment. During an observation on 2/8/19 at 11:38 A.M., CNA A and CNA C transferred the resident from the bed to a wheelchair in the following manner: -Staff provided incontinent care and dressed the resident. -Staff assisted the resident to sit at the edge of the bed. -CNA A applied the gait belt across the resident’s chest area. -CNA A and CNA C stood at each side of the resident and each staff hooked one of their arms under each of the resident’s arms, grasped the gait belt in the back of the resident and lifted the resident to stand. -The resident’s shoulders raised as staff lifted him/her. -Staff pivoted the resident and sat him/her in the wheelchair. |
| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/25/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265762 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER ST JOSEPH SENIOR LIVING | STREET ADDRESS, CITY, STATE, ZIP 1317 NORTH 36TH STREET | |||||||||
| For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. | ||||||||||
| (X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
|---|---|---|
| F 0689 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 6) During an interview on 2/8/19 at 11:59 A.M., CNA A said: -He/she was taught, that if the resident had a bigger chest, staff could place the gait belt on the upper chest. -He/she did not know staff should not place the gait belt up high. -Staff should not lift under the resident’s arms because it could cause a skin break due to the belt rubbing and could dislocate the shoulder. During an interview on 2/8/19 at noon, CNA C said: -Staff should place the gait belt below the resident’s breasts. -Staff should not lift under the arms. During a phone interview on 2/11/19 at 3:47 P.M., the Director of Nurses (DON) said: -Staff should place the gait belt around the resident’s waist. -Staff should not place the gait belt above the breasts or under the arm pits. -Staff should grasp the gait belt and should not place an arm under the resident’s arm pit to lift the resident. | |
| F 0759 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | Ensure medication error rates are not 5 percent or greater. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** |
| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/25/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265762 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER ST JOSEPH SENIOR LIVING | STREET ADDRESS, CITY, STATE, ZIP 1317 NORTH 36TH STREET | |||||||||
| For information on the nursing home’s plan to correct this deficiency, please contact the nursing home or the state survey agency. | ||||||||||
| (X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | |
|---|---|---|
| F 0759 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | (continued… from page 7) (CMT) A administered the resident’s medications in the following manner, and said: -Placed the residents [MEDICATION NAME] and [MEDICATION NAME] DR in a medication cup with several other medications. -Administered the medications to the resident in the dining room where the resident was eating his/her meal, with about half eaten. -Staff usually administer [MEDICAL CONDITION] medication and [MEDICATION NAME] before breakfast, the first thing of a morning. -This resident slept in and took his/her medications better when up, so staff waited until he/she was out of bed. 2. Review of Resident #5’s (MONTH) 2019 e-POS showed an order, dated 1/7/19, for [MEDICATION NAME] 20 mg three times a day with meals for malodorous urine. Observation and interview on 2/8/19 at 12:16 P.M. showed CMT A administered the resident’s [MEDICATION NAME] in the following manner and said: -Checked the e-MAR; -Removed the resident’s bottle of [MEDICATION NAME], with a label that indicated it contained [MEDICATION NAME]-[MEDICATION NAME] 0.6 mg-3 mg per tablet, from the medication cart,, placed one tablet in a medication cup and prepared to administer the medication to the resident; -When questioned about the dose, he/she said he/she had not previously noticed there was a different dose on the medication bottle compared to the 20 mg dose on the e-MAR. Review of the resident’s (MONTH) 2019 e-MAR showed staff administered [MEDICATION NAME] 20 mg three times a day with meals from 2/1/19 through the noon dose on 2/8/19. During an interview on 2/8/19 at 12:33 P.M., the assistant Director of Nurses (ADON) said: -He/she spoke with the resident’s physician and verified that the [MEDICATION NAME] dose was 3 mg. -The original [MEDICATION NAME] dose was 3 mg, but staff incorrectly entered it into the new e-POS computer system. During a phone interview on 2/11/19 at 3:47 P.M., the DON said: -Staff should give resident medications according to resident wishes. -The computer system gave staff two hours before and two hours after the time entered in the computer, which was 8:00 A.M. for the A.M. medication pass, that way the resident can decide when they want to take the medication. -Most [MEDICAL CONDITION] medication and [MEDICATION NAME] are scheduled for the A.M. medication pass. -Staff usually administer [MEDICAL CONDITION] medications and [MEDICATION NAME] before breakfast, but some residents do not get up before breakfast. -Staff should care plan for residents who do not want to take these types of medications before meals because they prefer to get up later. | |
| F 0880 Level of harm – Minimal harm or potential for actual harm Residents Affected – Few | 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: 9/25/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265762 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER ST JOSEPH SENIOR LIVING | STREET ADDRESS, CITY, STATE, ZIP 1317 NORTH 36TH STREET | |||||||||
| 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 – Few | (continued… from page 8) -This facility considers hand hygiene the primary means to prevent the spread of infections. -All personnel shall be trained and regularly in-serviced on the importance of hand hygiene in preventing the transmission of healthcare-associated infections. -Wash hands with soap and water when visibly soiled and after contact with a resident with specified infections, per policy. -Use an alcohol-based hand rub before and after direct contact with residents, before moving from a contaminated body site to a clean body site during resident care, after contact with a resident’s intact skin, after removing gloves and after contact with objects in the immediate vicinity of the resident. -The use of gloves does not replace hand hygiene. 1. Review of Resident #48’s care plan, last revised 8/20/18, showed: -Functional urinary incontinence related to injuries sustained in a motor vehicle accident; -Provide incontinence care after each incontinence episode. Review of the resident’s quarterly Minimum, Data Set (MDS), a federally mandated assessment instrument completed by facility staff, dated 12/1/18, showed: -Totally dependent for all care; -Had a urinary catheter (sterile tube inserted into the bladder to drain urine); -Had a [MEDICAL CONDITION] (surgical opening from the colon through the abdominal wall) for bowel elimination. During an observation on 2/5/19 at 2:54 P.M., Certified Nurse Assistant (CNA) D and CNA E provided care for the resident in the following manner: -CNA D was already in the resident’s room with gloves on. -CNA E brought a mechanical lift (device used to lift and transfer resident’s from one place to another) into the room and put on gloves, but did not wash his/her hands first. -Both staff transferred the resident from a wheelchair to the bed. -CNA D provided incontinent care to the resident’s front genital area, and with the same gloves on, sprayed peri cleanser to each pre-moistened wipe between each swipe, then opened the resident’s bedside drawer and put the container of peri cleanser in the drawer. -CNA E turned the resident to his/her right side and CNA D cleansed the resident’s backside and disposed of the wet brief. -Both staff placed a clean brief on the resident. -CNA D removed his/her gloves, did not perform hand hygiene, and took a bag of soiled items from the room. -CNA D returned and washed his/her hands and put on gloves. -CNA D removed the resident’s [MEDICAL CONDITION] bag, which contained fecal material, and cleansed the area around the [MEDICAL CONDITION] stoma (hole created in the abdominal wall), then with the same gloves on, placed the ostomy care supplies in the bedside drawer. -CNA E applied a new bag over the stoma, removed his/her gloves and washed his/her hands. -CNA D did not remove his/her gloves and touched the resident in multiple areas as staff dressed the resident, adjusted the lift sling (an assistive device a resident is placed in that is attached to a mechanical lift), helped attach the lift sling to the mechanical lift, touched the mechanical lift control, moved the mechanical lift to the wheelchair, touched the control on the resident’s electric wheelchair, adjusted the resident’s feet, touched the mechanical lift again in various places, touched the seat belt on the resident’s wheelchair, put the resident’s shoes on him/her, put a pillow under the resident’s feet, touched the wheelchair control again, then removed his/her soiled gloves, |
| DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES | PRINTED: 9/25/2019 FORM APPROVED OMB NO. 0938-0391 | |||||||||
| STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION | (X1) PROVIDER/SUPPLIER/CLIA IDENNTIFICATION NUMBER: 265762 |
| (X3) DATE SURVEY COMPLETED | |||||||
| NAME OF PROVIDER OF SUPPLIER ST JOSEPH SENIOR LIVING | STREET ADDRESS, CITY, STATE, ZIP 1317 NORTH 36TH STREET | |||||||||
| 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 – Few | (continued… from page 9) put a blanket over the resident’s legs, made the bed, obtained perfume from the bedside drawer, sprayed on the resident and returned it to the bedside drawer, then washed his/her hands. -CNA E removed his/her gloves and washed his/her hands. During an interview on 2/8/19 at 3:22 P.M., CNA D said: -Staff should sanitize their hands before and after they put on gloves, when they enter a resident’s room and before they exit the room. -Staff should remove their gloves and sanitize their hands when done cleansing one body area before they cleanse the next area. -Staff should remove their gloves and sanitize their hands after providing peri care and before they touch anything else. During a phone interview on 2/11/19 at 3:47 P.M., the Director of Nurses (DON) said: -Staff should sanitize their hands when they enter, before they leave a resident room and after each glove removal. -Staff should remove their gloves and sanitize their hands after they provide peri care and should not touch other items or surfaces with soiled gloves | |
