Deficiencies in Nursing Competency and Resident Care
Penalty
Summary
The facility failed to ensure competent staff were available to provide skilled nursing care and services, resulting in multiple deficiencies. One significant issue involved a resident who was served food items containing allergens, specifically wheat and milk, despite having documented allergies to these substances. The dietary staff, including the Certified Dietary Manager and Dietary Aides, acknowledged the error, stating that the resident's meal ticket was not properly reviewed, leading to the resident being served inappropriate food items. The facility was also out of almond milk, which was the resident's preferred alternative, and the family was expected to supply it. Another deficiency was observed with a resident who had undated bandages on their left side, contrary to the facility's policy requiring bandages to be dated and initialed by the nursing staff. This oversight was confirmed by the Director of Nursing and other nursing staff, who acknowledged the importance of dating bandages to track when they were last changed. Additionally, there was a failure to follow up on a physician's order for a medication with a black box warning for another resident. The medication was not administered since admission due to a lack of communication between the facility and the pharmacy, and the nursing staff did not notify the resident's physician to seek further instructions. The facility also failed to provide adequate nutrition and hydration services. One resident was not given lunch before a medical appointment and was not offered any food upon returning to the facility. Furthermore, several residents were observed in the activities room without being offered hydration, and staff were not aware of the residents' hydration needs. The Director of Nursing stated that residents should be offered hydration at least once an hour, and dietary staff should be notified to provide meals or snacks for residents who miss mealtime due to appointments.
Plan Of Correction
Resident # 163 was discharged from the facility. Resident # 66 was assessed with no negative outcome. Resident #73 was changed by our Nurse with no negative outcome. Resident # 91, 16, and 49 were assessed with no negative outcomes. Resident #264 had his medication, (HCI) discontinued by order from the Advanced Registered Nurse Practitioner. Residents with food have the potential to be affected. Residents with food will be reviewed to ensure no related consequences. Residents with have the potential to be affected by not being dated. Residents with will be reviewed to ensure are dated. Residents with medications with black box warnings have the potential to be affected. They will be reviewed to ensure no black box medication related negative effects. Current residents with since will be evaluated for negative consequences from not being provided a meal or snack with a scheduled outing. Residents' whose Activities of Daily Living are dependent on staff that spend time in the activity day rooms for hydration were reviewed to ensure the necessary assistance and fluids are being provided according to the resident needs and plan of care. The Director of Nursing / Staff Development Coordinator will complete training to the Licensed nurses and Certified Nursing Assistants on the process for ensuring food items that residents are to are not accessible, the facilities hydration policy and process with a focus on the residents that are dependent upon staff to meet their hydration needs. The training will also review the process for communicating resident to the kitchen and ensuring residents receive a snack or meal according to resident preferences. The Director of Nursing/ Staff Development Coordinator will educate licensed nurses on the need to ensure are dated and follow up on physician ordered black box warnings is completed timely. The Director of Nursing / Designee will complete 5 random weekly audits of day rooms to ensure residents do not have access to food to verify staff understanding of the education provided. The Director of Nursing/Designee will complete 5 random observations of to ensure they are labeled and 5 random audits of residents with black box warning to ensure physician orders are followed up on. In addition, the Director of Nursing/ Designee will interview 3 residents per week to determine if residents who have have been offered and/or provided a meal or snack and complete 5 random observations of dependent residents in the activity day rooms to ensure they are being provided and assisted with hydration. These audits, interviews and observations will validate staff competency and knowledge of the facility processes. The results of the audits will be tracked, trended and reported to the monthly Quality Assurance Performance improvement meeting until sustained compliance achieved.