Hickory Falls Health And Rehabilitation

Penalty

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to maintain a complete and accurate medical record for a resident when a new pressure injury was identified and wound treatments were not properly documented. Although a physician's order was written for wound care after a new skin issue was reported, there was no documentation in the medical record regarding the change in the resident's skin integrity on the date the issue was discovered. Additionally, the Treatment Administration Record (TAR) showed missing documentation for wound treatments on two days and indicated that treatments were not administered on four other days, despite the wound nurse being scheduled to work on those dates. Interviews with staff revealed that the wound nurse assessed the resident and obtained treatment orders but did not document the new pressure injury in the medical record. The wound nurse acknowledged that treatments were likely completed but may not have been signed off in the TAR, and that second shift nurses sometimes marked treatments as not administered to clear them from their screens. Other nursing staff confirmed that they did not complete the treatments when signing them as not administered. Both the Nurse Practitioner and Medical Director stated that new skin issues and treatments should be accurately documented, and the Director of Nursing and Administrator expected the TAR and medical records to reflect care provided.

Penalty

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to properly clean and disinfect an individually assigned glucometer according to the manufacturer's recommendations and did not follow its own infection control policy regarding glove use during blood glucose monitoring. Specifically, a nurse used alcohol-based hand disinfectant wipes, which were not listed as an approved disinfectant by the glucometer manufacturer, instead of the required Super Sani-cloth Germicidal disposable wipes that were available on the medication cart. The nurse was unaware of the manufacturer's specific disinfection instructions and believed the hand disinfectant wipes were sufficient. Additionally, the nurse performed a blood glucose check on a resident while wearing a torn glove, contrary to the facility's policy that requires gloves to be changed if torn or damaged. The torn glove was used throughout the procedure, including when obtaining a new test strip and performing a second blood glucose check after an initial error. The nurse was not aware that her glove was torn during the procedure. The Director of Nursing confirmed that the expectation was for intact gloves to be used and for the manufacturer's disinfection instructions to be followed.

Penalty

Inspection fine: $51,188

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to protect a resident's right to be free from physical abuse when a nurse aide (NA) punched a resident in the face. The incident occurred when the NA was providing care, and the resident, who had severe cognitive impairment and was dependent on staff for various activities, became combative. The NA responded by pushing the resident, causing the resident to hit his head on the bed rail, resulting in significant injuries including fractures to the nasal bone, maxillary sinus wall, maxilla, and orbital rim. The resident was later found with blood on his face and was sent to the emergency department for evaluation, where the extent of the injuries was confirmed through a CT scan. The resident required surgical intervention for the injuries sustained during the incident. The initial response from the facility staff included cleaning the resident's injuries and contacting the Director of Nursing (DON) and the Administrator. The DON and Administrator initially suspected that the injuries were the result of an unwitnessed fall. However, further investigation revealed inconsistencies in the accounts provided by the staff. The NA initially lied about the incident but later admitted to pushing the resident during a polygraph test conducted by law enforcement. The NA was subsequently terminated from employment. Interviews with other staff members and the resident's family indicated that the resident's injuries were not consistent with a fall. The family member expressed concerns about the explanation provided by the facility and contacted law enforcement, leading to an investigation. The law enforcement detective's investigation, including a failed polygraph test and a confession from the NA, confirmed that the resident had been physically abused. The facility's initial handling of the incident, including the delay in sending the resident to the hospital and the failure to immediately recognize the abuse, contributed to the deficiency.

Removal Plan

• The facility initiated an investigation of the incident and suspected the injury occurred from Resident #1 attempting to self-transfer resulting in an unwitnessed fall.
• Nurse Aides (NAs) were interviewed including NA #1 and revealed Resident #1 was last seen by NA#1 and he was in bed with no concerns noted.
• The Administrator and Director of Nursing met with Resident #1's family member to discuss the incident. Per Administrator and Director of Nursing report, Resident #1's family member stated that she called the police per instruction from another family member. She stated she had no specific complaints or allegations with specific person but thought the police could investigate to find the cause of the injury. The Administrator and Director of Nursing stated during the meeting that they suspected that resident sustained an unwitnessed fall while trying to get into bed, resulting in documented injury.
• Two employees from Adult Protective Services (APS) entered the facility and interviewed the Administrator and Director of Nursing regarding Resident #1. Health care records for Resident #1 were provided per request. The APS employees visited Resident #1 in his room and exited the building with no allegation or concern of abuse made.
• A Detective with the police department arrived at the facility to begin investigation on the report filed. Several staff members were interviewed in-person and via telephone by the Detective at this time. The Detective indicated to the Administrator that he was just investigating the incident and did not indicate abuse had been alleged.
• The Detective entered the facility to further interview Nurse Aide (NA) #1, NA #1 was the last one to provide care to Resident #1 before NA #2 found him with injuries.
• The Detective informed the Administrator there were inconsistencies regarding his investigation. Upon the Detectives exit, the Regional Operator put in a call to the Detective to try and obtain further detail as to what was being alleged. It was reported they were investigating abuse per what was reported from Resident#1's family member to the police. Nurse Aide #1 was suspended pending investigation. The facility began abuse investigation and submitted 24-hour report to DHSR. Resident's responsible party, law enforcement, Ombudsman and Adult Protective Services were notified that facility investigation of abuse was initiated.
• The facility was notified that during Nurse Aide#1's voluntary polygraph test he told the detective he pushed Resident #1 when he became combative during care. Nurse Aide #1 was terminated effective and was interviewed during a call with Administrator to notify of termination. During interview with NA#1, he stated, I went in to change Resident#1 and he was already in bed. He lunged at me, and I pushed him back and he hit the bed rail. He had one little skin tear with a small amount of blood, and I wiped it with a paper towel. He appeared fine and I left the room.
• Facility abuse investigation continues. Staff interviews were conducted. They were asked if they were aware of any abuse, neglect or exploitation of residents and if they were aware of any concerns related to abuse. Staff working on Resident #1's unit (B Hall) provided written statements regarding this allegation and day.
• A 5-day investigation report was made to DHSR which included the facility investigation.
• All residents with a Brief Interview of Mental Status (BIMS) of 12 or above were interviewed by the Administrator or designee to determine if they have experienced any type of resident abuse or were fearful in any way. No concerns were found.
• An audit consisting of thorough skin assessment of all residents with a BIMS of 11 or less was completed by licensed nurses to determine if there is evidence of abuse. No concerns were found.
• An ad hoc Quality Assurance (QA) meeting was held to discuss the deficient practice and to initiate a plan of correction and education for staff regarding abuse and neglect, audits and inclusion in QA.
• Education was provided to the Administrator and the Assistant Director of Nursing by the Regional Operations Manager, regarding the definition of abuse as defined in the abuse policy and the resident's right to be free from abuse.
• After being reeducated as outlined above, education for all staff was completed in person and via phone by the Administrator or designee. The education consisted of the following: The definition of abuse, neglect and misappropriation of property and the need to immediately notify the Administrator or Director of Nursing of all issues related to these infractions. If Administrator or Director of Nursing are not present in the facility, supervisors must be notified, and they must inform the Administrator or Director of Nursing immediately in person or by phone.
• Signs and symptoms of abuse and mental anguish such as loss of interest, change in routine, mood alterations, or difficulty eating.
• Our facility does not condone and has zero tolerance for resident abuse by anyone, including staff members, physicians, consultants, volunteers, staff of other agencies serving the resident, family members, legal guardians, sponsors, other residents, friends, or other individuals.
• The education focused on tactics to deal with difficult residents such as walking away to allow for de-escalation, providing time/place orientation, using a soothing tone of voice, providing gentle tactile cueing, use of gestures, offering distractions, and seeking assistance from other staff members.