Wesley Gardens Corporation
Deficiency Details, Complaint Survey, April 29, 2011
Regional Office: WRO--Rochester Area Office
F281 483.20(k)(3)(i): SERVICES PROVIDED MEET PROFESSIONAL STANDARDS
Severity: Potential for more than Minimal Harm
Corrected Date: June 10, 2011
The services provided or arranged by the facility must meet professional standards of quality.
Citation date: April 29, 2011
Based on resident and staff interviews, and record reviews conducted during an Abbreviated Survey (complaint #NY00099996) completed on 4/29/11, it was determined that for 3 of 33 residents reviewed for professional standards of quality, the facility did not provide services in accordance with professional standards. The issues involved a resident who did not receive prescribed medications or fasting sugar blood glucose (FSBG, blood test to monitor sugar level) as ordered, did not consistently receive a planned pre-dialysis snack, and did not have pre-dialysis vital signs taken (Resident #1), a resident whose prescribed laboratory testing was not completed (Resident #2), and a resident who did not consistently receive a prescribed dressing change on the night shift for treatment of a pressure area (Resident #3). This resulted in no actual harm with potential for more than minimal harm that is not immediate jeopardy, and is evidenced by the following:
1. Resident #1 has diagnoses including end stage renal disease and diabetes. The Brief Interview for Mental Status (BIMS), dated 2/28/11, revealed that the resident is cognitively intact. The 3/11/11 physician (MD) orders included Renvela (used to control phosphorus levels for residents receiving dialysis) 2,400 milligrams (mg) needs to be taken with a snack, and vital signs (blood pressure and pulse) at 4:30 a.m. on dialysis days (Monday, Wednesday, and Friday). The April 2011 Medication Administration Record (MARs) and Treatment Administration Record (TARs) lacked documented evidence that out of 12 opportunities, the resident missed three doses of Renvela, did not have or receive two pre-dialysis snacks and FSBGs, and did not have vital signs checked three times.
In an interview on 4/27/11 at 9:30 a.m., the Physician's Assistant (PA) stated that the medication, Renvela, is given to residents receiving dialysis to assist with electrolyte absorption, and if not given, could cause an electrolyte imbalance. In an interview at 12:10 p.m. that day, the resident stated that she does not always get her snack during the night (before dialysis) as staff are too busy.
2. Resident #2 has diagnoses including schizophrenia. The 1/20 and 3/11/11 MD orders include Clozapine (for management of schizophrenia) 200 mg twice daily and a complete blood count laboratory test every two weeks to monitor the Clozapine level.
Review of the February, March, and April 2011 MARs revealed that laboratory work slips are to be completed every two weeks by the night shift nursing staff. Three of six opportunities to schedule the complete blood count for this resident were blank (2/6, 3/20, and 4/18/11).
In an interview on 4/27/11 at 9:05 a.m., the Registered Nurse (RN)/Nurse Manager (NM) reported that night shift nurses are responsible for completing the laboratory request slips to ensure blood draws are done to complete the prescribed laboratory tests. After surveyor request, nursing staff contacted the facility's laboratory service provider who verified that the laboratory work was not done on 2/6, 3/20, and 4/18/11, and was not rescheduled at any time to make up for the missed dates. The RN/NM also stated that the complete blood count ordered to be done every two weeks should be done every two weeks. In an interview that day at 9:40 a.m., the PA stated that blood work needs to be monitored when a resident is receiving Clozapine because the medication can cause a dangerously low reduction in white blood cells, the cells that fight infection. The PA added that the pharmacy will not send the medication without verifying that laboratory work is monitored.
3. Resident #3 has diagnoses including chronic Stage IV pressure ulcers of the buttocks and thigh. The 3/15/11 MD order increased the number of dressing changes on the resident's wound from twice daily to every shift (three times daily) due to increased drainage from the wound. The 4/11/11 BIMS indicates the resident is cognitively intact.
Review of the April 2011 TARs revealed a lack of documented evidence to show that on 10 of 27 opportunities, the wound dressing was changed on the night shift. There were no documented reasons on the TARs for not completing these treatments.
In an interview on 4/27/11 at 11:30 a.m., the resident stated that staff do not change her dressings on most nights. She reported that she does not refuse the dressing, and she knows it is supposed to be done three times a day.
When interviewed on 4/27/11 at 11:40 a.m., Licensed Practical Nurse #2 stated that if a treatment is initialed and circled it means it was not done and a reason for not doing a treatment should be documented on the back of the TARs. At 12:00 p.m. that day, the RN/NM stated that if medications and treatments are not signed off, she considers these as missed. If they are circled (not done), she expects documentation as to why. The RN/NM further stated if she knows something has not been done as prescribed, she will ensure it gets done and will contact the MD.
[10 NYCRR 415.11(c)(3)(i)]