Bethany Gardens Skilled Living Center

Based on record reviews and staff interviews conducted during an abbreviated survey (complaint # NY00098070), it was determined the services provided by the facility did not meet professional standards for 1 of 1 sampled residents for falls/accidents (Resident #1). Specifically, a licensed practical nurse (LPN) performed an assessment of Resident #1 after she fell and the resident was moved though there were possible injuries. This resulted in no actual harm with potential for more that minimal harm that is not immediate jeopardy.

THIS IS A REPEAT DEFICIENCY FROM RECERTIFICATION SURVEYS of June 18, 2009 and August 25, 2010.
Findings include:

According to the New York State Education Department, LPNs cannot perform resident assessments.

1). Resident #1 was admitted to the facility on January 13, 2010 with diagnoses with include dementia and osteoarthritis. The most recent MDS, dated July 21, 2010, documented the resident's cognitive skills for daily decision making as modified independence.

The resident's comprehensive care plan, last reviewed January 20, 2011, documented the resident was at high risk for falls and should have anti-skid strips on the floor next to her bed, keep room free of clutter, wheelchair lap buddy with alarms, frequent observations, full rails in bed with alarm and monitor resident for sliding in wheelchair and out of recliner.

The facility fall protocol, titled "Protocol to Follow When a Fall Occurs," documented the rationale of the policy as "Falls are the leading cause of injury in nursing homes. Proper assessment and interventions after a fall occurs is needed to treat injuries resulting from the fall to prevent further injury." The procedure documented includes "The nurse will do an initial evaluation, checking for life threatening injuries....The nurse will then do a secondary, more thorough evaluation ... If there is a question of hip, leg or spinal fracture, do not move the resident. Stabilize only. The on call RN (registered nurse) will be notified during off shifts and Call the physician."

A nursing progress note dated February 20, 2011 documented the resident was found lying on her left side on the floor after she fell while trying to ambulate independently. The resident was checked, no injury was found and she was returned to bed. The resident then complained of pain in the upper right thigh and was unable to lift the right leg. The physician was contacted and ordered the resident to go the the local emergency room.

The incident report, dated February 20, 2011 documented the resident attempted to self-ambulate to the bathroom and fell. She was found lying on her left side and complained of right thigh and right arm pain, and was sent to the hospital. The RN DON (Director of Nursing) signed the Incident Report form page two after "Assessing RN Signature" and dated her signature February 20, 2011. The RN DON signed page two in two additional areas and dated both February 20, 2011. The RN DON signed page 5 of the Incident Report Form attesting that the resident was unable to give a statement due to dementia. This signature is also dated February 20, 2011.

The hospital emergency department physician progress note dated February 20, 2011 documented the resident was diagnosed with a comminuted acetabular, right iliac bone fracture and fracture of the inferior pubic ramus (bones of the hip).

Certified nurses aide (CNA) #1 was interviewed on March 24, 2011 at 3: 15 PM and stated she and CNA #2 entered the resident's room together and found her on the floor. The licensed practical nurse (LPN) was contacted. The RN (Director of Nursing ) was not present at the facility.

The LPN was interviewed on March 24, 2011 at 4:30 PM. She stated she is not supposed to assess residents and since the resident was in pain, she was sent to the hospital after the physician was informed of the fall and complaints of pain. The LPN stated if the residents do not have head injuries she directs them to move their arms and legs, and to attempt range of motion. She stated she knows the ROM for each resident. If the resident hits their head, she checks their eyes and pupils and looks for hematomas. If there is any bleeding or loss of consciousness, the resident is sent out to the hospital immediately. If they have fallen and have pain, an ambulance is called. If there is no pain, the staff monitor the resident and watch for signs or symptoms to change for three days. She stated there are no RNs on her shift (the evening shift), so the RN assessment is conducted the next day. The LPN stated that the RN (DON) was not present when Resident #1 fell and did not assess the resident.

CNA #2 was interviewed on April 1, 2011 at 5:30 PM and stated he, CNA #1 and the LPN picked the resident up and put her into bed after she was found on the floor. The resident was in pain so the LPN checked her. The RN (DON) was not present.

On April 5, 2011 at 11 AM, the RN DON was interviewed. She stated staff called her at home when Resident #1 fell on February 20, 2011. Staff stated they found the resident on the floor and they rolled her onto a blanket and three staff lifted her into bed. The RN DON stated she did not personally assess the resident and signed the incident report which indicated she had assessed the resident "out of habit." The RN DON stated the RN assessment occurs the following morning because RNs do not work the evening and night shifts. The RN DON stated the facility is trying to get an RN on call list together where the RN could be contacted and would go into the facility and perform an assessment off hours.

In summary, the resident was moved before she was assessed for injury and the assessment was not performed by a qualified professional. In addition, the RN DON documented that she assessed the resident on the date of the fall. She was at home and did not assess the resident after the fall on February 20, 2011.