Nassau Extended Care Facility

Based on record review, observation and staff interviews during the standard survey, the facility did not ensure that each resident's drug regimen was free from unnecessary drugs for 1 of 4 residents, reviewed for Psychotropic drug use, in a total sample of 40 residents. Specifically, Residents #237 did not have documented evidence that Seroquel was clinically indicated, or that an attempt was made to taper or discontinue the medication. This resulted in no actual harm with potential for more than minimal harm that is not immediate jeopardy.

The finding is:

Resident #237 had diagnoses that include Cerebrovascular Disease and Senile Dementia.

Physicians Order Forms (POF) dated 5/19/11- 9/27/11 documented to administer Seroquel 12.5 Milligrams (mg) twice daily for psychosis.

Comprehensive Care Plans (CCP) dated 5/11 through 9/27/11 documented that the resident had short and long term memory loss and was severely impaired with making decisions. There was no documented clinical indication in the CCP for the use of the Seroquel.

A Psychiatry Consults dated 7/29/11 did not evaluate the resident's Seroquel use. It documented that the resident was not on any psychotropic medication. The Psychiatrist diagnosed the resident with Vascular Dementia and did not document any findings of Psychosis. There was no indications for the use of Seroquel or any attempts made to taper or discontinue the medication.

The monthly physician notes were reviewed from May 2011 through September 2011. The physician documented that the resident is on Seroquel for Dementia. The physician documented that the resident was alert, depressed and disoriented every month. There was no documentation of any psychotic behavior for the use of Seroquel nor were there any attempts made to taper or discontinue the medication.

On 7/30/11, the Social Worker (SW) documented that resident was initially seen by the Psychiatrist and no Psychotropic medications were recommended.

Interdisciplinary Progress Notes dated 5/2011 through 10/2011 documented no evidence that Resident #237 had any behavioral symptoms.

An interview was held on 12/15/10 at 9:30 AM with the Registered Nurse (RN) Charge Nurse. The RN stated that the residents behavior has been stable.

An interview was held with the physician on 10/18/11 at 5:30 PM and stated the resident was admitted to the facility on Seroquel and in July 2011, she requested from the psychiatrist to evaluate the use of Seroquel. Although, the physician initialed the psychiatry consult dated 7/29/11, the physician stated that she was not aware that the psychiatrist had not evaluated Seroquel. The physician continued ordering the medication because the resident was on the medication prior to admission.

The Psychiatrist was not available for interview.

415.12(1)(i)

Based on observation and staff interview, during the recertification survey, it was determined that the facility did not ensure that the resident environment remains as free of accident hazards as is possible. This was evident for 1 of 40 resident rooms observed in stage 1. Specifically, Resident #303's room had no outlet cover for an electrical outlet. This resulted in no actual harm with potential for more than minimal harm that is not immediate jeopardy.
This is a repeat deficiency.

The findings are:

Resident has diagnoses that include Hypertension and Dementia.

The Minimum Data Set Assessment dated 7/14/11 documented that the resident had moderately impaired cognitive skills for decision making, memory problems and independently walking in his room requiring set-up help.

On 10/14/11 at 10:45 AM, Resident #303 room was observed. The electrical outlet cover near the residents bed was missing. The outlet was live and wire connections to the outlet were accessible.

The maintenance worker was immediately notified. At 11:30 AM, the maintenance worker installed the cover to the electrical outlet. He stated that the outlet was live (had current) and was not sure how the cover was removed. He stated that he was not notified of the missing outlet cover prior to today and should have been notified by staff.

415.12(h)(1)

Based on record review and resident and staff interview during the recertification survey, the facility did not ensure that residents' grievances, voiced during Resident Council Meetings, were acted upon. This was evident for one sampled resident in a total of 40 sampled residents. (Resident #5) This resulted in no actual harm with the potential for more than minimal harm that is not immediate jeopardy.
This is a Repeat Deficiency.

The findings are:

On 10/17/11 at 11:05 AM, Resident #5 was interviewed and stated that he is not transferred out of bed (oob) to a wheelchair before breakfast and has to eat breakfast in his bed. The resident also stated that he has been eating breakfast in his bed for 5 years. He stated that he is uncomfortable eating in his bed.

The Resident Council Meeting Minutes recorded by the Resident Council President dated August 9, 2011 documented that residents were waiting too long to be taken out of bed in the morning to eat breakfast in the dining room.

The Resident Council Minutes dated 10/11/11 documented under "Suggestions": "Some residents are requesting to be assisted out of bed earlier on the weekends. Residents are encouraged to voice this concern their nurse, but the recreation department will also forward this to the individual unit of the resident(s) making this request".

The activity supervisor present during the meetings was interviewed on 10/19/11 at 2:30 PM and stated that the she does remember that residents were complaining of not getting out of bed for breakfast in the August 9th and the October 11th meeting, but cannot recall who was making the complaints since it was not documented in the minutes.

The Director of Nursing Services (DNS) was interviewed on 10/19/11 at 12 PM and stated that she was not aware of the resident needs and stated that resident should be allowed to get oob for breakfast. She said a review of his schedule will be made so that the resident may eat breakfast in the dining room.

The Social Worker (SW) was interviewed on 10/19/11 at 12:30 PM and stated that she was not aware of residents wishes of wanting to eat breakfast oob.

415.5(c)(6)

Based on observation, record review and staff interviews during the recertification survey the facility did not ensure that there was documented evidence to support that a resident was ambulated in accordance to physician's orders to maintain or improve the resident's ability to ambulate. This was evident for one of three residents reviewed for community discharge. Specifically, Resident #182 was placed on an Floor Ambulation Program (FAP) with direction to ambulate daily with a rolling walker and one assist for 40 feet. There was no documented evidence that this order was carried out. This resulted in no actual harm with potential for more than minimal harm that is not immediate jeopardy.

The finding is:

Resident #182 has diagnoses including Diabetes, Hypertension and Cerebro-Vascular Accident with Hemiplegia.

The Admission Minimum Data Set (MDS) with the Assessment Reference Date of 8/21/11 documented that the resident understood and understands and had a Brief Interview for Mental Status (BIMS) score of 9, representing moderately impaired daily decision making skills. Resident #182 required extensive assist of one person for transfers and was non-ambulatory. The resident's balance was assessed as not steady, only able to stabilize with human assistance from sitting to standing. Ambulation balance was not assessed because ambulation did not occur. The resident was assessed as having functional rehabilitation potential and was placed on a Physical Therapy program 5 times per week.

A physician's order dated 9/28/2011 documented to ambulate approximately 40 feet with a rolling walker and minimal assistance of one person on the nursing unit.

The Comprehensive Care Plan (CCP) dated 9/6/11 for alteration in musculoskeletal status as evidenced by difficulty walking and weakness of both lower extremities included interventions not limited to: follow physician orders and/or PT/OT treatment plan. The CCP was updated on 10/05/2011 for the resident to participate with the Floor Ambulation Program (FAP) daily with the nursing staff.

The Certified Nursing Assistant Accountability Record (CNAAR) was reviewed on 10/19/2011. The was no direction regarding the resident's ambulatory status provided to the CNA on the directive page nor the CNAAR.

An observation on 10/19/2011 at 11:00 AM of Resident #182 ambulating was made. The resident ambulated with a Rolling Walker and one assist (Certified Nursing Assistant) approximately 30-40 feet.

An interview was held on 10/19/2011 at 11:10 AM with the 7 AM-3 PM CNA who provides direct care for Resident #182. The CNA stated that he ambulates the resident daily with a rolling walker to the dining room, that the resident's ambulatory distance varies, and the resident tends to ambulate with a quick pace. The CNA stated that he does not document that the resident ambulated because the computer system that the CNA's had utilized is no longer working. The CNA stated that the directive sheet is where he obtains information on how to care for the resident. Review of the CNAAR and directive sheet, with the CNA present, revealed that there was no direction provided to the CNA regarding the assistive device, the amount of assistance needed, the distance to ambulate nor the frequency of ambulation.

An interview was held on 10/19/2011 at 11:45 AM with the resident's Physical Therapist (PT). The PT stated that the nurse who picks up the FAP order is responsible to add the FAP information to the CNA's directive sheet. The nurse is also responsible to complete the CNAAR regarding the ambulatory assistive device, distance, frequency and amount of assistance needed for ambulate the resident on the FAP.

An interview was held on 10/19/2011 at 12:06 PM with the Licensed Practical Nurse (LPN) who picked up the 9/28/2011 physician's order for the FAP. The LPN stated that the facility has been utilizing different computer systems and she could not recall which system was being utilized on 9/28/2011. The LPN stated that she knew she was responsible to update the CNAAR but could not recall why the directive sheet and the CNAAR was not updated.

415.11(c)(3(ii)

The following waiver (s) is (are) on file with this office. Repeat waivers are granted based on previous justifications by the owner, previous NYSDOH and USDHHS reviews and certification that the condition under which the waivers have been granted have not changed. Please indicate if the facility wishes the waiver(s) to be continued.

Please indicate if the facility wishes the waiver (s) to be continued or provide a plan of correction.

Time Limited Waiver- Expires on 8/13/2012

The facility was not provided with a NFPA99- Health Care Facilities and NFPA70- National Electrical Code conforming Type 3 Essential Electrical System in that wiring from Article 700 Emergency System loads and Non-Article 700 Emergency System loads were not separated.
NFPA 101-2000 Life Safety Code: 9.1.2, NFPA 70-1999 National Electrical Code: Article 517-40. 517-41 NFPA 99-1999 Standard for Health Care Facilities: 16-3.3.2, 3-6, 3-5