Inspection Findings:
Based on interview and record review, it was determined the facility failed to monitor and document weekly progress of short-term changes of condition until the condition resolved for 1 of 4 sampled residents (#3) whose records were reviewed. Resident 3 had a yeast infection that worsened over time. Findings include, but are not limited to: Resident 3 was admitted to the facility 6/2020 with diagnoses including dementia and a history of colon cancer. During the entrance conference, 4/12/21, Resident 3 was identified as having a foley catheter and colostomy.Resident 3's 4/8/21 service plan instructed staff to provide "peri-care" and catheter care twice a shift. The service plan included detailed instructions on how staff were to provide peri-care, including how to position the resident, which direction to wipe to clean the area, what type of cloth to use and the position of the foley catheter tubing during care. A review of resident's clinical record, including service plan, progress notes, Home Health notes, MARs and temporary service plans indicated the following:On 1/15/21 Staff 2 (RN) documented the Home Health nurse noted "increased vaginal discharge that smelt yeasty, recommended to start Nystatin cream [topical used to treat skin infections] and request Diflucan [antibiotic]".The January 1st through 31st, 2021 MAR showed 1 dose of Diflucan 150 mg was administered on 1/19/21. On 2/4/21 staff documented "[Resident] has a yeast rash in [his/her] groin and vaginal area, have started Nystatin cream per MD order". There was no documented evidence the previously noted yeast infection had resolved, the yeast infection originally noted had been monitored for improvement or worsening of the infection, or if the medication used to treat the infection had been effective. Staff further documented: * On 2/5/21 resident refused application of the Nystatin cream;* On 2/15/21 resident "refused to stand" for application of cream; and * On 2/16/21 "resident was in beauty salon" so Nystatin cream was not applied. A note from the Home Health RN, 2/11/21 described a "strong yeast odor noted. Labia is red, swollen and very sensitive to touch making [catheter] changes difficult". A follow up note, written 2/17/21, by Staff 2 indicated she needed to "follow up on Diflucan".The February 1st through 28th, 2021 MAR showed 1 dose of Diflucan 150 mg was administered on 2/23/21. On 3/8/21 staff documented "Rash on groin is very raw and was bleeding". No further documentation regarding the yeast infection was made in the residents' record until 3/23/21 when staff wrote "yeast rash on peri area and breast looked a lot better. Not raw or very red." There was no previous mention of a yeast rash under the resident's breast and no monitoring of the condition documented in the resident's chart. A summary note, written by Staff 2 on 3/24/21, stated during a catheter change on 3/23/21, the Home Health nurse observed a "large amount of drainage from peri-area, education provided by [Staff 2] to caregiving staff that [Resident] is to have peri-care and catheter care twice shift routinely". Staff documented on 3/24/21 "Yeast rash looks clean and not so raw. No redness under the breasts". On 4/13/21, Staff 15 (CG) assigned to work with Resident 3 on day shift, stated she emptied resident's catheter bag "several times during the day", but was unsure if she had noticed a yeast infection under the residents breasts or groin area. Staff 11 (MT) stated she did not apply the Nystatin powder on her shift, so was unaware of the infection. There was no documented evidence the facility consistently monitored the resident's perineum yeast infection, evaluated interventions used to treat the infection for effectiveness, or considered new interventions to address the issue between 1/15/21 and 4/12/21 at the time of survey. This resulted in the condition worsening over time. The need to ensure short term changes of condition were monitored, weekly progress noted, and interventions were reviewed and evaluated for effectiveness was discussed with Staff 1 (Executive Director) and Staff 2 on 4/13/21 and 4/14/21. They acknowledged the findings.
Based on observation, interview and record review, it was determined the facility failed to determine what actions and interventions were needed for 2 of 2 sampled residents (#6 and 7) when they experienced short-term changes of condition and failed to communicate the actions and interventions to staff on each shift; failed to evaluate 1 of 2 sampled resident (#7) who experienced a significant change of condition, refer to the facility RN, document the change and update the service; and failed to monitor changes of condition through resolution. Resident 7 experienced significant weight loss and gain. This is a repeat citation. Findings include, but are not limited to:1. Resident 7 was admitted to the facility in February 2020 with chronic kidney disease. Review of Resident 7's 6/13/21- 9/7/21 progress notes, service plans, temporary service plans, physician orders and communications and weight records revealed the following: a. Resident 7's documented weight went from 155 lbs on 6/18/21 to 147.2 on 7/21/21. This constituted a 5.03% weight loss in one month which was significant. Resident 7 was hospitalized from 7/28/21 for a right total hip replacement and returned to the facility on 8/1/21. His/her documented weight was 148 lbs on 8/2/21. An 8/11/21 RN assessment related to the 7/21/21 significant weight loss was documented in the progress notes. The RN stated, "No further interventions indicated at this time as the weight is stable x 3 weeks." The last documented weight on record was on 8/2/21 and the RN assessment did not indicate a current weight for the resident. Resident 7's weight on 8/13/21, two days after the RN assessment, was 136.2 pounds, which constituted an 11.8 pound or 7.97 % weight loss since 8/2/21, which is considered severe, and an 18.8 pound or 12.13% weight loss since 6/18/21. There was no documented evidence the facility evaluated the resident, determined what actions and interventions were needed for the resident, updated the service plan and referred the resident to the facility RN when the resident experienced continued weight loss. Resident 7's documented weights subsequent to 8/13/21 were as follows: *8/20/21 138.4, + 2.2 pounds;*8/25/21 142.8, + 4.4 pounds;*8/27/21 146.8, + 4 pounds; and*9/3/21 146.8. The above weight gain constituted a total 10.6 pounds or 7.8% of his/her body weight between 8/13/21 and 8/27/21. There was no documented evidence the facility evaluated the resident, determined what actions and interventions were needed for the resident, updated the service plan and referred the resident to the facility RN when the resident experienced the weight gain. Staff 19 (CG), reported during an interview on 9/8/21 that Resident 7 was in a lot of pain and "did not eat much" after his/her return from the hospital for hip replacement surgery on 8/1/21. Staff 19 reported the resident's appetite improved when her pain diminished and is eating well.b. Resident 7 experienced multiple short-term changes of condition related to skin and edema which were not monitored through resolution. The failure of the facility to evaluate the resident when s/he experienced significant changes of condition related to weight, to determine what actions and interventions were needed, refer the resident to the facility RN, update the service plan and monitor changes of condition through resolution was discussed with Staff 1 (ED) and Staff 2 (RN) on 9/8/21. They acknowledged the findings. 2. Resident 6 was admitted to the facility in April 2021 with diagnoses including Alzheimer's Disease. Review of the resident's 6/13/21 through 9/7/21 progress note, service plans, temporary service plans and physician communications revealed the resident experienced multiple short-term changes of condition without documented monitoring until resolution and/or resident specific directions to staff in the following areas:* Medication changes;* Urinary urgency;* 7/24/21 fall;* Increase in episodes of crying; and* Decreased food intake. The need to provide clear instruction to staff on all shifts when residents experience short-term changes of condition and monitor the changes through resolution was discussed with Staff 1 (ED), Staff 2 (RN) on 9/8/21. They acknowledged the findings.
Plan of Correction:
OAR 411-054-0040(1-2) Change of Condition and Monitoring.1. Resident #3 - HWD assessed for yeast infection and put skin integrity note in place. At time yeast infection is resolved. 4/14/212. Staff will document skin condition with Skin Report Cards and Shower Schedule per policy. HWD will provide a weekly skin assessment for all residents added to skin Management System until resolved.3. Skin report Cards and Open Area Flow Sheets - Skin management Reports will be reviewed by HWD and ED at Daily Clinical Meeting.4. Responsible Parties: HWD, ED, or designee.This community will be in compliance by 5/15/21OAR 411-054-0040(1-2) Change of Condition and Monitoring.1. Resident #7 - HWD assessed for weight loss and completed sig change of condition and update plan for monitoring and TSP in place for meal monitoring. Placed on nutrition at risk and weekly weights. Resident #6 - ED completed a COC service plan with clear instructions for staff regarding medication changes, crying and urinary frequency, food intake, redirections.2. Weekly weights will be reviewed weekly by ED for changes and HWD will complete and significant changes assessment.3. Weekly weights and alert charting will be reviewed by HWD and ED at Daily Clinical Meeting.4. Responsible Parties: HWD, ED, or designee.This community will be in compliance by10/1/21