Inspection Findings:
2. Resident 4 was admitted to the facility in 11/2022 with diagnoses including dementia and chronic obstructive pulmonary disease. Observations of the resident, interviews with staff, and review of the resident's clinical record, including a review of the most recent service plan, dated 07/29/23, and intermittent service plans, showed the service plan was not reflective of the resident's current care needs and did not provide clear direction to staff in the following areas: * Increased confusion, hallucinations, and wandering; * An overall decline in physical health and an increase in ADL care needs;* Specific times of day for incontinent care;* Nutritional status;* Oxygen therapy care instructions;* Interventions to minimize falls; and* Specific evacuation instructions.The need to ensure resident service plans were reflective of current care needs and provided clear direction to staff was discussed with Staff 2 (Associate ED), Staff 3 (Wellness Nurse LPN) and Staff 16 (Health Services Technician) on 08/11/23. They acknowledged the findings. 3. Resident 5 was admitted to the facility in 03/2023 with diagnoses including Type 2 diabetes, and chronic pancreatitis.Observations of the resident, resident and staff interviews, and review of the resident's clinical record, including a review of the most recent service plan dated 08/04/23 and intermittent service plans, showed the service plan was not reflective of the resident's current care needs and did not provide clear direction to staff in the following areas: * Treatment instructions for pelvic fracture; * Mental health status and interventions for challenging behaviors;* Level of assistance needed with ADLs;* Frequency of incontinent episodes;* Interventions to prevent falls;* Skin condition and treatment;* Specific instructions for monitoring hypoglycemia and hyperglycemia; and* Status of alcohol use.The need to ensure service plans were reflective of current care needs and included clear directions to staff was discussed with Staff 2 (Associate ED), Staff 3 (Wellness Nurse LPN) and Staff 16 (Health Services Technician) on 08/11/23. They acknowledged the findings.
Based on observation, interview, and record review, it was determined the facility failed to ensure service plans were reflective of residents' current care needs and provided clear directions to staff regarding the delivery of services for 4 of 5 sampled residents (#s 3, 4, 5, and 6) whose service plans were reviewed. Findings include, but are not limited to:1. Resident 3 was admitted to the facility in 09/2022 with diagnoses including atrial fibrillation, anticoagulation monitoring, chronic diastolic (congestive) heart failure, and macular degeneration.Observations were made of the resident's care on 08/10/23. Interviews with facility staff and Witness 1 (Family) were conducted. The current service plan dated 05/18/23 was reviewed. Witness 1 (Family) accompanied the resident every day for approximately four to five hours to assist with ADLs, as well as daily taking of vital signs and weight.Resident 3's service plan was not reflective of the resident's current needs and lacked clear instructions to staff in the following areas:* Presence of depression, thought disorders, behavioral and mood problems;* Toileting;* Hearing and use of assistive devices;* Dental status; * Personality, including how the person copes with change or challenging situations;* Non-pharmaceutical interventions for pain, including how a person expresses pain or discomfort;* Instructions for bleeding precautions and interventions while on Coumadin; * Oxygen equipment precautions and instructions for proper maintenance;* Delivery of services during hours when family members were not present; and* Skin condition.The need to ensure the service plan reflected the resident's current needs and provided clear instructions to staff regarding delivery of services was reviewed with Staff 1 (ED), Staff 2 (Associate ED), and Staff 3 (Wellness Nurse LPN) on 08/11/23 at 11:40 am. They acknowledged the findings. No further information was provided.
4. Resident 6 was admitted to the facility in 06/2023 with diagnoses including Type 2 diabetes, cellulitis of right lower limb, and right humerus fracture.Observations of the resident, interviews with staff, and review of the resident's clinical record, including a review of the most recent service plan, dated 07/17/23, and intermittent service plans, showed the service plan was not reflective of the resident's current care needs and did not provide clear direction to staff in the following areas: * Safety checks;* Assistive devices used for ambulation and level of assist needed on outdoor surfaces;* Assistance with "TED hose and/or tubigrip";* Instructions for bleeding precautions while on Coumadin; and* Outside providers, including HH RN and PT services being provided.The need to ensure service plans were reflective of current care needs and provided clear direction to staff was discussed with Staff 1 (ED), Staff 2 (Associate ED) and Staff 3 (Wellness Nurse LPN) on 08/11/23. They acknowledged the findings.
2. Resident 10 was admitted to the facility in 04/2018 with diagnoses including acute gout attack, arthritis, and Diabetes Type II.Interviews with caregivers indicated the most current service plan available to staff was dated 04/28/23. Observations and interviews conducted between 12/11/23 and 12/13/23 revealed Resident 10's service plan did not provide clear instruction to staff in the following areas:* Lactose intolerance;* Home health PT/OT services; and* Use of a leg immobilizer.The need to ensure service plans were readily available to staff, were updated quarterly, were reflective of the identified needs of the resident, and provided clear direction to staff was discussed with Staff 1 (ED) on 12/13/23. She acknowledged the findings.3. Resident 12 was admitted to the facility on 08/18/23 with diagnoses including dementia, malnutrition, and perianal cyst.Interviews with caregivers on 12/11/23 indicated the most current service plan available to staff was dated 08/18/23. Review of the service plan showed staff had reviewed and signed the service plan from 08/18/23 through 12/08/23.Observations and interviews conducted between 12/11/23 and 12/13/23 revealed Resident 12's service plan was not reflective and did not provide clear instruction to staff in the following areas:* Hospice services;* Wound care;* Order for mechanical soft diet;* Monthly weights and nutritional supplements; and* Use of a walker.The need to ensure service plans were readily available to staff, were reflective of the identified needs of the resident, were updated quarterly, and provided clear direction to staff was discussed with Staff 1 (ED) on 12/13/23. She acknowledged the findings.
Based on observation, interview, and record review, it was determined the facility failed to ensure resident service plans were updated, reflective of resident needs, were readily available to staff, and provided clear direction to staff regarding the delivery of services for 3 of 4 sampled residents (#s 10, 12, and 14) whose service plans were reviewed. This is a repeat citation. Findings include, but are not limited to:1. Resident 14 was admitted to the facility in 05/2023.During an interview with Staff 25 (CG) on 12/12/23, s/he stated Resident 14 used their wheelchair to self-propel inside facility. Previously they used a walker. There was no specific information on the service plan regarding Resident 14's change in mobility.The staff were using a service plan that was dated 06/20/23. The resident's service plan was not reflective of the resident's current needs and did not provide clear direction to staff in the following area:* Ambulation.The need to ensure service plans were updated quarterly, were reflective, and provided clear direction to staff was discussed with Staff 1 (ED) on 12/12/23. She acknowledged the findings.
Based on observation, interview, and record review, it was determined the facility failed to ensure the current resident service plans were readily available to staff and provided clear direction to staff regarding the delivery of services for 2 of 2 sampled residents (#s 1 and 15) whose service plans were reviewed. This is a repeat citation. Findings include, but are not limited to:1. Resident 1 moved into the facility in 06/2022 with diagnoses including atrial fibrillation. Resident 1 was reported to have pressure wounds to his/her buttocks.a. Progress notes reviewed included documentation of the resident's pressure wounds identified on 01/24/24 and monitored through 02/28/24. Staff documented on 01/28/24 the bandage covering the wound(s) needed "to be changed after each" bowel movement. During an interview on 03/07/24, Staff 16 (MT) and Staff 19 (MT) were asked about instructions to staff regarding changing of the bandage. Staff 16 confirmed MT's changed the bandage as needed if it was soiled but was unable to locate directions for staff to follow regarding the bandage changes.b. The "service plan binder" direct care staff reportedly used to access the resident service plans was reviewed on 03/06/24. Resident 1's service plan in the binder was last updated 04/24/23. The 04/23 service plan available to staff did not include information in the following areas:* Evacuation needs in the event of an emergency; and* Turning and positioning in bed/chair.On 03/06/24, Staff 1 (ED) provided a copy of a more recent service plan for Resident 1, last updated 01/16/24. The 01/16/24 service plan was not included in the service plan binder available to staff.The need to ensure service plans were readily available to staff and provided clear direction regarding the delivery of services was discussed with Staff 1 (ED), Staff 37 (Associate ED), Staff 38 (RN) and Staff 39 (MCC Director) on 03/07/24. They acknowledged the findings.
2. Resident 15 was admitted to the facility in 02/2021 with diagnoses including shortness of breath. The resident's service plan dated 05/11/23, temporary service plans, and physician orders dated 03/01/24 were reviewed, observations were made, and interviews were conducted. The following was identified:a. The service plan did not provide clear direction regarding the delivery of services in the following area:* Oxygen use when the resident was outside of his/her room.b. The "service plan binder" direct care staff reportedly used to access the resident service plans was reviewed on 03/06/24. Resident 2's service plan in the binder was last updated 05/11/23. The service plan available to staff did not include information in the following areas:* Ambulation;* Call pendant use;* Cueing and redirection due to dementia;* Eating/meals;* Fall risk;* Housekeeping;* Laundry;* Leisure Activity;* Monitoring physical/behavioral conditions or symptoms;* Pain management;* Personal hygiene/oral care;* Repositioning;* Impaired skin integrity;* Treatments; and* Evacuation needs in the event of an emergency.On 03/06/24, Staff 1 (ED) provided a copy of a more recent service plan for Resident 1, last updated 12/01/23. The 12/01/23 service plan was not included in the service plan binder available to staff.The need to ensure the service plan provided clear direction regarding the delivery of services and was available to staff was discussed with Staff 1, Staff 37 (Associate ED), and Staff 39 (MC Director) on 03/07/24. They acknowledged the findings. C 260: OAR 411-054-0036 (1-4) Service Plan: General1. DHS-RN and ALD will complete all service plans to reflect any changes and clear directions for staff through TSPs, orders, diagnosis, and significant change in conditions. All service plans will be printed, signed, and placed in charts with staff copies within access to all care staff in the "service plan binder".Resident 1: Service plan is up to date, reflective of changes, and provides clear direction for resident care. Updated service plan available to staff. Resident 15: Service plan has been updated and provides clear direction for resident care. Updated service plan available to staff. 2. Training will be provided to ALD, HSA, DHS-RN or designee in person centered care planning and chart reviews.3. Quarterly and as significant changes occur4. ED, DHS-RN, ALD, and designee
Based on interview and record review, it was determined the facility failed to ensure resident service plans were accurate, provided clear direction to staff regarding the delivery of services, and were reviewed and updated after a change of condition for 1 of 2 sampled residents (#18). This is a repeat citation. Findings include, but are not limited to:Resident 18 moved into the facility in 11/2022 with diagnoses including aortic valve stenosis. The "service plan binder" direct care staff used to access the resident service plans was reviewed on 05/13/24. Resident 18's service plan in the binder was dated 04/15/24. Review of the 04/15/24 service plan available to staff, interim service plans (ISPs), home health notes and interviews with Staff 17 (Med Tech) and Staff 12 (Caregiver/Med Tech) indicated the service plan did not include current information, instructions for staff, or ISPs in the following areas:* Treatments and interventions for Stage II pressure ulcers;* Use of a pressure relief cushion;* Home Health nursing, occupational, and physical therapy services;* Fall prevention interventions and fall risk; and* Assistance required for incontinence care and toileting.The need to ensure service plans were updated to reflect current status, were readily available to staff and provided clear direction regarding the delivery of services was discussed with Staff 37 (Executive Director), Staff 38 (RN), and Staff 43 (Director of Assisted Living) on 05/15/2024. They acknowledged the findings.
1. Resident 18's service plan have been updated to ensure it is reflective of their conditions and services. Caregiver instructions have been added for Resident 18's service plan to reflect routine as it pertains to outside providers, any interventions in place, and specific instructions as related to certain ADLs. For outside providers, additions include who is providing the services, how often they visit the community, what they do when they visit the community, what direct care staff should be doing between visits, and how to contact the outside agency if there are questions to be asked. All resident service plans will be audited using this knowledge and updated as needed.2. We will correct this system by ensuring that we include all aspects of the resident's care in their service plan, including those through outside providers. All service plan updates will be added to the ISP binder for staff review and should be initialed and dated by all staff members. These will stay in place until the issue resolves or will be added to the permanent service plan if this is the resident's new baseline during their quarterly service plan review.3. This new system will be evaluated quarterly. Following our weekly quality assurance meetings, if there are any changes to a resident's care that affects their service plan, an ISP will be implemented. This will be done to ensure accuracy and timeliness as related to resident changes.4. The Executive Director, Associate Executive Director, Assisted Living Director, Health Services Director, and Administrator or designee will be responsible for making sure these corrections are implemented and monitored.
Plan of Correction:
1. Review existing resident service plans for content and revise for compliance to include specific instruction for care as evidenced in resident assessment. Ensure pre-admission service plans are thorough and compliant before resident is admitted.Resident 3 service plan was updated to ensure the current needs of the resident and to give clear instruction and direction to caregivers; including Presence of depression, thought disorders, behavioral and mood problems;Toileting;Hearing and use of assistive devices;Dental status;Personality, including how the person copes with change or challenging situations;Non-pharmaceutical interventions for pain, including how a person expresses pain or discomfort; Instructions for bleeding precautions and interventions while on Coumadin; Oxygen equipment precautions and instructions for proper maintenance; Delivery of services during hours when family members were not present; and Skin condition.Resident 4 service plan was updated to ensure the current needs of the resident and to give clear instruction and direction to caregivers; including Increased confusion, hallucinations, and wandering; An overall decline in physical health and an increase in ADL care needs; Specific times of day for incontinent care; Nutritional status; Oxygen therapy care instructions;Interventions to minimize falls; and Specific evacuation instructions.Resident 5 service plan was updated to ensure the current needs of the resident and to give clear instruction and direction to caregivers;including Treatment instructions for pelvic fracture; Mental health status and intervention for challenging behaviors; Level of assistance needed with ADLs; Frequency of incontinent episodes; Interventions to prevent falls; Skin condition and treatment; Specific instructions for monitoring hypoglycemia and hyperglycemia; and Status of alcohol use Resident 6 service plan was updated to ensure the current needs of the resident and to give clear instruction and direction to caregivers; including safety checks;assistive devices used for ambulation and level of assist needed on outdoor surfaces; assistance with "TED hose", outside provider HH RN and HH PT serivcesResident 6 that is on Anticoagulation therapy will have a notation in their service plan and evaluation. This will include instructions to monitor for risk of bleeding, a detailed description of the medication, who provides and coordinates therapy, and instructions on who to notify for any changes. 2. Facility will ensure service plan aligns with assessment in electonic system (AL Advantage).3. For pre-admission, prior to resident moving in and again at the required 30 days. At time of any change of condition/reassessment/any other change as required per resident care team/family/POA/etc.4. Director of Health Services, Health Services Assistant, Wellness Nurse, AED, ED. o C 260: OAR 411-054-0036 (1-4) Service Plan: General1. DHS, ALD, CFLD, RN to will complete all service plans to reflect any changes through ISPs, orders, diagnosis, and significant change in conditions. All service plans will be printed, signed and placed within access to all care staff.2. MBK to provide training to ALD, HSA, DHS in person centered care planning and chart reviews.3. Quarterly and as significant changes occur4. ED, DHS, ALD, HSA, and designee C 260: OAR 411-054-0036 (1-4) Service Plan: General1. DHS-RN and ALD will complete all service plans to reflect any changes and clear directions for staff through TSPs, orders, diagnosis, and significant change in conditions. All service plans will be printed, signed, and placed in charts with staff copies within access to all care staff in the "service plan binder".Resident 1: Service plan is up to date, reflective of changes, and provides clear direction for resident care. Updated service plan available to staff. Resident 15: Service plan has been updated and provides clear direction for resident care. Updated service plan available to staff. 2. Training will be provided to ALD, HSA, DHS-RN or designee in person centered care planning and chart reviews.3. Quarterly and as significant changes occur4. ED, DHS-RN, ALD, and designee1. Resident 18's service plan have been updated to ensure it is reflective of their conditions and services. Caregiver instructions have been added for Resident 18's service plan to reflect routine as it pertains to outside providers, any interventions in place, and specific instructions as related to certain ADLs. For outside providers, additions include who is providing the services, how often they visit the community, what they do when they visit the community, what direct care staff should be doing between visits, and how to contact the outside agency if there are questions to be asked. All resident service plans will be audited using this knowledge and updated as needed.2. We will correct this system by ensuring that we include all aspects of the resident's care in their service plan, including those through outside providers. All service plan updates will be added to the ISP binder for staff review and should be initialed and dated by all staff members. These will stay in place until the issue resolves or will be added to the permanent service plan if this is the resident's new baseline during their quarterly service plan review.3. This new system will be evaluated quarterly. Following our weekly quality assurance meetings, if there are any changes to a resident's care that affects their service plan, an ISP will be implemented. This will be done to ensure accuracy and timeliness as related to resident changes.4. The Executive Director, Associate Executive Director, Assisted Living Director, Health Services Director, and Administrator or designee will be responsible for making sure these corrections are implemented and monitored.