For the month of August there were three initial or recertification surveys available for review. 2 of 3 were insufficiency free, while the other received 1 insufficiency. Additionally, there were 9 complaints or incident surveys available for review. 5 resulted in insufficiencies cited with an average of 7.6 per survey and all received a fine. 4 of the 9 didn’t receive insufficiencies. There are numerous survey results that have not been released in the last few months.
Two of the fines were issued for insufficiencies cited under 481-67.2 for not following the program’s policies and procedures. Examples include:
- An incident report wasn’t completed for behavioral issues that resulted in bruising.
- Staff failed to respond to the door alarm alerts which allowed a tenant to leave the program without staff knowledge.
- A tenant fell and complained of pain to their leg. According to the policy if there is reported pain, the tenant would be transported to the ER as well as notify the family and the program nurse. None of those steps were completed and the tenant was later identified to have a fractured femur.
Two of the fines were issued for insufficiencies cited under 481-67.3 when the program staff failed to provide adequate care and services to the tenants. Examples include:
- A tenant utilized home health services for skilled nursing and therapy for wounds and ongoing edema. The home health notes identified on several occasions that staff were provided with instructions to assist with incontinence care timely due to the pressure wounds on the tenant’s buttocks, apply TED hose to help reduce the edema, obtain a wheelchair cushion and walk with the tenant to meals. The task sheets didn’t include applying TED hose or lotion, the directions to have the tenant stand and walk were not included on the task sheets, and the task sheets didn’t identify the directives to increase the frequency of toileting assistance.
- A tenant’s hospice care notes identified that they required assistance for ADLs and had difficulty communicating needs while the program’s assessments indicated the tenant was much more independent. Due to a risk of falls, the hospice program encouraged increased rounding which was not carried through and the task sheets lacked the necessary assistance with mobility. The tenant had multiple falls which resulted in the tenant suffering an acute subdural hematoma and subsequently passing away.
- A tenant was a high risk for falls without fall reduction interventions identified on the service plan. Additionally, the staff failed to document ADL supports on multiple occasions. During staff interviews they reported feeling that the tenant was neglected and confirmed that the family expressed concern about the lack of care. Two other tenants also didn’t receive assistance with ADLs according to the program’s documentation.
Lastly, a fine was issued under 481-67.5 when staff failed to follow the physician’s orders which included multiple tenants. This was cited as staff did not sign out medications as being administered and the MARs lacked documentation of monitoring blood glucose and pain medication effectiveness.
Important notes about insufficiencies that didn’t result in fining:
- With agency staff you need to ensure that you’re completing or have verification of nurse delegation training and competency evaluation. Additionally, ensure that you have documentation of completed background checks for any contracted agency staff.
- Posted notes about tenant’s needs resulted in an insufficiency being cited under tenant rights based on a lack of respect and dignity.
- There was an increased frequency of insufficiencies cited under 481-67.9 for nurse delegation training and competency evaluation including when staff were interviewed and reported to the surveyor that the program nurse just had them sign their packet. There were also examples of a lack of sufficient staff as evidence by delayed response to pendants and failure to complete ADLs according to the task sheets.
- There were also an increased number of insufficiencies cited under 481-69.25 when staff failed to document nurse’s notes by exception.