ASTA CARE CENTER OF ROCKFORD
Facility Name I.D. Number 0041772
707 W. Riverside Blvd.
Rockford, IL 61103
Date of Survey 11/1/00
Complaint Investigation
Every facility shall respect residents' right to make decisions relating to their own medical treatment, including the right to accept, reject, or limit life-sustaining treatment. Every facility shall establish a policy concerning the implementation of such rights. Included within this policy shall be:
Procedures for providing life-sustaining treatments available to residents at the facility;
Procedures detailing staff's responsibility with respect to the provision of life-sustaining treatment when a resident has chosen to accept, reject, or limit life-sustaining treatment, or when a resident has failed or has not yet been given the opportunity to make these choices;
The facility shall honor all decisions made by a resident, an agent, or a surrogate pursuant to subsection (c) above and may not discriminate in the provision of health care on the basis of such decision or will transfer care in accordance with the Living Will Act, the Powers of Attorney of Health Care Law, the Health Care Surrogate Act or the Right of Conscience Act (Ill. Rev. Stat. 1991, ch. 111 ½, pars. 5301 et seq.) {745 ILCS 70}.
The facility must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of the resident, in accordance with each resident's comprehensive assessment and plan of care. Adequate and properly supervised nursing care and personal care shall be provided to each resident to meet the total nursing and personal care needs of the resident.
AN OWNER, LICENSEE, ADMINISTRATOR, EMPLOYEE OR AGENT OF A FACILITY SHALL NOT ABUSE OR NEGLECT A RESIDENT. (A, B) (Section 2-107 of the Act)
This REQUIREMENT is not met as evidenced by:
Based on interviews and record review, the facility failed to provide one resident of three residents in the sample with the necessary services and care to sustain life. The facility discontinued all medications and removed the feeding tube for R-1 without the consent of the resident or a representative recognized by Illinois State Law.
Findings include:
Review of R-1's admission face sheet indicates R-1 was readmitted to the facility on 3/10/00. R-1 had the following diagnoses to include: Dysphagia, Peg tube placement (since 3/99), Alzheimer's Disease, Chronic Renal Failure, Insulin Dependent Diabetes and Anxiety.
Review of R-1's Minimum Data Set (MDS) dated 7/5/00 revealed, R-1 was confused to time, place and person with behavioral problems. On 10/26/00 at 12:20 p.m. in E-1's office, E-1 and E-2 were interviewed. Staff stated, "(Z-1) was (R-1's) Power of Attorney for Health Care and the facility notified (Z-1) concerning (R-1's) health care decisions."
Review of the nurses notes revealed:
a) On 3/14/00: Z-1 signed R-1's advance directives documentation form. Review of this form revealed it was only a Do Not Resuscitate statement and was not specific regarding tube feeding, medications and/or IV's.
b) On 6/27/00: R-1's Peg tube was leaking. R-1 was sent to local hospital and the Peg tube was reinserted.
c) On 7/9/00 (1400): R-1 pulled out his Peg tube. R-1 was sent to local hospital and tube reinserted.
On 10/26/00 at 12:20 p.m. in E-1's office, E-2 was interviewed and stated, "I knew that (Z-1) was ill and in the hospital. I read the obituaries each day and I saw (Z-1's) obituary in it. That's how I knew (Z-1) died. I told staff here..." E-1 further stated, "I was under the understanding that (R-1) had no living relatives. We called (Z-1's) attorney after (Z-1) died. I am aware of the Illinois Health Care Surrogate Act."
On 10/26/00, Z-1's obituary dated August 2, 2000 was reviewed and revealed, Z-1 died on July 29, 2000 and Z-1 and R-1 had living relatives and friends in Rockford. Survivors of R-1 include a son, five grandchildren, several great-grandchildren, nieces, nephews and cousins. On 10/26/00 at 10:50 a.m. per telephone, Z-5 was interviewed. Z-5 stated, "If the nursing home asked me to be a representative for (R-1) after (Z-1) died, I would had done it. No one called me from the nursing home...(Z-1) has daughters in this area and they would have also taken over guardianship for (R-1)..."
On 10/26/00 at 1:50 p.m. in the Medical record room, E-5 was interviewed. E-5 stated, "We thought (R-1) had no other living relatives. On 8/30/00, I called (Z-1's) attorney. He told me to call (Z-6). I called (Z-6) and she gave me a name of an attorney which I called. I explained the situation to him and he told me to call the Office of State Guardianship to get a POAH for (R-1). I didn't carry through with it and/or inform (E-1) and (E-2). I was not present at the Ethic Committee meeting on 9/21/00."
Review of the policy on Ethic Committee revealed:
a) Purpose: "To provide for a means of investigating and resolving situations that may involve conflict with the Mission Statement (‘...Providing Superior Quality Services...')
b) The Ethic Committee shall include the following staff members: Administrator, Director of Nursing or designee, Medical director and Social Service Director.
c) ...meet... ‘ when the facility is faced with a situation in which outside sources make a request or demand that directly conflicts with the Mission Statement...'
Review of Z-2's progress note for R-1 dated 9/20/00 revealed, "...Contractures lower extremities bilateral with bed sores on heels. Dementia, Type II Diabetes, CPM (comfort measures)/prognosis guarded, Code DNR...discuss issues with the ethic committee regarding tube feeding"
On 10/26/00 at 3 p.m., Z-2 was interviewed per telephone. Z-2 stated, "The facility asked me about guardianship for (R-1). I told them they needed to look around for next of kin. (R-1) was a very good patient of mine for a long time. I was not his guardian. Once his guardian died, I told the staff to look for the next of kin. I was called about (R-1's) condition. The facility never told me about the need to do surgical intervention concerning (R-1's) legs and/or bed sores. The facility was concerned that (R-1's) condition was deteriorating and felt the feeding tube and medication should be stopped. I saw (R-1) and (ordered) an Ethic Committee review. No, I was not present at meeting..."
On 9/21/00, the Ethic Committee met consisting of Z-7, E-1 and E-2. On 10/30/00 at 11 a.m. in the front office on first floor, E-2 was interviewed and stated, "we met then I called (Z-2). (R-1's) tube feedings were discontinued and all medication except a Duragesic Patch."
Review of R-1's telephone orders dated 9/21/00 at 2:10 p.m. revealed, E-2 wrote telephone orders to: ‘Discontinue (D/C) all meds. D/C tube feeding. Duragesic 25mg. patch change every 72 hours. Comfort measures only'. This telephone order was signed by Z-2.
Review of medication administration record dated 9/21/00 and interview with E-2 (on 10/30/00 at 11 a.m.) revealed, R-1's medications except Duragesic 25mg. patch and tube feedings were discontinued by E-6 and E-7 at approximately 3 p.m. on 9/21/00.
Review of nurses notes dated 9/26/00 at 2010 revealed, "(R-1) had no pulse/heart rate and no breathing. (Z-2) informed of (R-1's) death..."
On 10/26/00 at 12:20 p.m. in E-1's office, E-1 was interviewed and stated, "We have no policy on if a resident's POAH dies..." The facility census on 10/18/00 was 107. Review of the list of all resident residing in the facility revealed, 100 of the 107 residents have POAH.