MERCY HEALTHCARE AND REHABILITATION CENTER
Facility Name I.D. Number: 0025940
19000 Halsted St.
Homewood, Illinois 60430
Survey Date: 9/13/00
The facility shall notify the resident's physician of any accident, injury, or significant change in a resident's condition that threatens the health, safety or welfare of a resident, including, but not limited to, the presence of incipient or manifest decubitus ulcers or a weight loss or gain of 5 percent or more within a period of 30 days. The facility shall obtain and record the physician's plan of care for the care or treatment of such accident, injury or change in condition at the time of notification.
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.
General nursing care shall include at a minimum the following and shall be practiced on a 24-hour, seven-day a week basis.
Objective observations of changes in a resident's condition, including mental and emotional changes, as a means for analyzing and determining care required and the need for further medical evaluation and treatment shall be made by nursing staff and recorded in the resident's medical record.
AN OWNER, LICENSEE, ADMINISTRATOR, EMPLOYEE OR AGENT OF A FACILITY SHALL NOT ABUSE OR NEGLECT A RESIDENT.
These requirements are not met as evidenced by:
Based on staff and physician interview, clinical record, policy (on change of condition), the shower flow sheets, and 3-11 shift assignment sheets review, facility staff failed to report and follow-up in a timely manner on R1's change of condition of a noted open draining wound of the upper aspect of the right breast. This failure to provide necessary care and treatment resulted in R1's medical condition deteriorating and eventually leading to a right mastectomy in August 2000.
Findings as follows:
Review of R1's clinical record revealed DOB 8/08/22 and admission date of 9/30/98 with diagnoses of History of Melanoma, Senile Dementia and Cataract. R1's assessment dated 7/13/00 revealed R1 to be independent in all Activities of Daily Living, continent of bowel and bladder and independent in cognitive skills.
Interview of facility staff and Z1 revealed R1 to be a very private and shy resident, often refusing staff to shower her or Z1 to examine her.
Interview of E8 on 9/06/00 revealed she noticed a palpable bluish-purple nodule on R1's right breast in March 2000 during R1's scheduled 7-3 shift shower. E8 reported this finding to E9. In June 2000 again during a scheduled 7-3 shower, E8 noticed an open draining wound on R1's right breast in the same spot she had noted and reported the palpable discolored nodule several months before. E8 reported this wound to E9 again. There is no documentation to prove E9 passed this information on or followed-up to provide R1 necessary care and treatment in March or June.
Review of R1's clinical record, shower flow sheet, and interview of E1 and E2 revealed on 8/10/00 at 6 a.m., shower team staff observed a 2x3 cm open and draining wound on the upper aspect of the right breast. The wound was 0/5 cm deep. Z1 was notified at 2 p.m. on 8/10/00. Z1 did not observe and examine R1 until 8/14/00 at 8:30 p.m. Z1 noted in the physician progress notes, large deep mass right breast most likely Ca of Breast, will consider treatment and radiation. On 8/14/00 Keflex 500 mg every 6 hours times 2 weeks was ordered. On 8/16/00 an order to cleanse right breast with normal saline solution and apply dry protective dressing was noted.
Interview of Z2 on 9/06/00 revealed R1 had a breast biopsy on 8/22/00 at St. James Hospital.
Review of Bone Scan and blood work up-dated 8/22/00 at St. James Hospital revealed: sclerosis of left scapula and cortical thickening compatible with Paget's Disease, diagnosis right breast mass.
Interview of E1 on 9/06/00 revealed E9 was terminated from the facility on 9/05/00 due to lack of resident assessment, reporting and follow-up for R1's change of condition in order to provide necessary quality care and treatment.
Interview of Z1 on 9/06/00 revealed he was not notified by facility staff of R1's change of condition until 8/10/00.
Interview of Z1 on 9/06/00 revealed R1 had a Right Simple Mastectomy on 8/29/00 at St. James Hospital for cancer of the right breast.