I.D. Number 0028985
191 EAST QUEENWOOD ROAD
MORTON, ILLINOIS 61550
Survey Date: 5/18/99
The facility shall have written policies and procedures, governing all services provided by the facility which shall be formulated by a Resident Care Policy Committee consisting of at least the administrator, the advisory physician or the medical advisory committee and representatives of nursing and other services in the facility. These policies shall be in compliance with the Act and all rules promulgated thereunder. These written policies shall be followed in operating the facility and shall be reviewed at least annually by this committee, as evidenced by written, signed and dated minutes of such a meeting.
Every facility shall respect the 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.
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.
These REQUIREMENTS are not met as evidenced by:
Based on observation and record review, the facility failed to ensure that advanced directives recorded would be followed for 1 resident of the selected sample.
Findings include but are not limited to the following:
1) During observation of the noon meal on 05-15-99 at 1:00 p.m. this surveyor observed one resident
approach a staff nurse and stated "a resident needs help". The nurse went immediately to check on R26, who was seated at a dining table in a wheelchair with head hyperextended over back of the wheelchair with an ashen color present to face. The nurse summoned help and immediately pushed R26's wheelchair out of the dining room, down C-wing hallway and then to M-wing room 4.
This was approximately 140 feet from where R26 was seated in the dining room. Two professional nurses transferred R26 to bed and turned to right side. One nurse rubbed R26's back and talked to R26,encouraging the resident to breathe, while the second nurse checked the radial pulse for one minute and then proceeded to check the blood pressure. There was no breathing noted, except for two brief expiratory breaths after being turned on the right side. There was no radial pulse noted and there was no blood pressure reading and the skin color remained ashen to blue with palms of hands very pale. One of the professional nurses stated "R26 is a Do Not Resuscitate." So no steps for cardiac resuscitation were started and/or initiated. By this time approximately eight minutes had elapsed since first noting that R26 was unresponsive and transporting R26 from the main dining room.
At this time this surveyor left room M4 and proceeded back toward the main dining room to resume observations on the selected sample. A supervisor nurse had left the M4 room earlier and had checked the clinical record of R26 and discovered that R26 had signed an advanced directive designating in case of an emergency, to initiate a full code. So this supervisor nurse called the fire department and got the crash cart and proceeded to room M4, where emergency CPR was started on R26. The time lapse between these happenings, the time R26 was first noted to have a problem and when the facility finally determined that R26 requested a full code be done in the case of an emergency was at least 10 minutes, determined by this surveyor checking own personal wristwatch at the time that R26 was first assisted and the time this surveyor left the room M4.
The name plate for Room M4 also had a RED DOT present which designated a DO NOT RESUSCITATE had been chosen by R26.
The designation for CPR for R26 was not accurate at the door of R26's room and the facility failed to inservice professional nurses in regard to which residents were full codes and which were DO NOT RESUSCITATE.