PARIS HEALTH CARE CENTER
Facility I.D. Number: 0045336
Date of Survey: 09/19/2002
The facility must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psycho-social well-being of the resident, in accordance with each residents 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.
Objective observations of changes in a residents 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 residents medical record.
All necessary precautions shall be taken to assure that the residents environment remains as free of accident hazards as possible. All nursing personnel shall evaluate residents to see that each resident receives adequate supervision and assistance to prevent accidents.
This REQUIREMENT is not met as evidenced by:
Based on observation, record review, and interview the facility neglected to provide care and services in a timely manner by not notifying the physician and family immediately for R8, after R8 became unresponsive, flaccid on the right side with difficulty swallowing. Facility neglected to contact the physician and did not provide emergency treatment for approximately 12 hours. This resulted in the resident not receiving medical attention after suffering a Cerebral Vascular Accident.
According to the admission record, R8 was admitted 04/24/02, with the assessment dated 04/28/02 showing that she needed assist of two for transfer and assist of one to two for ambulation with a rolling walker. R8 was able to feed herself and had no limitation assessed with range of motion. There were no significant changes on the quarterly assessment dated 07/24/02.
Review of the current physician orders dated August, 2002, show that R8 could bear full weight as tolerated and ambulate with walker with one assist and transfer with one assist.
According to the nurses notes dated 09/01/02 at 6:00A.M., R8 was found to be non responsive. Vital signs were taken and the results are as follows: T(temperature) 100.7, P(pulse) 84, R(respirations) 22, B/P (blood pressure) 122/60, and oxygen level was 81%. R8 was also found with the corner of her mouth drooping and the right arm and hand were flaccid. The end of the documentation says, "will monitor closely." There is no indication that the physician was called or the family notified of this significant change. This was verified by interview with E2 (Director of Nursing) on 09/11/02 at approximately 3:45 P.M..
The nurses notes of 09/01/02, document that this monitoring continued throughout the day with the same symptoms until 1:45P.M. when it is documented that Z2 (attending physician) was called with no answer at home. At 2:35, a call was made to Z6 (daughter) and a message was left on the answering machine regarding R8's condition. At 3:30P.M., Z6 arrived at the facility and requested that R8 be taken to the hospital and that the facility should call the physician on call. Z1(on call physician) did give an order to send R8 to the emergency room for an evaluation.
Interview with E2 on 09/11/02 found that, E5 (Licensed Practical Nurse) began working the day shift and received report from E4. E5 continued to monitor R8 and notations made in the nurses notes show that at 9:00A.M. and 1:00P.M., staff tried to feed R8. R8 was on a regular low concentrated sweets diet and at 9:00A.M. the notation states, "let food run out of mouth". Interview with E5 at 3:45P.M. on 09/11/02 found that E5 felt a diet change was needed, so the diet was down graded to low concentrated sweets puree diet. E5 also added thickened liquids. Nurses notes dated 09/01/02 at 1:00P.M. state, "attempted to feed res pureed diet, res let food run back out of mouth."
At 1:45P.M. according to the nurses notes E5 tried to contact Z2 (attending physician) with no answer. At 2:35, a call was placed to Z6 (daughter) and a message was left on the answering machine. Interview with E5 on 09/11/02 found that no physician had been contacted regarding R8's condition even though a designated physician was on call at the time and the facility has an on call list for every day of the month. Z2 was not the physician on call but Z1 (physician), was on call for that day.
Nurses notes state at 4:50P.M. that, "(Emergency service) has not yet arrived, (emergency service) was notified at approximately 3:40P.M.." On 09/11/02, it is noted that interview with Z7 (emergency room nurse) found that R8 did not arrive at the emergency room until 6:00P.M. This was 12 hours after the resident was first noted to have had a change in condition. E2 (Director of Nursing) contacted the emergency service office on 09/11/02 at approximately 3:45P.M. and found that their records show that they were not called until 5:23P.M. and that they picked up R8 for transport at 5:25P.M.
On 09/17/02 at 8:30A.M., interview with Z1 (physician on call in the emergency room on 09/01/02), stated, "I was very furious. The family has a right to be furious also. If (R8) had gotten to the hospital sooner I would have administered TPA, a blood thinner and it may have helped (R8). The CT scan showed that (R8) had a thromboembolic event (blood clot). There is a 3- hour window for treatment with TPA."
Observation of R8 on 09/11/02 showed that R8's right side of the face is drooping and R8 is unable to talk. Interview with Z2 (attending physician) on 09/17/02 at approximately 1:30P.M. found that R8 has paralysis of the right arm and right leg and can't swallow. Z2 stated, "I talked to them about failure to call physician and or family right away."