Other·September 13, 2021

F580 §483.10(g)(14) Notification of Changes. (i) A facility must immediately inform the resident; consult with the resident's physician; and notify, consistent with his or her authority, the resident representative(s) when there is- (A) An accident involving the resident which results in injury and has the potential for requiring physician intervention; (B) A significant change in the resident's physical, mental, or psychosocial status (that is, a deterioration in health, mental, or psychosocial status in either life-threatening conditions or clinical complications); (C) A need to alter treatment significantly (that is, a need to discontinue an existing form of treatment due to adverse consequences, or to commence a new form of treatment); or (D) A decision to transfer or discharge the resident from the facility as specified in §483.15(c)(1)(ii). (ii) When making notification under paragraph (g)(14)(i) of this section, the facility must ensure that all pertinent information specified in §483.15(c)(2) is available and provided upon request to the physician. (iii) The facility must also promptly notify the resident and the resident representative, if any, when there is- (A) A change in room or roommate assignment as specified in §483.10(e)(6); or (B) A change in resident rights under Federal or State law or regulations as specified in paragraph (e)(10) of this section. (iv) The facility must record and periodically update the address (mailing and email) and phone number of the resident representative(s). § 72311. Nursing Service - General (a) Nursing service shall include, but not be limited to, the following: (3) Notifying the attending licensed healthcare practitioner acting within the scope of his or her professional licensure promptly of: (B) Any sudden and/or marked adverse change in signs, symptoms or behavior exhibited by a patient. § 72311. Nursing Service - General (b) All attempts to notify licensed healthcare practitioners acting within the scope of his or her professional licensure shall be noted in the patient's health record including the time and method of communication and the name of the person acknowledging contact, if any. If the attending licensed healthcare practitioner acting within the scope of his or her professional licensure or his or her designee is not readily available, emergency medical care shall be provided as outlined in Section72301(g). The facility failed to follow the aforementioned regulations when the facility failed to notify the physician after Resident 1 fell, which resulted in Resident 1 having treatment for a broken hip delayed for 13 hours and 36 minutes, and exhibiting signs of pain and discomfort. During a review of Resident 1's facility document titled, "Face Sheet," the Face Sheet indicated Resident 1 was admitted to the facility in 2019. During a review of Resident 1's Minimum Data Set (MDS, a resident assessment tool use to guide care) dated 2/9/21, the MDS indicated Resident 1 had a score of six on the Brief Interview for Mental Status exam. (BIMS, a scoring system used to determine the resident's cognitive status regarding attention, orientation, and ability to register and recall information. A BIMS score of thirteen to fifteen is an indication of intact cognitive status; a score of six is an indication of severe impairment.) The MDS indicated Resident 1's preferred language was Spanish, and she needed/wanted an interpreter for communication with health care staff but was able to make herself understood using verbal and nonverbal expression. The MDS also indicated Resident 1 was unsteady during transfer and required total assistance from two or more staff for transfer between surfaces. During an interview on 2/23/21 at 1:35 p.m., with Certified Nursing Assistant 3 (CNA 3), CNA 3 stated on the evening shift (3 p.m. to 11:30 p.m.) of 2/16/21, she was assigned to care for Resident 1. CNA 3 stated before dinner on that evening, CNA 3 saw Resident 1 take off her blankets, and move her feet off the bed toward the floor. CNA 3 stated LVN 3 responded to her calls for assistance, and the two of them were able to control Resident 1's descent to the floor at the side of Resident 1's bed. During an interview on 2/25/21 at 3:44 p.m., with LVN 3, LVN 3 stated on 2/16/21, Resident 1 had been restless; Resident 1 had pointed to the floor mat "as if she wanted to go to the floor," and tried to climb out of bed. LVN 3 stated he and a certified nursing assistant "eased" Resident 1 to the floor mat. LVN 3 stated he was not familiar with Resident 1, as he usually worked in a different unit. LVN 3 further stated he documented the "eased down" incident two days after the event occurred. During a review of Resident 1's Physical Therapy (PT) Treatment Encounter Notes, by Physical Therapist Assistant 1 (PTA 1), dated 2/16/21 at 7:24 p.m., the Encounter Notes indicated Resident 1 had complained of hip pain, and held her right hip while lying on the floor mat next to her bed. The notes reflected Resident 1 was unable to do physical therapy tasks, so physical therapy was not done the evening shift of 2/16 21. The notes reflected PTA 1 had reported Resident 1's condition to Licensed Vocational Nurse 3 (LVN 3). During a review of Resident 1's nursing Progress Notes dated 2/16/21 at 3 p.m., to 2/17/21 at 7:30 a.m., there were no documented pain assessments, no documentation of Resident 1's assisted fall to the floor, no documentation that PTA 1 had reported to nursing staff that Resident 1 seemed to be in pain. The notes further indicated an entry dated 2/19/21 at 5:32 p.m., as a late entry for 2/16/21 at 4:50 p.m., by LVN 3, "Resident 1 eased herself down the Charge Nurse from her bed to the impact pad, gave gesture that she wanted to be on the floor." During an interview on 2/25/21 at 2:24 p.m., with Physical Therapist Assistant 1 (PTA 1), PTA 1 stated he had gone to Resident 1's room to provide physical therapy around dinner time on 2/16/21. PTA 1 stated he found Resident 1 lying on the fall mat next to her bed, holding her hip and grimacing. PTA 1 stated Resident 1 appeared to be in pain, so he left the room and told Licensed Vocational Nurse 1 (LVN 1) that Resident 1 was on the floor, on the fall mat, and seemed to be in pain. LVN 1 accompanied PTA 1 back to Resident 1's room, and they transferred Resident 1 back into bed. PTA 1 stated he attempted to perform sit-to-stand exercises with Resident 1, but she refused to participate and kept rubbing her right hip. PTA 1 stated he left Resident 1's room and again told LVN 1 that Resident 1 seemed to be in pain. LVN 1 told him she was not in charge and he should make his report to Licensed Vocational Nurse 2 (LVN 2). PTA 1 stated he then told LVN 2 about Resident 1's pain, but LVN 2 told him she was not Resident 1's nurse, and she had referred him to LVN 3. PTA 1 stated he found LVN 3 and reported he had found Resident 1 on the floor, and she appeared to be in pain, as she was holding her right hip, and refused to do physical therapy. PTA 1 stated LVN 3 told him Resident 1 preferred to lay on the floor mat. During an interview on 2/25/21 at 3:44 p.m., with LVN 1, LVN 1 confirmed PTA 1 had told him Resident 1 was on the floor fall mat, pointing at her hip, and seemed to be in pain. LVN 1 stated PTA 1 had reported he had not been able to do physical therapy with Resident 1 and thought Resident 1 should have an Xray. LVN 1 stated she told PTA 1 she was currently doing overtime, but only to help with medication administration, and PTA 1 should speak to LVN 2. During a telephone interview on 2/25/21 at 8:29 p.m., Licensed Vocational Nurse 2 (LVN 2) stated she recalled PTA 1 had told her of Resident 1's pain and she referred PTA 1 to LVN 3. During an interview on 2/25/21 at 11:45 a.m., with LVN 3, LVN 3 stated he did not recall PTA 1 reporting Resident 1 was in pain on 2/16/21. During an interview on 2/23/21 at 1:10 p.m., with LVN 2, LVN 2 stated she had gone to Resident 1's room on 2/17/21, between 8 a.m. and 9 a.m., and Resident 1 was screaming in a non-English language and pointing to her back and right hip. LVN 2 stated she called Certified Nursing Assistant 3 (CNA 3) into Resident 1's room to translate. During an interview on 2/23/21 at 1:37 p.m., with Certified Nursing Assistant 1 (CNA 1), CNA 1 stated on 2/17/21 around 9 a.m., LVN 2 called her into Resident 1's room to act as a translator for Resident 1. CNA 1 stated when she entered the room, Resident 1 was screaming words. CNA 1 stated she translated the words as, "I have pain! I have pain!" During a telephone interview on 3/25/21 at 1:45 p.m., with the Director of Nursing (DON), the DON stated Resident 1's pain was first reported to the Nurse Practitioner on 2/17/21. During a review of Resident 1's facility document titled, "Observation Detail List Report," dated 2/17/21 at 6:30 p.m., the Report indicated Resident 1's Nurse Practitioner/Physician was notified 2/17/21 at 9 a.m., that Resident 1 was complaining of "hip pain upon movement." During a review of Resident 1's, "Radiology Order," dated 2/17/21 at 9:00 a.m., the order indicated "stat (immediate or urgent) X-R (x-ray) ..." of both right and left hips, and pelvis. During a review of Resident 1's acute care Hospital Discharge Summary dated 2/19/21, the discharge summary indicated Resident 1 was admitted to the hospital for a right hip fracture on 2/18/21, had surgery of the right hip on 2/18/21, and was discharged back to the facility on 2/19/21. During a telephone interview with Resident 1 and the Language Interpreter Services representative on 3/5/21 at 3:47 p.m. Resident 1 stated she had gone to the hospital, but she was feeling "really bad" and did not want to talk.