Willowcrest (December 13th)

Based on facility policies and procedures, review of clinical records and interviews with staff, it was determined that the nursing home failed to consult with the resident’s physician regarding elevated blood sugars for two of 16 residents reviewed. The findings included the following: Review of Resident R54’s clinical record revealed nursing documentation indicating that the resident was admitted to the facility on an unspecified date with an undisclosed diagnosis. Review of facility policy, Bedside Blood Glucose Testing, effective date October 31, 2011, revealed no documentation that the resident’s physician and/or kidney transplant physician or team was notified of elevated levels. Interview with Employee E3 on December 12, 2012, at 1:45 p.m. confirmed these elevated levels should have been reported to the resident’s physician and/or transplant team. Resident CL2 was admitted to the facility on an unspecified date with an undisclosed diagnosis. The physician ordered insulin to be administered through an insulin pump for Resident CL2. The physician also ordered glucometer readings to be taken before meals and at the hour of sleep Clinical record documentation revealed that a glucometer reading was obtained on August 3, 2012 of a blood glucose level of 279 mg/dl. There was no clinical record documentation to indicate that the physician had been notified of the blood glucose level of 279 mg/dl on August 3, 2012. This lack of contact with the physician was confirmed during an interview with the nursing room manager, Employee E4, at 1:00 p.m., on December 13, 2012. According to the facility’s established policies and procedures for the use of insulin pumps, the nursing staff was expected to the contact the physician and temporarily discontinue the insulin pump for glucometer readings above 250 mg/dl.

Based on staff and resident interviews, clinical record review and review of facility policy and procedure, it was determined that the Philadelphia nursing home failed to determine safe self administration of medication for one of 16 residents reviewed. Findings included the following: In an interview with Employee E4, licensed nurse, on December 11, 2012, at 9:15 a.m., revealed that the resident was not assessed by staff for competency of safety using and storing of the medication left at the bedside. An interview with Resident R10 on December 11, 2012 at 10:45 a.m., confirmed that the medication inhaler was at the bedside. Review of the facility’s policy and procedure, Self-Administration of Medication Policy, dated December 21, 2009 and reviewed yearly revealed that the interdisciplinary team would assess the resident prior to self administration of medication for competence and proper storage of the medication.

Based on staff interviews, review of facility policy and procedures and clinical record review it was determined that the facility failed to perform diagnosis screening on admission to the facility for one of the 16 residents interviewed. Findings included the following: Review of Resident R10’s clinical record revealed that the resident was admitted to the facility on an unspecified date and that the resident was not provided with a diagnosis screening to rule out if the resident had an undisclosed diagnosis to prevent the spread of this infection.