Titusville Rehabilitation & Nursing Center
TITUSVILLE REHABILITATION & NURSING CENTER in TITUSVILLE, FL — inspection on June 7, 2024.
Found 4 citations. Severity: Standard violations.
Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.
Inspection Findings
Triage RN: I work in a different system and do not have access to that information but I can call the
LPN A: Ok thank you. 6:12 AM Triage places LPN A on HOLD to talk to On Call Nurse (see call below*) 6:15 AM Triage RN returns to state On Call Nurse will need to get access to the chart. On Call Nurse will follow up with a call and will be making a visit with appropriate paperwork if it is there.
LPN A: Well I do not have an actual DNR but I am looking at his hospice book you guys give and under the medicare thing (the election of benefit) it says 'I request no cardiopulmonary resuscitative measures (CPR) at the time of my death.' I mean he is gone at this point so there is nothing I can do anyway. I just need to know whether he is a full DNR or not. 6:17 AM call is ended after long pause between callers. *6:12 AM Triage RN places message to On Call Nurse (our employed LPN) On Call Nurse indicates she needs to be added to the chart to verify code status.
Discussion to the ability to add On Call Nurse, determine she needs to call Point On Call. 6:15 AM On Call Nurse calls point on call to get added to chart.
Looks at attachments and does see a DNR. 6:23 AM On Call Nurse calls LPN A (facility nurse) stating she sees a DNR but LPN A says, our records state full code On Call Nurse let her know she is on the way to the facility to make visit and told LPN A if you know if your records show full code, then continue to do CPR and call 911. 6:32 AM On Call Nurse reads notes and point care alert and see where it does state patient full code.
On Call Nurse called to speak to PCM [Patient Care Manager] to verify and PCM noted in the comments of attachments that patient rescinded DNR. 6:34 AM On Call Nurse called LPN A back to confirm patient was in fact a full code .
After the reading of the transcript the RM said she could not come to a conclusion about what happened because more information was required.
The RM indicated she was not confident to say there was a delay in CPR.
She said the facility's investigation was reopened during the current survey because of discrepancies which demonstrate the investigation was not complete and thorough.
She indicated the facility would be file an immediate report to the State Agency as more/new information had come to light.
105448 06/07/2024
Titusville Rehabilitation & Nursing Center 1705 Jess Parrish CT Titusville, FL 32796
verbalized understanding of the education provided.
jeopardy to resident health or Interviews, and record reviews revealed no concerns for residents #1, #11, #25 and #87 related to safety Advance Directives and code status.
105448 06/07/2024
Titusville Rehabilitation & Nursing Center 1705 Jess Parrish CT Titusville, FL 32796
pertinent details of the code event, including the time the resident was found without pulse and
911 assumed care of the resident.
They stated the code sheet was a tool to aid documentation in the resident's clinical record.
The resident's clinical records were reviewed with the DON, and she acknowledged the progress note documented on [DATE] at 6:29 AM, was the only documentation by nursing staff identified regarding the change in the resident's condition.
On [DATE] at 11:28 AM, and on [DATE] at 11:44 AM, the Corporate Director of Risk Management (RM) stated that in reviewing the incident, the facility identified an opportunity for improved documentation.
The Regional Consultant Nurse stated LPN A verbalized information in her documentation was in error and should have been documented appropriately in the resident's clinical record.
When asked why documentation was not completed, LPN A said she was tired.
The RM stated the facility identified discrepancies on the Code Blue worksheet, documentation in the resident's EMR, hospital records, and the Emergency Medical Services run report.
She acknowledged the facility had a responsibility to ensure documentation was complete and accurate.
Essential duties and responsibilities listed on the Job description for DON dated [DATE] indicated the DON was to ensure, Adherence by staff pertaining to proper documentation of patient care.
Essential duties and responsibilities listed on the Job description for LPN with date of [DATE] included, Maintains accurate, detailed reports and records.
Review of hospice orders for Advance Directive on [DATE] read, Do Not Resuscitate, and a different order dated two days later on [DATE] noted Resuscitate.
Review of Hospice Note Reports dated [DATE], and [DATE] revealed the resident's code status was Full code.
A progress note documented by LPN A, dated [DATE] at 6:29 AM, read, Patient has expired Hospice notified, MD notified.
105448
Form Approved OMB
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.
Building 105448 B.
Wing 06/07/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Titusville Rehabilitation & Nursing Center 1705 Jess Parrish CT Titusville, FL 32796
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Source: This inspection report was downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases nursing home inspection reports in bulk. The findings reflect what state surveyors documented in the official Form CMS-2567 Statement of Deficiencies on the date of the inspection.
Plan of correction not included: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to their state survey agency and those responses may not appear in CMS public data at the time of release. The absence of a plan of correction in this report does not mean one was not filed. Readers who want information about corrective steps taken by the facility are encouraged to contact the facility or their state survey agency directly.
Corrections may have been made: This report reflects conditions observed on the date of the survey. The facility may have implemented staffing changes, additional training, policy revisions, or other corrective actions since this report was issued. We publish what CMS provides and encourage readers to seek current information from the facility.