Pruitthealth- Dillon

Review of R55's Face Sheet revealed R55 was admitted to the facility on [DATE], with diagnoses including but not limited to: respiratory syncytial pneumonia, sleep apnea, type 2 diabetes, and muscle weakness.

Review of R55's Quarterly MDS with an Assessment Reference Date (ARD) of 06/05/24, revealed R55 had a Brief Interview for Mental Status (BIMS) score of 15 out of 15, which indicates that R55 is cognitively intact.

Further review of the Quarterly MDS revealed that R55 utilizes oxygen as a special treatment.

Review of R55's Physician Order Report dated 05/21/24 - 06/21/24, revealed R55 had an order for oxygen with a start date of 05/16/24, at 2 liters/minute via nasal cannula as needed.

Review of R55's Care Plan revealed R55 no care plan or interventions related to oxygen or oxygen usage.

During an interview on 06/18/24 at 11:30 AM, R55 revealed they were unsure of the last time the facility spoke with her about her plan of care/care plan meetings.

During an interview on 06/21/24 at 10:36 AM, Licensed Practical Nurse (LPN)4 verified that R55 had not been care planned and has no intervention for oxygen use in her Electronic Medical Record (EMR) at this time. LPN4 stated that according to the EMR, R55's last care plan conference occurred on 03/04/24 and a quarterly care plan should have taken place on 06/02/24, but was unable to verify that it occurred.

425113

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 425113 B.

Wing 06/21/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Pruitthealth- Dillon 413 Lakeside Court Dillon, SC 29536