Nhc Healthcare, Murfreesboro

Review of the referral received by Facility #2 revealed Resident #4's wandering and intrusive behavior and risk for elopement was not documented on the Nursing Summary referral. No discharge summary was provided to Facility #2.

During an interview on 8/1/2024 at 12:08 PM, the NP stated, .[Named Resident #4] wandered and was exit seeking, very ambulatory .a secured unit would have been better for her .

During an interview on 8/1/2024 at 1:00 PM the Administrator was asked if the facility kept a copy of the referral that was sent out on (Named Resident #4).

The Administrator stated, .We don't keep a copy of the referrals we send out .

During an interview on 8/1/2024 at 3:25 PM, SW H stated, .I saw [Named Resident #4] get on elevator behind some visitors .I was not aware the facility [Named Facility #2] did not have locked doors .I was not aware the facility did not have a wanderguard [ankle monitoring] system . SW H was asked if he had any email correspondence with the admission Coordinator at [Named Facility #2] he stated, we only talked by phone about [Named Resident #4].

During an interview on 8/1/2024 at 4:07 PM, the Administrator stated, .She [Named Resident #4] was always on the 2nd floor .she never got on the elevator .It was my understanding that [Named Facility #2] had a secured unit .

The Administrator was asked does she feel Resident #4 had a safe transfer considering the facility did not have a secured unit.

The Administrator stated, .I still feel it would be better for her .

During an interview on 8/2/2023 at 8:40 AM, the Medical Director (MD) stated, .[Named Resident #4] was transferred to another facility where I make visits also [Named Facility #3] .

The MD was asked why Resident #4 had to be transferred to (Named Facility #3). MD stated, .she needed to be in a locked memory unit the previous settings were not appropriate for her needs .

445108 08/02/2024

Nhc Healthcare, Murfreesboro 420 N University St Murfreesboro, TN 37130

Review of the medical record revealed Resident #4 was admitted to the facility on [DATE] and readmitted on [DATE], with diagnoses which included Dementia, Obsessive-compulsive disorder, Unspecified Psychosis, Depression, Alcohol Dependence with alcohol-induced persisting Dementia, Anxiety Disorder, and Pseudobulbar affect. Resident #4 was discharged on 7/27/2023.

Review of the Quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #4 had a Brief Interview for Mental Status (BIMS) score of 4, which indicated severe cognitive impairment.

Review of Resident #4's Comprehensive Care Plan, with revision date 5/31/2023, revealed no discharge plan.

Review of the Psychiatric Nurse Practitioner (NP) Progress Notes for Resident #4, revealed, .6/9/2023 .Chronic pacing .Due to severity of cognitive deficits, her behaviors will most likely progress/worsen as her overall condition declines.

Redirection or patient education is not effective due to her cognition and inability to recall information .Prognosis is guarded and she may eventually need placement in a memory care unit or a geriatric behavioral nursing facility .

Review of the Care Conference Report for Resident #4, dated 7/20/2023, revealed, .Care Plan meeting held today.

Present were Social Work, Nurse Manager, Dietician, and participating by telephone was patient's daughter .Patient's behavior was discussed and nurse shared that there are memory care units that are designed for patients that wander and might be more helpful to her.

Daughter agreed with referral being made .

Review of the Progress Notes for Resident #4, dated 7/26/2023, revealed, .SW (Social Worker) made referral to several long term care facilities that have Dementia and Memory Care units per daughter .agreement during recent care plan meeting .[Named Facility #2] has accepted .[Named Resident #4] as a patient and daughter is in agreement with her mother being transferred and admitted there. [Named Facility #2] to contact daughter and set up a date and time for admission and will inform SW .

Review of the Progress Notes for Resident #4, dated 7/27/2023, revealed, .[Named Facility #2] social worker called and stated they are able to admit [Named Resident #4] today .Care Ride Van Service has been arranged to transport patient around 3:30 PM today .

During an interview on 8/1/2024 at 3:25 PM, Social Worker H was asked to review [Named Resident #4]'s care plan to see if a discharge plan was noted in her care plan. SW H stated, .I don't see one .

During an interview on 8/1/2024 at 4:07 PM, the Administrator was asked to review [Named Resident #4]'s care plan for a discharge plan.

The Administrator stated, .I don't see a discharge care plan on her .

445108 08/02/2024

Nhc Healthcare, Murfreesboro 420 N University St Murfreesboro, TN 37130

During a telephone interview on 8/1/2023 at 2:00 PM, CNA P stated, .I was told when I came in after [Named Resident #3] fell [9/30/2023], she had been trying to get up and they found her in the floor and the staff didn't know how long she had been in the floor .I found her clip alarm not clipped several times .I would tell them her alarm wasn't on .the staff was very aware of her fall risk .

During a telephone interview on 8/1/2024 at 2:28 PM, the Activity Staff stated, .I done some in room stuff with [Named Resident #3] she didn't come to group activities much .I don't remember any meetings we had where they discussed a specific activity plan for her .I just encouraged her to come to group activities .

During an interview on 8/2/2024 at 8:40 AM, Medical Director stated, .[Named Resident #3] had Afib that is why she was on Eliquis [blood thinner] .constantly trying to get up, [Resident #3] just couldn't remember she couldn't walk anymore and needed help .the hematoma was a complication from the Eliquis .I vaguely remember her being put on isolation .dementia was a contributing factor .she was placed in a room at the end of the hall to limit the people going by the room .

The Medical Director was asked why he felt limiting people going by the room would be necessary to stop the spread of Shingles.

The Medical Director stated, .it was a reasonable decision to make .it's more commonly spread by touch .less traffic better idea .

The Medical Director was asked if a special focus, trending, or tracking was performed for Resident #3 since she had numerous falls with injuries.

The Medical Director stated, .I can't recall .falls happen no way to prevent falls .

During an interview on 8/2/2024 at 4:30 PM, the Administrator was asked if the facility considered placing the resident in isolation so far from the nurse's station could have contributed to her falls.

The Administrator stated, .the family met with us after the fall, and they voiced concerns about her being moved at the end of the hall, we moved her back closer to the nurse's desk .

The Administrator was asked if the Interdisciplinary Team had performed any tracking, trending, root cause analysis, or developed a specific activity plan related to Resident #3's multiple (over 30) unwitnessed falls in her room, with various injuries (including two major injuries).

The Administrator stated, .just what we have given you and what is in the chart .I don't know of anything else .she was on a low bed, fall mat, everything was in place already .she was never transferred out to the psych unit .

During an interview on 8/2/2024 at 4:45 PM, the Interim DON was asked to review Resident #3's care plan and her fall event for 10/17/2023.

The Interim DON confirmed Resident #3 required use of a mechanical lift with 2 persons assist.

The Interim DON stated the CNA was trying to prepare to transfer Resident #3 on 10/17/2023 when the resident slid off the bed and stated, .I think any fall could be prevented with another person but maybe she was just getting her ready .

During a telephone interview on [DATE] at 2:00 PM, CNA P stated, .the staff was very aware of her [Resident #3] fall risk .I have found chairs next to her bed to keep her in the bed .I told the staff it's a restraint she could get hurt you can't do that .it was more than one time I found it that way .

During a telephone interview on [DATE] at 2:27 PM, an Anonymous Registered Nurse (RN) stated, .I knew about the chairs sitting next to [Named Resident #3]'s bed .the staff said the family was doing it and staging it but the family said the staff was doing it .I have walked into the room when family had not been there and found two burgundy straight back chairs next to the bed and the other side of the bed against the wall .the daughter reported that the second shift was doing it .the Administrator was aware of it .I told the staff you can't do that .

The RN was asked was an in-service given to the staff or any education given to the family about restraints.

The Anonymous RN stated, No.

During an interview on [DATE] at 4:30 PM, the Administrator was asked if she had been made aware of staff or family placing chairs against the side of Resident #3's bed to restrain her in the bed.

The Administrator stated, .Not that I know of .you can't leave chairs next to a bed, that is a restraint .

The Administrator reviewed the picture provided by FM O and identified the person in the photo was Resident #3 and confirmed the photo had been taken in Resident #3's room.

The photo revealed Resident #3 lying in bed with one side of the bed pushed up against the wall and the other side had 2 chairs placed against the opposite side of the bed.

445108

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 445108 B.

Wing 08/02/2024

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

Nhc Healthcare, Murfreesboro 420 N University St Murfreesboro, TN 37130