Forest Park Nursing & Rehabilitation

exacerbation of the resident's symptoms. He stated his expectation for resident care was for

jeopardy to resident health or resident's dialysis center next week to ensure the Doctor order were correct. He stated the Medical safety Doctor agreed the meeting with dialysis was a good idea.

they were trained between 06/10/24 and 06/13/24 on change in condition, of drops in resident's BP and documentation residents vital signs.

Interviews on 06/14/24 between 11:44 am - 3:34 pm revealed, LVN K, Medical Record L, MA M, Housekeeper/Laundry aide N, Housekeeper O, Dietary aide P, Dietary cook Q, Laundry aide R, Laundry aide S, RN T, ADON U, , CNA X, MA Y, RN Z stated they were trained between 06/10/24 and 06/14/24 on change in condition, documentation, stop and watch and notifying the nurses, the DON and ADONs when a resident had a change in condition.

Record review on 06/13/24 of the facility's Supporting documents emailed by the Administrator on 06/12/24 at 9:10 pm revealed, Inservice trainings on 06/10/24 with mostly administrative/department head staff and some floor staff.

And on 06/11/24 and 06/12/24 more floor staff were trained on change in condition and stop and watch reporting.

Record review on 06/13/24 of the facility's Supporting documents emailed by the Administrator on 06/13/24 at 2:22 pm, revealed three duplicate in service signature sheets dated 06/10/24.

There was signed training sheets from the 8:00 am to 5:00 pm staff on 06/10/24 on topics change in condition and documentation.

And signature sheets on 06/12/24, posttests from 06/10/24 - 06/13/24 and resident chart audits from 06/10/24 to 06/13/24 revealed staff were proficient in change in condition and documentation procedures.

Record review of signage posting currently being put at all nurses stations: NOTIFY MD/NP OF LOW BLOOD PRESSURES . SYSTOLIC LESS THAN 95 DIASTOLIC LESS T:HAN . SYSTOLIC GREATER THAN 170 AND DIASTIC GREATER THAN 90 . ASSESS YOUR PATIENT AND DOCUMENT.

Record review of LVN A's Corrective Action Memo dated 06/12/24 by DON revealed, Violation of policy and procedure, carelessness, Employer Statement: Acute change in condition is a sudden, clinically important deviation from the patient's baseline in physical, cognitive, behavioral, or functional domains.

Clinically important means a deviation that, without intervention, may result in complications or death.

Alert charting is documentation done to track a medical event for a period of 72 hours or longer.

Events may include but not necessarily limited to suspected or actual change in condition.

Action being taken Suspension Objective/Solution: Employee will understand the importance of communicating change of condition with DON, ADON, on call phone.

Employee will review abnormal vital signs and verbalize values in EMR Failure to document indicates task was not completed.

Employee will be suspended pending investigation.

Employee statement: blank.

Signed by LVN A and DON.

Record review of LVN B's Corrective Action memo dated 06/13/24 by DON revealed, Violation of policy and procedure Employer Statement: Treatments completed and documented as per physician's order.

Documentation will be completed by the end of the assigned shift.

Failure to document

676293 06/14/2024

Forest Park Nursing & Rehabilitation 6825 Harry Hines Blvd Dallas, TX 75235

Licensed Nurse will contact the Facility's Medical Director for direction and

and the ordering practitioner's response or additional orders, if any.

676293 06/14/2024

Forest Park Nursing & Rehabilitation 6825 Harry Hines Blvd Dallas, TX 75235

D.

Alert charted describes what is going on.

(a) Describe the resident's condition, include what you see, hear, smell, feel, etc. (c) Describe what you have done in response to what is going on with the resident.

Review of the Medication Aides charting she had recorded a BP high enough that BP reducing medication according to parameters was administered.

The medication aide said that the patient seemed stable and normal with no signs of distress during medication administration, and he received medications well. LVN A admits that he did not notify the physician of the abnormal vitals on Saturday. He also admits that he did not document the later vital signs that he had taken in the medical record.

Actions to Address:

LVN A was given one on one in-service by DON on expectations for physician notification for any abnormal vital signs and medication administration.

Employee suspended pending investigation. [END]

Interviews on 06/13/24 between 10:32 am - 11:40 am with RN E, RN F, LVN G, MA H, CNA I revealed they were trained between 06/10/24 and 06/13/24 on change in condition, notifying PA/MD of drops in resident's BPs.,

Interviews on 06/14/24 between 11:44 am - 3:34 pm revealed, LVN K, Medical Record L, MA M, Housekeeper/Laundry aide N, Housekeeper O, Dietary aide P, Dietary cook Q, Laundry aide R, Laundry aide S, RN T, ADON U, OT (Occupational Therapy) V, PTA (Physical Therapy Assistant) W, CNA X, MA Y, RN Z stated they were trained between 06/10/24 and 06/14/24 on change in condition, notifying the PA/MD, stop and watch and notifying the nurses, the DON and ADONs when a resident had a change in condition.

676293

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 676293 B.

Wing 06/14/2024

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

Forest Park Nursing & Rehabilitation 6825 Harry Hines Blvd Dallas, TX 75235