Avina Of Mayville
Avina of Mayville in Mayville, WI — inspection on August 15, 2024.
Found 1 citation. 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
F-F104's falls to determine the root cause nor implement fall prevention interventions based on the identified root cause to prevent future falls.
Findings include:
The facility's policy and procedure entitled, Accidents/Fall Prevention Program, dated 1/30/2023, was reviewed by Surveyor.
The policy documents: The facility strives to promote safety, dignity and overall quality of life for its residents by providing an environment that is free from any hazards for which the facility has control and by providing appropriate supervision and interventions to prevent avoidable accidents.
Any episode of a fall should be documented in risk management.
Each fall must be investigated and/or assessed using a root cause analysis process to determine the cause of the fall and prevent any further injury.
The individual care plan is to be updated with any changes or new interventions post fall and communicated to staff and implemented.
R104 was admitted to the facility on [DATE], at 12:50 PM with a diagnosis of TBI (Traumatic Brain Injury) with subarachnoid hemorrhage. R104 has a Guardian for decision making.
The Admission Nursing Assessment conducted on 6/29/24, at 12:50 PM, assesses R104 as a fall risk.
Surveyor notes R104 was at the facility from 6/29/24 through 7/3/24 and had 4 falls during this time. R104 discharged prior to the completion of an Admission Minimum Data Set (MDS) assessment.
The initial plan of care for Fall Risk dated 6/29/24, with a resolved date of 7/1/2024, with a goal date of 9/27/2024 documents interventions dated 6/29/24: Call light within reach; Educate the resident/family/caregivers about safety reminders and what to do if a fall occurs; Ensure proper footwear; Follow facility fall protocol.
The initial plan of care for ADL (activity of daily living) self-care performance deficit due to TBI with weakness, and poor impulse control, which increases risk for complications, such as falls and incontinence, dated 6/29/24 with revisions on 7/1/24, 7/5/24 and 7/8/24, and a goal date of 9/27/2024, was reviewed.
The interventions documented: 7/1/24 provide adequate adaptive equipment necessary during transfer; toilet riser in bathroom; encourage to use call light; wheelchair with anti-rollbacks; 7/2/24 an intervention of do not leave alone in room.
There is a revision date of 7/5/2024 with no changes in interventions.
There is a revision date of 7/8/2024 with interventions: bariatric bed with bolsters and extender; call family and allow them to talk as this helps decrease agitation; encourage resident to stay in the common area when awake.
525616
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 525616 B.
Wing 08/15/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Crossroads Care Center of Mayville 305 S Clark St Mayville, WI 53050