East Glen

In the surveyor’s words

From the most serious findings on record at East Glen, in the surveyor’s own words.

• Immediate jeopardy, isolatedF678Jun 10, 2023

  Based on record review, interviews, and review of a facility policy titled Cardiopulmonary Resuscitation (CPR) Compression Airway Breathing (CAB), The American Heart Association (AHA) current website for CPR & First Aid Emergency Cardiovascular Care, and the AHA Adult Basic Life Support (ABLS) Algorithm for Health Care Providers the facility failed to initiate CPR in accordance with facility policy and in accordance with the AHA, ABLS for Resident Identifier (RI) #1 on [DATE], when Employee Identifier (EI) #4, a Licensed Practical Nurse (LPN), determined RI #1 was unresponsive and had no palpable pulse upon returning to the facility. On [DATE], RI #1 was transferred by a transport van contracted by the facility to and from a medical appointment. […]

• No harm, potential for more than minimal, isolatedF641Mar 16, 2023

  Based on interviews, resident record reviews, and review of the Centers for Medicare & (and) Medicaid Services Long-Term Care Facility Resident Assessment Instrument 3.0 User's Manual, the facility failed to ensure Resident Identifier (RI) #24's quarterly Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of 01/17/2023 was accurately coded for Dialysis and Oxygen Therapy and RI #7's quarterly MDS with an ARD of 02/12/2023 was accurately coded for Hospice services. This affected two of 18 sampled residents for whom MDS assessments were reviewed. Findings Include: The Centers for Medicare & (and) Medicaid Services Long-Term Care Facility Resident Assessment Instrument 3.0 User's Manual Version 1.17.1, dated October 2019, documented: . […]

• No harm, potential for more than minimal, isolatedF684Mar 16, 2023

  Based on observations, interviews, resident record review, and review of Potter and Perry, Fundamentals of Nursing, NINTH EDITION, the facility failed to ensure licensed staff, Employee Identifier (EI) #10, Licensed Practical Nurse (LPN)/Wound Care Nurse, followed physician orders for treatment for Resident Identifier (RI) #24. This was observed on 03/16/2023 when dressings on RI #24's legs had not been changed the night before as ordered. This deficient practice had the potential to affect RI #24, one of three residents for whom wound treatments were reviewed. Findings Include: A review of Potter and Perry's 2017, Fundamentals of Nursing, NINTH EDITION, Chapter 23, Legal Implication in Nursing Practice, page 311, revealed the following: . Health Care Providers' Orders. […]

• No harm, potential for more than minimal, isolatedF919Mar 16, 2023

  Based on observations, interviews, resident record review, and review of a facility policy titled Call Light, the facility failed to ensure Resident Identifier (RI) #41's call light was positioned within reach of the resident on 03/14/2023 while RI #41 was in a wheelchair in his/her room. This affected one of 18 sampled residents. Findings include: A facility policy titled Call Light effective 12/2016, documented: . PURPOSE: Call lights serve as notice to the staff the resident has a need or request. Prompt answering of call lights provides a sense of security to the resident. 4. Place the call light within reach of the resident before leaving the room. RI #41 was readmitted to the facility on [DATE]. […]