Nursing Assignment | Custom Essay Services

Prepare a 3-page typed paper inclusive of introduction, respond to the questions below, and provide a summary. Times New Roman, 12 size font, typed, cover, reference page, and 3 cited references are required. It is recommended you use the paper template provided by VNI. Support your opinions with authoritative references (references in the past 5 years, not Wikipedia, WebMD, but published articles, peer-reviewed, or textbooks). Please review the last paper you submitted and show progress by not making the same errors in this paper. Point deduction for repeat errors can be up to 20 points.

Question 1: Which deficiency was the most egregious in nature, in your opinion and why.
Question 2: If you were the manager on the unit where the most egregious deficiency occurred, what would you have done differently to correct/prevent the issue from occurring again. This must be different than what the plan of correction already states.
Question 3: What was your impression after reading this survey report on the types of overall deficiencies cited? Did you feel the surveyor was fair in writing the deficient practices? why or why not?
Question 4: How did reading this survey report help you to become a better nurse in practice? Please be very specific and share at least two ways this assignment will help you to improve your nursing practice.
Rubric:
Topic Descriptor Point Value Points Achieved
Cover Page /spell check/ semantics /diction 10
Introduction 10
Question 1 15
Question 2 15
Question 3 15
Question 4 15
Summary 10
References 10
Total Points 100

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
335590
SS=J
I. The following actions were accomplished
for the residents identified in the sample:
Resident #402
• Resident is no longer at the facility
• A medical record review has been
completed to ensure all improvement
opportunities related to the change of
condition that was identified without
physician notification have been identified
and addressed in this plan of correction.
• LPN #5 is no longer employed by the
facility
• LPN #4 is no longer employed by the
facility
• LPN #4 investigation into incident with
resident #402 has been completed
II. The following corrective actions will be
implemented to identify other residents
who may be affected by the same practice:
All residents have the potential to be
affected by this practice:
• Progress notes for all residents over the
past thirty (30) days have been reviewed to
ensure any resident with an identified
change in condition, that the Physician/PA
has been notified.
• Progress notes for all residents over the
past thirty (30) days have been reviewed to
ensure Licensed Practical Nurses are
practicing within their scope of practice,
specifically as it relates to assessing
residents
III. The following system changes will be
implemented to assure continuing
compliance with regulations:
As per the Directed Plan of Correction, the
Consultant has developed and
implemented an In-service Program to
address:
• The Abuse Reporting and Prevention
policy has been newly adopted
483.10(g)(14)(i)-(iv)(15) Notify of Changes F 580 06/11/2019
(Injury/Decline/Room, etc.)
§483.10(g)(14) Notification of Changes.
(i) A facility must immediately inform the
resident; consult with the resident’s physician;
and notify, consistent with his or her authority,
the resident representative(s) when there is-
(A) An accident involving the resident which
results in injury and has the potential for
requiring physician intervention;
(B) A significant change in the resident’s
physical, mental, or psychosocial status (that is,
a deterioration in health, mental, or psychosocial
status in either life-threatening conditions or
clinical complications);
(C) A need to alter treatment significantly (that
is, a need to discontinue an existing form of
treatment due to adverse consequences, or to
commence a new form of treatment); or
(D) A decision to transfer or discharge the
resident from the facility as specified in
§483.15(c)(1)(ii).
(ii) When making notification under paragraph
(g)(14)(i) of this section, the facility must ensure
that all pertinent information specified in
§483.15(c)(2) is available and provided upon
request to the physician.
(iii) The facility must also promptly notify the
resident and the resident representative, if any,
when there is-
(A) A change in room or roommate assignment
as specified in §483.10(e)(6); or
(B) A change in resident rights under Federal or
State law or regulations as specified in
paragraph (e)(10) of this section.
(iv) The facility must record and periodically
update the address (mailing and email) and
phone number of the resident
representative(s).
F 580
If continuation sheet Page 1 of 35
LABORATORY DIRECTOR’S OR PROVIDER/SUPPLIER REPRESENTATIVE’S SIGNATURE
FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: HI2111 Facility ID: 0732
TITLE (X6) DATE
Any Deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide
sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of the survey whether or not a
plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the
facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.
This form is a printed electronic version of the CMS 2567L. It contains all the information found on the standard document in much the same form. This electronic form once printed and
signed by the facility administrator and appropriately posted will satisfy the CMS requirement to post survey information found on the CMS 2567L.
Electronically Signed 05/10/2019
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
PRINTED:
(X2) MULTIPLE CONSTRUCTION
A. BUILDING
B. WING __________________________
(X3) DATE SURVEY
COMPLETED
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
(X4) ID
PREFIX
TAG
SUMMARY STATEMENT OF DEFICIENCIES
(EACH DEFICIENCY MUST BE PRECEDED BY FULL
REGULATORY OR LSC IDENTIFYING INFORMATION)
ID
PREFIX
TAG
PROVIDER’S PLAN OF CORRECTION
(EACH CORRECTIVE ACTION SHOULD BE
CROSS-REFERENCED TO THE APPROPRIATE
DEFICIENCY)
(X5)
COMPLETE
DATE
06/10/2019
FORM APPROVED
PONTIAC NURSING HOME
303 EAST RIVER ROAD
OSWEGO, NY 13126
04/19/2019
OMB NO. 0938-0391
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
335590
F 580 Continued From page 1 F 580
o Administrator and Department
Management have been re-educated on
this policy as it relates to the investigation
of all alleged or suspected incidents of
abuse, neglect, mistreatment, or
misappropriation of resident property
o All staff have been re-educated on
this policy as it relates to the reporting of all
alleged or suspected incidents of abuse,
neglect, mistreatment, or misappropriation
of resident property
• The Notification of Significant Changes
policy has been newly adopted
o All licensed nurses have been reeducated
on this policy with emphasis on
the prompt notification of medical provider
with change in condition
• The Licensed Practical Nurse Job
Description has been reviewed without
revision.
o All licensed practical nurses have
been re-educated on the contents of their
job description as it relates to providing
care within their scope of practice
• The On-Call Nursing Administration
policy and procedure has been newly
adopted
o All licensed nurses have been
educated on the policy with emphasis on
contacting an RN, on-call RN with any
change of condition as soon as it is
observed
• The Stop and Watch Early Warning Tool
policy has been reviewed without revision
o All licensed nurses and certified nurse
aides have been re-educated on the Stop
and Watch with emphasis on reporting
identified changes of condition
• All new staff will be educated on the
above policy details during general
orientation
§483.10(g)(15)
Admission to a composite distinct part. A facility
that is a composite distinct part (as defined in
§483.5) must disclose in its admission
agreement its physical configuration, including
the various locations that comprise the
composite distinct part, and must specify the
policies that apply to room changes between its
different locations under §483.15(c)(9).
This REQUIREMENT is not met as evidenced
by:
Based on record review and interview during the
abbreviated survey (NY00231469) the facility did
not ensure the physician and family
representative were notified of a change in
resident condition for 1 of 6 residents (Resident
#402) reviewed for quality of care. Specifically,
Resident #402 had a decline in condition,
remained compromised for several hours and
the physician was not notified. Emergency
Medical Services was called, and the resident
expired in the hospital. This resulted in
Immediate Jeopardy and Substandard Quality of
Care for Resident #402.
The facility policy Notification of Changes for
Residents updated 12/1/17 documented the
facility shall promptly notify the resident and/or
the resident representative and his or her
physician or delegate of changes in the
resident’s condition or status in order to obtain
orders for appropriate treatment and monitoring.
The nurse will immediately notify the resident’s
physician of a significant change in the
resident’s physical status that is a deterioration
in health.
Resident #402 was admitted to the facility on
8/3/16 and had diagnoses including chronic
FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: HI2111 Facility ID: 0732 If continuation sheet Page 2 of 35
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
PRINTED:
(X2) MULTIPLE CONSTRUCTION
A. BUILDING
B. WING __________________________
(X3) DATE SURVEY
COMPLETED
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
(X4) ID
PREFIX
TAG
SUMMARY STATEMENT OF DEFICIENCIES
(EACH DEFICIENCY MUST BE PRECEDED BY FULL
REGULATORY OR LSC IDENTIFYING INFORMATION)
ID
PREFIX
TAG
PROVIDER’S PLAN OF CORRECTION
(EACH CORRECTIVE ACTION SHOULD BE
CROSS-REFERENCED TO THE APPROPRIATE
DEFICIENCY)
(X5)
COMPLETE
DATE
06/10/2019
FORM APPROVED
PONTIAC NURSING HOME
303 EAST RIVER ROAD
OSWEGO, NY 13126
04/19/2019
OMB NO. 0938-0391
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
335590
F 580 Continued From page 2 F 580
IV. The facility’s compliance will be
monitored utilizing the following quality
assurance system:
As per the Directed Plan of Correction, a
QA&A Committee meeting was held on
May 2, 2019 to examine this deficiency.
• Progress notes will be audited weekly
for three (3) months to ensure:
o any identified changes in condition
have been communicated to the
Physician/PA
o investigations have been conducted
and appropriate actions taken when
warranted
o Licensed Practical Nurses have
notified the RN once a change in condition
has been identified, and
o LPNs are not completing
assessments
• All Stop and Watch forms will be audited
weekly for three (3) months to ensure all
identified changes in condition have been
addressed
• Audit results will be reported to the
QA&A Committee monthly for three
months. Frequency of on-going audits will
be determined by the Committee based on
audit results.
• Consultant will participate in QA&A
Committee Meeting monthly for 3 months.
Completion Date: June 11, 2019
Responsibility: Director of Nursing
obstructive pulmonary disease (COPD),
diabetes and hypertension. The 8/17/18
Minimum Data Set (MDS) assessment
documented the resident’s cognition was
moderately impaired and he required
supervision for bed mobility, transfers, limited
assistance for personal hygiene and extensive
assistance for dressing.
A nursing progress note dated 12/16/18 by
registered nurse (RN) #3 documented on
12/15/18 she was asked by a certified nurse
aide (CNA #8) at 11:30 PM to check on the
resident. The resident was in his room,
unresponsive. At 12:40 AM on 12/16/18 the
resident’s oxygen saturation was 79% and RN
#3 placed 3 liters of oxygen on the resident and
his oxygen saturation increased to 83%. He
remained unresponsive, 911 was called and the
resident was sent to the emergency room.
Hospital records documented the resident
arrived at the emergency room at 1:22 AM on
12/16/18. The resident arrived with secretions in
his airway, obvious aspiration (inhalation of a
foreign substance in the lungs) and was
responsive only to pain. He was hypoxemic (lack
of oxygen to the brain) with an oxygen saturation
of 50% and was arousable to tactile (touch)
stimuli only. The laboratory results from the
emergency room included a white blood cell
count (WBC, indicates infection) of 22.87
(normal 4-11), blood glucose of 43 (normal 70-
100) and encephalopathy (brain disease) in the
setting of pneumonia and a urinary tract
infection (UTI). The resident expired in the
hospital on 12/23/18.
During an interview with certified nurse aide
(CNA) #8 on 2/1/19 at 10:10 AM she stated she
had worked the evening and night shifts starting
FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: HI2111 Facility ID: 0732 If continuation sheet Page 3 of 35
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
PRINTED:
(X2) MULTIPLE CONSTRUCTION
A. BUILDING
B. WING __________________________
(X3) DATE SURVEY
COMPLETED
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
(X4) ID
PREFIX
TAG
SUMMARY STATEMENT OF DEFICIENCIES
(EACH DEFICIENCY MUST BE PRECEDED BY FULL
REGULATORY OR LSC IDENTIFYING INFORMATION)
ID
PREFIX
TAG
PROVIDER’S PLAN OF CORRECTION
(EACH CORRECTIVE ACTION SHOULD BE
CROSS-REFERENCED TO THE APPROPRIATE
DEFICIENCY)
(X5)
COMPLETE
DATE
06/10/2019
FORM APPROVED
PONTIAC NURSING HOME
303 EAST RIVER ROAD
OSWEGO, NY 13126
04/19/2019
OMB NO. 0938-0391
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
335590
F 580 Continued From page 3 F 580
on 12/15/18. When she arrived at 2:00 PM she
saw the resident and he was complaining of leg
pain. She told LPN #11 who stated he had
already had Tylenol. A little while later she
checked on him and he was still complaining of
leg pain. She told LPN #5 who started work at
3:00 PM and she said she would get him
something for the pain. CNA #8 stated she
checked on the resident again and he was still
complaining of pain and wanted to go to bed.
Once in bed he started yelling out, so they put
him back in his wheelchair. Sometime after 5:00
PM she entered the resident’s room and he was
not responding and was drooling. She notified
LPN #5 who obtained the resident’s vital signs.
His oxygen level was 82%. and the resident was
put back to bed. LPN #5 obtained his blood
sugar and it was in the 70’s. CNA #8 stated she
had tried to give him orange juice to raise his
sugar level and he was not able to swallow it
and just came back out of the sides of his
mouth. She did not know if the supervisor (LPN
#4) was called but sometime after 6:00 PM she
saw LPN #4 talking with LPN #5 at the
medication cart. She did not see LPN #4 go in
the resident’s room and check on him. CNA #8
stated she had checked on the resident
periodically throughout the remainder of the shift
and obtained his vital signs. At one point his
oxygen level was reading in the 50’s and she
had notified LPN #4. When RN #3 came in
around 11:00 PM she met her at the front door
and asked her to check on the resident.
During an interview with CNA #18 on 4/16/2019
at 4:20 PM she stated she had worked the
evening of 12/15/2018 and when she started her
shift at 2:00 PM there was something not right
about the resident as he was normally more
“uppity”. Sometime before 5:30 PM she noticed
the resident was falling asleep and sluggish at
FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: HI2111 Facility ID: 0732 If continuation sheet Page 4 of 35
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
PRINTED:
(X2) MULTIPLE CONSTRUCTION
A. BUILDING
B. WING __________________________
(X3) DATE SURVEY
COMPLETED
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
(X4) ID
PREFIX
TAG
SUMMARY STATEMENT OF DEFICIENCIES
(EACH DEFICIENCY MUST BE PRECEDED BY FULL
REGULATORY OR LSC IDENTIFYING INFORMATION)
ID
PREFIX
TAG
PROVIDER’S PLAN OF CORRECTION
(EACH CORRECTIVE ACTION SHOULD BE
CROSS-REFERENCED TO THE APPROPRIATE
DEFICIENCY)
(X5)
COMPLETE
DATE
06/10/2019
FORM APPROVED
PONTIAC NURSING HOME
303 EAST RIVER ROAD
OSWEGO, NY 13126
04/19/2019
OMB NO. 0938-0391
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
335590
F 580 Continued From page 4 F 580
which time LPN #5 instructed the CNAs to get
vital signs. His oxygen saturation was lower than
70% at that time. Throughout the shift his
oxygen saturations were in the 50’s, he was not
talking, was not able to keep his eyes open very
long and he continued to struggle to breath. She
had notified both LPN #5 and LPN #4 the
resident was struggling to breathe, several times
during the shift, and they did not do anything for
him.
During an interview with LPN #5 on 1/31/19 at
1:10 PM she stated she had worked the evening
shift on 12/15/18 and when she went into
Resident #402’s room he was not responding,
and he appeared to be struggling to breathe.
She could not remember what time she went
into to see him after the start of her shift at 3:00
PM. She took his blood glucose which was 79
and they put the resident to bed. She checked
his oxygen saturation and it was fluctuating in
the 80’s and 90’s, his baseline was usually in the
high 90’s. She notified LPN #4 who was the
nursing supervisor. LPN #4 came to the unit and
looked at the resident’s diagnoses and told LPN
#5 it was part of his illness and there was
nothing the hospital could do for him. She did
not see LPN #4 go in to the resident’s room.
LPN #5 stated the resident remained in the
same condition the rest of the shift. After 11:00
PM registered nurse (RN) #3 saw the resident
and called the ambulance. LPN #5 also stated
she had not called the physician to report the
resident’s change in condition as it was the
responsibility of the supervisor to call the
physician.
During an interview with LPN #4 on 2/1/19 at
12:15 PM she stated she had worked the day
and evening shift on 12/15/18 as a medication
nurse and the nursing supervisor. On the
FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: HI2111 Facility ID: 0732 If continuation sheet Page 5 of 35
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
PRINTED:
(X2) MULTIPLE CONSTRUCTION
A. BUILDING
B. WING __________________________
(X3) DATE SURVEY
COMPLETED
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
(X4) ID
PREFIX
TAG
SUMMARY STATEMENT OF DEFICIENCIES
(EACH DEFICIENCY MUST BE PRECEDED BY FULL
REGULATORY OR LSC IDENTIFYING INFORMATION)
ID
PREFIX
TAG
PROVIDER’S PLAN OF CORRECTION
(EACH CORRECTIVE ACTION SHOULD BE
CROSS-REFERENCED TO THE APPROPRIATE
DEFICIENCY)
(X5)
COMPLETE
DATE
06/10/2019
FORM APPROVED
PONTIAC NURSING HOME
303 EAST RIVER ROAD
OSWEGO, NY 13126
04/19/2019
OMB NO. 0938-0391
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
335590
F 580 Continued From page 5 F 580
she had been called and told the resident was
complaining of pain in his knees. She did
attempt to see the resident, but he was in his
room sleeping. After dinner, she was called
again and was told the resident was not eating
and was hard to arouse. She was in the middle
of a medication pass so when she finished she
went to look at the resident and he was in bed
sleeping and snoring. She stated she could not
recall the time. She attempted to wake the
resident up, he was hard to arouse and when he
did awaken he said he was sleepy and went
right back to sleep. She went out and asked the
staff if that was normal for him and the CNA told
her he was normally up, eating and watching
television at that time. LPN #4 stated she
reviewed the resident’s diagnoses with LPN #5
and she may have said to LPN #5 the snoring
was part of his illness. She did not remember
being told his oxygen saturation was low. She
did not call the physician as the resident was
just sleeping and snoring.
During an interview with RN #3 on 2/14/19 at
8:20 AM she stated on 12/15/18 when she
arrived for the night shift around 11:00 PM she
was immediately notified by CNA #8 that
Resident # 402 was sick. She went into the
resident’s room around 11:30 PM and he was
unresponsive. She tried to wake him, performed
a sternal rub and there was no response. RN #3
stated his oxygen saturation was low, she
applied oxygen and called 911. She had advised
CNA #8 to call the ambulance herself next time
as there were two nurses that worked that
evening and they had not addressed the
resident’s condition. RN #3 stated this was an
ongoing issue when LPN #4 was the supervisor
as LPN #4 did not do anything when residents
got sick. RN #3 stated she had previously
communicated her concerns to administration
FORM CMS-