state survey and a bad reputation

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I work in a facility that was on the verge of being closed down a year and a half ago. The place has a bad reputation but from the day I started I could see the potential in the place and the dedication of some of the staff. It just seems as if theyre just not sure of how to correct some of the problems. Most of the issues are simple issues such as keeping track of BM's, intake (even though they dont track output). Things that are common in other facilities. My frustration is that theyre trying to scramble to cover things up. For example, I was asked to add up the fluid intake of all the residents at the end of each day (I work night shift), which is fine, but my 4 weeks of orientation was on day shift, and not once did I see any aides or nurses go around and see what people actually ate. When you look at the books its obvious that they just filled in random numbers. Due to a heated discussion this morning between the floor secretary and the DON, I overheard the DON mention that if theyre under 1500cc intake for the day then the Nurse Manager is supposed to do something about it. I wasnt even aware of that facility policy because when I was orginally approached about it adding up the consumptions (this policy was just put into effect last week), the only instruction I received was to "add them up". Well, with all the numbers that were put in, most of the total amounts of fluid intake for the day only add up to 1440cc for the day. I suppose they'd be over 1500cc for the day if any snacks were actually recorded in the books, but there arent any. Ive also seen places where the nurses have to record the amount of fluids given with each med pass, but they dont do that here either. So if the state actually looks at all the totals for the month, these people have been under 1500 since the 1st...they'll question why is the Nse Manager just now doing something about the situation. Its the middle of the month! I tried to clarify what the DON said, but she didnt want to be pulled into the discussion. Unprofessional. I just dont understand why they want to give the illusion that theyre doing something when they really arent. I dont know, there's some good staff there, my night crew is great. The residents are great, its not their fault they couldnt go to a more high scale facility with a better reputation. They still deserve good care. I dont know whats going to happen, but I hope theyre able to stay afloat.

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Specializes in LTC, ER, ICU, Psych, Med-surg...etc....

A facility should not have a "bad reputation" only that they had some problems with survey- at least that's the way I try to look at it. Unfortunately lots of facilities get themselves in more trouble trying to "hurry ip" and correct/cover things rather than dealing with the issues. I don't understand why there is all the fuss about intake and output- why are resident's even on it unless you are afraid they are getting dehydrated or are loosing weight or something of that nature and then it should be on an individual basis and there should be other things going on other than putting them on I&O. Even fluid restriction can be tricky because if people are not going to document, then there is a problem. If you have people on I&O then of course the state is going to look at it, and if there is lack of documentation then there could be a problem. The least is that it could be an inaccurate clinical record, and the most is harm if someone is dehydrated/or has a serious outcome because they were on I&O and it was not done and they suffered for it. Why do you have to do I&O on a person who has a foley catheter, if they have had it for a long time? If staff are looking at it every day and doing cath care, then you should know if there is a problem with it draining, or whatever. The same applies to blood pressures daily- now who gets daily blood pressures? If the resident has been on the medication for a long time and are stable, then why are you monitoring blood pressures every day? If they were at home taking this medication would they take their blood pressure every day? No they would not. Blood sugars are another- why do we stick people who are 90 years old 4 or 5 times a day when they have been diabetic for years and usually only get 2 units of coverage? I have seen it done only once daily, or even 3 times a week and the MD reviews them and adjusts accordingly- however, A1C is the best indicator. I&O...we make so much useless work for rouselves....I am not saying that I&0 is not indicated at times, but I certainly would pick and choose....also one more thing- tube feedings- why on earth do we do I&0 on them? If you have a physicians order for a tube feeding for 100cc per hour for 16 hours with 200cc flushes three or four times a day- hummmmm...why would you need to track that unless you are concerned the resident is not getting the tube feedings as ordered or flushes...we make so much work for ourselves- HOWEVER if your facility policy for tube feedings or foleys or I&O says that you are going to do it and you don't do it, then there could be a problem, but again a facility should never be cited for policy alone....at least that is my thinking. Sorry to ramble....

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Specializes in LTC, Memory loss, PDN.

For each deficiency cited by the state, the facility has to submit a plan of correction which has to be approved by the state, so the plan has to be in place already. 1500 ml per day is generally accepted as the daily minimum regardless of age, weight, etc. Of course you may see fluid restrictions below 1500 ml, but I think I've only seen this twice and only in fully cognicent patients who promptly choose not to comply.

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Specializes in Long Term Care.

The facility I currently work in is now going to have a provisional II license..in pa...I am not quite exactly sure what that all entails but i can tell you it is not going to be fun!! just went through the second full survey for this year and I am sure that now there will be a third!!! And of course we have to come up with solutions and "band aides" to all the problems instead of looking at the root cause of all this stuff. My firm belief is that if there was enough staff on the floor and the state didn't make the requirements so low of staffing than these issues would decrease!!!! But NOOO why do that just push off the plan of correction to someone else instead of holding ppl accountable for their actions!! I personally don't think that the facility I work in gives horrible care...I see the compassion every day but I also see the frustration of the staff when they are so short!! I don't have any idea how two cna's can do their job efficiantly when they have 12 residents each to care for. I am a nurse however I am not a med nurse...I am a rehab nurse....I do answer bells for them, transfer, answer alarms etc...and they appreciate it so much when someone gives the cnas a hand! The nurses have so much on thier plate as well....I currently have another job offer and while I love LTC and the residents I am afraid they will end up shutting us down. I am sure the plan of correction is going to be hell! i dont know if i can take yet another full week survey!!!! I know what you are going through with the bad rep thing....we are in the daily newspaper at least once a week and it is so embaressing and the residents read the paper...i can' t even imagine how they feel. I hope things get better for you!

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Specializes in Gerontology, Med surg, Home Health.

Sometimes problems like this can be overwhelming. You have to start from scratch...do the basics well and then progress from there. I+Os are a constant problem in every facility. You need to write a policy that makes sense. We took all tube feeds off I+O. In comes the state and asks why we don't do I+O on them. It's clearly documented on the MAR how much fluid they are getting and clearly documented on the CNA flows that they are voiding. The state said "We can't tell you what kind of policy to have and you are following the one you do have so fine." Same for old foleys...as long as they are draining it's time consuming and not clinically warranted to measure what comes out. We need to spend a bit of time going over the MARs and TARs and getting rid of stupid, useless things so we have time to do the things that are important.

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we just has state in and ended up in imedieate jeapary and was finally cleared after 5 days. the big problem that hurt us so bad it that we did report it and the state surveyor even told us, you did an extra good investigation even talked to the housekeepers etc..., these things we reported were reportable incidents. so now I think the administrator things we should not report things. The state also told us you will be better off for being honest but we found out we dont get paid for a WHOLE YEAR---- this is crap and depressing, We inservice and inservice, seems like the nurses that did not do as they where suppose to do and have possibly 'covered up' stuff and charting documentation just happened to disappear. I am sick over this - and feeling I always looked at survey as a learning process now our star ratings are down to 1 -- I guess this to shall pass just wish when you try to NOT cover up and report you still get spanked and boy does it hurt!!!

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Specializes in Gerontology, Med surg, Home Health.

I've worked in beautiful buildings;I've worked in ugly buildings. I've worked with good and not so good staff. I've had corporate people scream at me for reporting something they didn't want reported or wanted reported in a certain way. You have to hold your ground. As the DNS, it's my license on the line and my name on that report. I report more than anyone I know...to the DPH, the BON and yes, even the DEA. I have a reputation with them for being honest, straight forward, and completely truthful so when something does happen, and even they know that things happen, they trust I will investigate and do what has to be done. Always tell the truth to the DPH. If you don't and they find out (and they usually do) you will be worse off than if you had told the truth. It is hard to work in a building like the one you're in, but stick with it, follow the plan of correction, do your job the best you can and the residents will be better off for it.

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Specializes in Mostly geri :).

1-I'm loling at the intake but no output issue. 2- You want to fix the problems, they want to cover them up. That says a lot about your character as well as theirs. I would leave.

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the worst part of the whole thing is that we lost the nurse aide program that of course I teach.. so I feel personally punished. I called the nurse aide creditialing office in our state they say I know it is not FAIR but.... you can not teach the class for 2 years. We can have the nurse aide class but has to be someone has never taught it --- this makes me feel like I did something wrong. I have only had less than a handful of students fall the thing in the last few years. sure I can spend more time with MDS stuff and careplans. When I get back to work I am going to call them back and see if I can teach at the nursing home in the next town I have already put in my application. If they tell me that is ok I will of course be glad but be confused at the same time. so I can teach at another home but not in the current one?? that will not make sence . I will let you know what they say.

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Specializes in Gerontology, Med surg, Home Health.

The theory behind not allowing substandard facilities to have CNA classes is this: if you do so poorly on survey, it won't be a good learning environment for students. Don't take it so personally. All of this is still about the residents...not about your class and not about you.

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Specializes in LTC, ER, ICU, Psych, Med-surg...etc....
we just has state in and ended up in imedieate jeapary and was finally cleared after 5 days. the big problem that hurt us so bad it that we did report it and the state surveyor even told us, you did an extra good investigation even talked to the housekeepers etc..., these things we reported were reportable incidents. so now I think the administrator things we should not report things. The state also told us you will be better off for being honest but we found out we dont get paid for a WHOLE YEAR---- this is crap and depressing, We inservice and inservice, seems like the nurses that did not do as they where suppose to do and have possibly 'covered up' stuff and charting documentation just happened to disappear. I am sick over this - and feeling I always looked at survey as a learning process now our star ratings are down to 1 -- I guess this to shall pass just wish when you try to NOT cover up and report you still get spanked and boy does it hurt!!!

If you don't mind, please explain to me what it was that you all got IJ on- if you identified it and reported it,.....hummmmm I'm confused......

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yeah I am still confused, we had reported 5 incidents with injury and one of them there was no incident report and we really did not know how the fx happened. So we went into extended survey and with that lost the NATCEP training class in a very rural community this will sink us not having enough nurse aide. I am still bummed about it but we do have a new DON that seems very knowledgable. Plus the Don had lost half the paperwork on one of the incidents. It was a real mess.

I really hope it all works out in the end.

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