department of health and human services centers for medicare ...

DEPARTMENT OF HEALTH AND HUMAN SERVICES
PRINTED: 10/24/2011
FORM APPROVED
CENTERS FOR MEDICARE & MEDICAID SERVICES OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
A. BUILDING
______________________
B. WING _____________________________
(X3) DATE SURVEY
COMPLETED
295037 03/04/2011
NAME OF PROVIDER OR SUPPLIER
HENDERSON HEALTHCARE CENTER
STREET ADDRESS, CITY, STATE, ZIP CODE
1180 E. LAKE MEAD DRIVE
HENDERSON, NV 89015
(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)
COMPLETION
DATE
F 248 Continued From page 19 F 248
February 2011 by the Activities Assistant,
revealed the resident received 14 visits from
Activities staff during the two-month period. Most
of the one-to-one visits lasted five minutes and
involved turning on the radio or TV, and some
conversation. For four visits, the Activities
Assistant massaged the resident's arm with
lotion. On two visits, the resident was sleeping.
The Activities Director (Employee #13) reported
on 3/3/11 at 1:00 PM, activity preferences for
Resident #19 were never reassessed, and family
members were not contacted for input into the
development of the resident's Activities Plan of
Care. The Activities Director confirmed attempts
were never made to have the resident go out of
his room for activities.
The Activities Director acknowledged an updated
Activities Evaluation and Care Plan, identifying
the resident's activity preferences, should have
been developed with the involvement of the
resident's family. The Director further
communicated one-to-one visits should occur at
least three times per week, and last at least 15
minutes.
The facility's Activities Policies and Procedures,
dated 2/2008, included the following protocols:
"Activity/Recreation programs are based on the
abilities, interests, and needs of the residents
expressed through the Activity individual
assessment; Resident's or resident's
representative(s) expressed needs and interests
are included in the development of programs;
Activity programs are designed based on
resident's leisure interests, and implemented to
address the needs (physical, cognitive, creative,
FORM CMS-2567(02-99) Previous Versions Obsolete
Event ID: J8O811
Facility ID: NVS263S If continuation sheet Page 20 of 68