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 311 Continued From page 45 F 311
documented that a R/A evaluation was completed
but was deferred at the time.
There were no other rehabilitation screenings,
assessments, treatments completed for 2010.
Resident #4's Rehabilitation Services Screening
Request signed by the physical therapy assistant
and dated 1/25/2011 documented under the
contractures section:
-"...B (bilateral) Ankles Foot Drop."
On the same form under Comments
documented:
"...Refer to R/A (restorative aid) ROM (range of
motion) and exe (exercises) and bed mobility."
On 3/3/2011, in the afternoon, the Director for
R/A services indicated that R/A services were not
initiated on Resident #4 because she did not
receive a communication form to initiate services.
On 3/4/2011, in the morning, the Director of
Rehabilitation Services indicated they have had a
communication problem and R/A staff may have
not received the information to start R/A services
for Resident #4. The Director of Rehabilitation
Services indicated quarterly screenings should be
performed for each resident. There was no
documented evidence quarterly screenings were
completed for Resident #4 after the initial one on
2/15/2010. The next rehabilitation screening was
completed 11 months later on 1/25/2011, which
possibly identified foot drop for Resident #4. R/A
services were referred but never initiated until the
surveyor informed the facility. The Director of
FORM CMS-2567(02-99) Previous Versions Obsolete
Event ID: J8O811
Facility ID: NVS263S If continuation sheet Page 46 of 68