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PRINTED: 02/06/2018FORM APPROVEDHealth Regulation & Licensing AdministrationSTATEMENT OF DEFICIENCIESAND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CLIAIDENTIFICATION NUMBER:BRINTON WOODS HEALTH & REHAB CENTERAT DUPONT CIRC(X4) IDPREFIXTAGA. BUILDING:(X3) DATE SURVEYCOMPLETEDB. WINGHFD02-0001NAME OF PROVIDER OR SUPPLIER(X2) MULTIPLE CONSTRUCTION01/16/2018STREET ADDRESS, CITY, STATE, ZIP CODE2131 O STREET NWWASHINGTON, DC 20037SUMMARY STATEMENT OF DEFICIENCIES(EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORYOR LSC IDENTIFYING INFORMATION)L 051 Continued From page 2PROVIDER'S PLAN OF CORRECTION(EACH CORRECTIVE ACTION SHOULD BECROSS-REFERENCED TO THE APPROPRIATEDEFICIENCY)IDPREFIXTAG(X5)COMPLETEDATEL 051(b)Reviewing medication records for completeness,accuracy in the transcription of physician orders,and adherences to stop-order policies;(c)Reviewing residents' plans of care forappropriate goals and approaches, and revisingthem as needed;(d)Delegating responsibility to the nursing staff fordirect resident nursing care of specific residents;(e)Supervising and evaluating each nursingemployee on the unit; and(f)Keeping the Director of Nursing Services or his orher designee informed about the status of residents.This Statute is not met as evidenced by:Based on resident and staff interviews and recordreview for six (6) of nine (9) sampled residents, thecharge nurse failed to update/revise thecomprehensive care plan with goals andapproaches to address the following: three (3)residents with aggressive behaviors towards otherresidents, to discontinue care plans that did notaccurately reflect one (1) resident's current healthcare needs, to address behavioral health careneeds for one (1) resident and to address the useof a cardiac care device for one (1) resident.Residents' #87, 130, 216, 141, 149 and 367.Findings included.1. Resident # 87 care plan has beenreviewed and updated to reflect goalsand approaches related to resident’saggressive behaviors documented07/29/2017 & 09/12/2017.1. The charge nurse failed to update the care planto address physical aggressive behaviors ofResident # 87.Health Regulation & Licensing AdministrationSTATE FORM68997O2O11If continuation sheet 3 of 19

PRINTED: 02/06/2018FORM APPROVEDHealth Regulation & Licensing AdministrationSTATEMENT OF DEFICIENCIESAND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CLIAIDENTIFICATION NUMBER:BRINTON WOODS HEALTH & REHAB CENTERAT DUPONT CIRC(X4) IDPREFIXTAGA. BUILDING:01/16/2018STREET ADDRESS, CITY, STATE, ZIP CODE2131 O STREET NWWASHINGTON, DC 20037SUMMARY STATEMENT OF DEFICIENCIES(EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORYOR LSC IDENTIFYING INFORMATION)L 051 Continued From page 3PROVIDER'S PLAN OF CORRECTION(EACH CORRECTIVE ACTION SHOULD BECROSS-REFERENCED TO THE APPROPRIATEDEFICIENCY)IDPREFIXTAGL 051Review of the Nursing Progress notes for Resident# 87 revealed:"On July 29, 2017, at 15:39, Resident #87 used herfoot to kick [Resident #83's] wheel chair after beingverbally aggressive towards the resident in the maindining room. Resident #87 stated that she kicked[Resident #83's] wheelchair because "He .reportedme .to the social workers that I bought a cigarettefrom store and I keep cigarettes .After theincident immediately both residents were separatedand removed to different areas of the facility ."(X5)COMPLETEDATEResident # 130 report of “beingthreatened by roommate” has beeninvestigated, documented andreported to state to state agency.Resident # 130’s person centeredcare plan has been initiated toreflect interventions and services toattain or maintain resident’s highestpracticable physical, mental, andpsycho-social well being.Resident # 216 care plan has beenreviewed and updated with newgoals and approaches to addressresident’s physical aggressivebehavior documented 12/20/2017."On September 12, 2017, at 17:10 [5:10 PM],"[Resident #87] was interviewed re: complaint bynurse that she refused to allow another resident(Resident # 40) to enter her room and hit her in theface with a bag that has items from the Gift Shop.[Resident #87] .admitted that she did hit her as sheplays in the water in the bathroom and no one doesanything about it. Further-the-more, the facility[can't] put her out as she knows her Rights ."Resident # 141 inaccurate careplans for anticoagulation related toAtrial Fibrillation and impaired skinintegrity has been discontinued.Resident # 149 medical records hasbeen reviewed to ensure thatpsychiatric follow up notes andrecommendations are availablewith notes to confirm resident’s IDTmeetings.A review of Resident # 87's care plan with a focusarea entitled, " .Potential to display aggressivebehavior including verbal abuse and kicked anotherresident wheelchair .by using her feet ." careplan was not updated with new goals and newinterventions to address Resident # 87's behaviorafter she kicked another resident and after she hitanother resident in the face with a bag thatcontained items from the gift shop.Care plan was reviewed andupdated to address resident’sbehavioral health care needs andpsychosocial well-being.During a face-to-face interview with EmployeeHealth Regulation & Licensing AdministrationSTATE FORM(X3) DATE SURVEYCOMPLETEDB. WINGHFD02-0001NAME OF PROVIDER OR SUPPLIER(X2) MULTIPLE CONSTRUCTION68997O2O11If continuation sheet 4 of 19

PRINTED: 02/06/2018FORM APPROVEDHealth Regulation & Licensing AdministrationSTATEMENT OF DEFICIENCIESAND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CLIAIDENTIFICATION NUMBER:BRINTON WOODS HEALTH & REHAB CENTERAT DUPONT CIRC(X4) IDPREFIXTAGA. BUILDING:01/16/2018STREET ADDRESS, CITY, STATE, ZIP CODE2131 O STREET NWWASHINGTON, DC 20037SUMMARY STATEMENT OF DEFICIENCIES(EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORYOR LSC IDENTIFYING INFORMATION)L 051 Continued From page 4PROVIDER'S PLAN OF CORRECTION(EACH CORRECTIVE ACTION SHOULD BECROSS-REFERENCED TO THE APPROPRIATEDEFICIENCY)IDPREFIXTAG(X5)COMPLETEDATEL 051Resident # 367 no longer resides inthe facility.#16 on January 12, 2018, at approximately 11:22AM, he acknowledged that the care plan was notupdated to include interventions to monitor Resident#87's aggressive behavior and to protect the otherresidents.2. Facility residents have the potentialto be affected.Nurse Managers will completefacility wide audit of residents’medical records to ensure thatresidents care plans arecomprehensive reflecting accurateclinical and psycho-socialpresentation of residents.3. Staff Development Coordinator willin-service IDT members on theimportance of timely andaccurately completingcomprehensive care plans forresidents to meet residents’ clinicaland psycho-social needs.4. Director of nursing will conductrandom audit of resident’s medicalrecords daily during clinical roundsto ensure that resident’s care plansmeet state guidelines and IDTmeetings are documented. Auditresults will be reported to QAcommittee monthly for threemonths.2. Charge Nurse failed to develop a care plan tomeet the goals and approaches to address aresident with behaviors. Resident #130.During an interview on January 9, 2018, at 12:36PM with Resident #130, the Resident stated, "threemonths ago I was threatened by my roommate; Ioverheard him say he was going to stab me in myback." "He needed a lot of care, and the nurseswould come in all through the night and this woulddisturb my sleep, and I did not like that, they movedhim, and I had to sign a contract."A review of Resident #130 medical record showed aSocial Work Progress Note with a date ofSeptember 12, 2017, "Decision was made totransfer roommate as both had made threats toeach other and [Resident #130] will remain in theroom effective 9/12/17, as each resident have aright to safety, comfort, and care". "He wasintroduced to his new roommate and was told thiswill be the last chance of moving anybody awayfrom the room he may be the next to move becausethis is the third resident moved from the room."During an interview on January 12, 2018, atapproximately 10:00 AM with Employee #13, NurseManager, "I know of one incident where the residentreported that they keep giving his roommatemedication every 4 hours and it was interfering withhis sleep, the social worker wasHealth Regulation & Licensing AdministrationSTATE FORM(X3) DATE SURVEYCOMPLETEDB. WINGHFD02-0001NAME OF PROVIDER OR SUPPLIER(X2) MULTIPLE CONSTRUCTION68997O2O112/28/18If continuation sheet 5 of 19

PRINTED: 02/06/2018FORM APPROVEDHealth Regulation & Licensing AdministrationSTATEMENT OF DEFICIENCIESAND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CLIAIDENTIFICATION NUMBER:BRINTON WOODS HEALTH & REHAB CENTERAT DUPONT CIRC(X4) IDPREFIXTAGA. BUILDING:(X3) DATE SURVEYCOMPLETEDB. WINGHFD02-0001NAME OF PROVIDER OR SUPPLIER(X2) MULTIPLE CONSTRUCTION01/16/2018STREET ADDRESS, CITY, STATE, ZIP CODE2131 O STREET NWWASHINGTON, DC 20037SUMMARY STATEMENT OF DEFICIENCIES(EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORYOR LSC IDENTIFYING INFORMATION)L 051 Continued From page 5PROVIDER'S PLAN OF CORRECTION(EACH CORRECTIVE ACTION SHOULD BECROSS-REFERENCED TO THE APPROPRIATEDEFICIENCY)IDPREFIXTAG(X5)COMPLETEDATEL 051involved, and a contract was signed, the care plancould say more about how we will maintain residentsafety." At the time of the review, there is nodocumented evidence of harm to the resident.A review of Resident#130's medical record lackedevidence of a person-centered care plan withinterventions and services to attain and or maintainthe resident's highest practicable physical, mentaland psychosocial well-being.3. The charge nurse failed to update the care planto address physical aggressive behaviors ofResident #216.A review of the Nursing Progress note with a date ofDecember 20, 2017, at 12:42 PM revealed, "Atabout 8:45 AM this morning resident wasapproached while she was in her room withcomplaints of having attacked [Resident # 120] .byapproaching her bedside, pulling away her curtains,and seizing her water pitcher and splashing wateron her, her bed and on the floor ."A review of the care plan with a focus area entitled ".Potential to demonstrate physical aggressivebehaviors r/t (related to) anger, poor impulse control." was not revised with new goals and newinterventions to address Resident # 216's behaviorafter she attacked another resident.During a face-to-face interview with Employee #26on January 12, 2018, at approximately 11:22 AM,she acknowledged that the care plan was notupdated to include interventions taken to monitorResident #216's aggressive behavior and to protectthe other resident.Health Regulation & Licensing AdministrationSTATE FORM68997O2O11If continuation sheet 6 of 19

PRINTED: 02/06/2018FORM APPROVEDHealth Regulation & Licensing AdministrationSTATEMENT OF DEFICIENCIESAND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CLIAIDENTIFICATION NUMBER:BRINTON WOODS HEALTH & REHAB CENTERAT DUPONT CIRC(X4) IDPREFIXTAGA. BUILDING:(X3) DATE SURVEYCOMPLETEDB. WINGHFD02-0001NAME OF PROVIDER OR SUPPLIER(X2) MULTIPLE CONSTRUCTION01/16/2018STREET ADDRESS, CITY, STATE, ZIP CODE2131 O STREET NWWASHINGTON, DC 20037SUMMARY STATEMENT OF DEFICIENCIES(EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORYOR LSC IDENTIFYING INFORMATION)L 051 Continued From page 7PROVIDER'S PLAN OF CORRECTION(EACH CORRECTIVE ACTION SHOULD BECROSS-REFERENCED TO THE APPROPRIATEDEFICIENCY)IDPREFIXTAG(X5)COMPLETEDATEL 051An observation on January 9, 2018, at 10:00 AMshowed resident lying in bed with bed sheetcovering his face and Resident stated: "I don't wantto be interviewed, just go."During an interview on January 9, 2018, at 11:30AM, Employee #31, Registered Nurse, stated," Ihave been working with the resident for the past twoweeks, and I try to converse with him but he alwaysturns his face, and he is always angry and talks withanger to all the staff that work with him. He refusesdialysis, and his sister has to convince him to go, heonly gets out of bed to go to dialysis, and he doesnot talk to his roommate or participate in activities. Itseems like once he started dialysis, he became likethis, he is not verbally abusive, but he talks toeveryone with anger, he never threatened staff, andhe eats well and takes his medications, but I am notsure if they put in for a psychiatric consult."During an interview on January 9, 2017, at 1:30 PM,Employee #13, Clinical Manager, stated, "yes, Iknow that they put in for a psychiatric consult theycome to see him, but they sometimes don't put thenotes in the chart." They have IDT (interdisciplinaryteam) meetings, but I am not sure if the notes are inthe chart, or if there is an updated care plan in thechart. "I am glad that you are saying this now sothat we can know what to do."The facility staff did not provide evidence of IDTmeetings or a person-centered care plan withinterventions to support the resident's behavioralhealth.A review of Resident #149 medical record showed,a Progress Note with a date of January 16, 2018,with the following diagnoses: Chronic KidneyDisease, Stage 3, Hemiplegia andHealth Regulation & Licensing AdministrationSTATE FORM68997O2O11If continuation sheet 8 of 19

PRINTED: 02/06/2018FORM APPROVEDHealth Regulation & Licensing AdministrationSTATEMENT OF DEFICIENCIESAND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CLIAIDENTIFICATION NUMBER:BRINTON WOODS HEALTH & REHAB CENTERAT DUPONT CIRC(X4) IDPREFIXTAGA. BUILDING:(X3) DATE SURVEYCOMPLETEDB. WINGHFD02-0001NAME OF PROVIDER OR SUPPLIER(X2) MULTIPLE CONSTRUCTION01/16/2018STREET ADDRESS, CITY, STATE, ZIP CODE2131 O STREET NWWASHINGTON, DC 20037SUMMARY STATEMENT OF DEFICIENCIES(EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORYOR LSC IDENTIFYING INFORMATION)L 051 Continued From page 9PROVIDER'S PLAN OF CORRECTION(EACH CORRECTIVE ACTION SHOULD BECROSS-REFERENCED TO THE APPROPRIATEDEFICIENCY)IDPREFIXTAG(X5)COMPLETEDATEL 051Resident # 367's was admitted to the facility afterCoronary Artery Bypass Grafting (CABG) on12/18/2017.Further review of resident physician's order with adate of 12/29/2017 showed "wear cardiac huggerand do not lift anything greater than 5lbs (pounds)for 2 months from date of surgery (12/20/17)".The resident's care plan initiated 12/28/2017, lackedevidence the care plan was revised to include goalsand approaches to managing the resident's cardiaccare to include applying cardiac hugger and weightlifting limitations.Employee #3 acknowledged the findings during aface-to-face interview on January 16, 2018, atapproximately 10:00 AM.L 056 3211.5 Nursing Facilities1. Additional registered nurses/ APRNL 056Beginning January 1, 2012, each facility shallprovide a minimum daily average of four and onetenth (4.1) hours of direct nursing care per residentper day, of which at least six tenths (0.6) hours shallbe provided by an advanced practice registerednurse or registered nurse, which shall be in additionto any coverage required by subsection 3211.4.were added to the daily staffingschedules to provide a minimumdaily average of four and one tenthhours of direct nursing care perresident per day of which at least sixtenth hours are provided by aregistered nurse/ APRN.2. As all residents have the potential ofbeing affected by this deficientpractice, none were affected.3. The Administrator or designee willeducate the staffing coordinator onthe important of keeping the Dailynursing schedule NHPPD at 4.1 with.06 provided by RN’s or APRN’s. TheStaffing Coordinator or designee willcheck the Nursing Schedule daily forcompliance.This Statute is not met as evidenced by:Based on record review and staff interview during areview of staffing [direct care per resident dayhours], it was determined that facility staff failed tomeet 0.6 [six tenth] hour for RegisteredNurses/APRN [Advanced Practice RegisteredHealth Regulation & Licensing AdministrationSTATE FORM68997O2O11If continuation sheet 10 of 19

PRINTED: 02/06/2018FORM APPROVEDHealth Regulation & Licensing AdministrationSTATEMENT OF DEFICIENCIESAND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CLIAIDENTIFICATION NUMBER:BRINTON WOODS HEALTH & REHAB CENTERAT DUPONT CIRC(X4) IDPREFIXTAGA. BUILDING:(X3) DATE SURVEYCOMPLETEDB. WINGHFD02-0001NAME OF PROVIDER OR SUPPLIER(X2) MULTIPLE CONSTRUCTION01/16/2018STREET ADDRESS, CITY, STATE, ZIP CODE2131 O STREET NWWASHINGTON, DC 20037SUMMARY STATEMENT OF DEFICIENCIES(EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORYOR LSC IDENTIFYING INFORMATION)L 067 Continued From page 12PROVIDER'S PLAN OF CORRECTION(EACH CORRECTIVE ACTION SHOULD BECROSS-REFERENCED TO THE APPROPRIATEDEFICIENCY)IDPREFIXTAGL 067A comprehensive on-going in-service educationprogram shall be provided by the facility and shallinclude training on the provision of resident care.This Statute is not met as evidenced by:1. Based on staff interview and review of thefacility's documentation for newly hired employees,the facility staff failed to ensure three (3) of 35 newlyhired employees were trained on abuse prior tointeracting and caring for residents in the facility.Findings included.A review of the "Abuse Prevention Program" revisedDecember 2016 stipulates, "Require stafftraining/orientation programs that include suchtopics as abuse prevention, identification, andreporting of abuse, stress management, andhandling verbally or physically aggressive residentbehavior."A review of the facility's documentation listing thenewly hired employees within the past four (4)months revealed the following:1. Employees #28, #29, and, #30received abuse training after workedcaring for residents as identified inthe citation.No report of negative outcomereceived or noted due to thisdeficient practice.2. Human resource director completedaudit of newly hired employees. Noother employee found to be indeficient practice.3. Administrator will provide educationto Staff Development and HRDirector on the importance ofproviding abuse training to staff priorto interacting and caring forresidents in the facility.4. Director of nursing will conduct auditof newly hired employees monthly toensure compliance for three monthsand report results of the audits to QAcommittee for further review.(X5)COMPLETEDATE2/28/18A. Employee #28's hire date was September 26,2017; she received orientation on October 17, 2017.According to t

brinton woods health & rehab center at dupont circ street address, city, state, zip code 2131 o street nw washington, dc 20037 provider's plan of correction (each corrective action should be cross-referenced to the appropriate deficiency) (x5) complete date id prefix tag (x4) id prefix tag summary statement of deficiencies