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32 | On R1’s physician’s report dated 8/18/2022, it indicates R1 had a history of a kidney transplant and diabetes. The report is incomplete, with no marks about R1’s ability to complete Activities of Daily Living, including bathing self, dress/groom self, feed self, care for own toileting needs, and able to manage own cash resources. R1’s service plan dated 9/21/2022 states R1 may require stand-by assistance for ambulation, needs assistance with bathing twice a week, and needs assistance with application and removal of support stockings. There is no indication R1 needed assistance with toileting. R1’s updated assessment dated 10/20/2022 indicates they are alert and oriented, had no neurocognitive issues, and do not require additional status checks. R1 also handled some of their own medications, including insulin.
LPA reviewed incident reports for the facility for November and December 2022. LPA observed an incident report notifying CCL that R1 had COVID-19, but did not observe any other incident reports. LPA reviewed documentation from R1’s facility. The facility notified R1’s Primary Care Physician (PCP) of a fall on 11/1/2022 where the resident had no injuries, nor complaints of pain or discomfort, so they were not sent to the hospital. On 11/4/2022, R1 slid off their bed but stated they did not hit their head. On 11/7/2022, R1 had a fall and refused to go to the hospital. On 11/3/2022, 11/10/2022 and 11/16/2022, R1 was seen by home health where they provided bladder irrigation. The facility notified R1’s Primary Care Physician (PCP) that R1 tested positive for COVID-19 on 11/17/2022. R1 isolated in their apartment at the facility for 10 days. Charting notes for R1 indicate on 11/7/2022 on the PM shift R1 was weak, sleepy, with body aches, cough and runny nose. R1 went to the hospital to receive an IV infusion and returned. On 11/19/2022 R1 stated they “feel okay.” On 11/22/2022 R1 did not have any complaint of pain or discomfort. The other entries between 11/17/2022 and 11/26/2022 indicate R1’s temperature, heart rate, and oxygen saturation.
Charting notes for R1 indicate on 11/28/2022 during the PM shift, a visitor observed R1 to be more confused than normal. Staff checked on R1 and found them shaky with swollen feet and feeling nausea; 911 was called and paramedics found R1’s blood sugar to be high. Paramedics instructed R1 to take their insulin, which they forgot to do at lunchtime. R1 and paramedics agreed not to send R1 to the hospital, and R1 felt better after taking insulin. R1 was checked on multiple times during the shift. The overnight shift reported R1 stated they were doing better. On the morning of 11/29/2022, R1 woke up late and staff reminded R1 to take their medications and food. In the evening, R1 was wheeling self around the room putting clothes away.
Please continue to 9099-C, Pg 3.
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