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“LPN #5 indicated she had been exhausted and could no longer think.”

GOLDEN LIVING CENTER – BRENTWOOD

LOCATED: 30 EAST CHANDLER AVENUE, EVANSVILLE, IN 47713

GOLDEN LIVING CENTER – BRENTWOOD was cited by the DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES for the following deficiencies:

PLEASE NOTE: The following highlighted quoted text is only a portion of the full report/survey submitted by DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES. The full report/survey can be found here.

FACILITY FAILED TO LET THE RESIDENT REFUSE TREATMENT OR REFUSE TO TAKE PART IN AN EXPERIMENT AND FORMULATE ADVANCE DIRECTIVES

LEVEL OF HARM –IMMEDIATE JEOPARDY

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on interview and record review, the facility failed to have a system in place to determine code status for 2 of 2 residents who were not provided Cardiopulmonary Resuscitation. The facility failed to perform Cardiopulmonary Resuscitation (CPR) on a resident who had requested to be a full code. (Resident #51) The facility failed to obtain a valid code status for Resident #36.

On [DATE] at 3:30 p.m., LPN #5 was interviewed. LPN #5 indicated she had walked into the resident’s room and found him without evidence of vital signs and walked out to the nurse’s station to check the resident’s code status. LPN #5 indicated there was not an Advanced Directive in the resident’s chart. At that time, LPN #5 indicated she was unaware of how to proceed and contacted the physician. LPN #5 indicated the physician instructed her to make Resident #51 a DNR (Do Not Resuscitate). LPN #5 indicated she had not performed CPR on Resident #51. LPN #5 was asked to describe what should happen when a resident is found without vital signs. LPN #5 indicated one nurse should contact the physician and another nurse should retrieve the crash cart. When queried regarding who would initiate CPR and who would call for the emergency services, LPN #5 indicated the nurse who contacted the physician would call the emergency services. The nurse who retrieved the crash cart, should initiate CPR.

When queried regarding the late entry of charting surrounding Resident #51’s death, LPN #5 indicated she had been exhausted and could no longer think.

Personal Note from NHA-Advocates: NHAA shares with all the families of loved ones who are confined to nursing homes the pain and anguish of putting them in the care of someone else. We expect our loved ones to be treated with dignity and honor in the homes we place them. We cannot emphasize enough to family members of nursing home residents; frequent visits are essential to our loved ones’ well-being and safety. This nursing home and many others across the country are cited for abuse and neglect.

You can make a difference. If you have a loved one living in this nursing home or any other nursing home where you suspect any form of abuse or neglect, contact us immediately.

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One Response to ““LPN #5 indicated she had been exhausted and could no longer think.””

  1. vivian middleton says:

    My Sincere Condolences to the families of those involved. Every Patient(Resident) that is admitted to a Long Care Term Facility should ALWAYS have an Advance Directive. It is the duty of the Admitting Nurse to make sure that DNR status is confirmed either by patient or by family or Physician. As a retired Nurse of 30+yrs in the Medical Profession, I started out years ago in Long Term Care. This was before Advanced Directives were even talked about. However, in todays Medical Field EVERY NURSE has this knowledge. Each Nurse caring for a patient for any length of time should know if her patient is a DNR. There are some Nursing Homes that now place a small red sticker next to the name plate and it should always be on the front of the chart. This is a grievous mistake that could have been avoided. That is just my opinion. The excuses mentioned are NOT AN VALID EXCUSE. I spent a great deal of time as an Educator as well as a Trauma Nurse. My heart aches for those that we received from some of the nursing homes into the ER. I Pray that this Nursing Home changes it’s policies or enforces the ones already in place. This is not the first time I have heard about this facility. I Pray it will be the last.

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