cms_GA: 3467

In collaboration with The Seattle Times, Big Local News is providing full-text nursing home deficiencies from Centers for Medicare & Medicaid Services (CMS). These files contain the full narrative details of each nursing home deficiency cited regulators. The files include deficiencies from Standard Surveys (routine inspections) and from Complaint Surveys. Complete data begins January 2011 (although some earlier inspections do show up). Individual states are provides as CSV files. A very large (4.5GB) national file is also provided as a zipped archive. New data will be updated on a monthly basis. For additional documentation, please see the README.

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rowid facility_name facility_id address city state zip inspection_date deficiency_tag scope_severity complaint standard eventid inspection_text filedate
3467 SCOTT HEALTH & REHABILITATION 115671 12 SMITH LANE ADRIAN GA 31002 2017-09-21 329 D 0 1 VM8J11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, clinical record review and staff interview the facility failed to ensure behavior monitoring was reviewed and utilized regarding an attempt at gradual dose reductions for an antipsychotic medication for Residents (R#7 and R#52). This affected 2 residents of 5 reviewed regarding unnecessary medications. Findings include: 1. R#7 had [DIAGNOSES REDACTED]. The medical record current Physician order [REDACTED]. The medication had no attempted gradual dose reductions since the order date. The medical record Minimum Data Set (MDS) quarterly assessment dated [DATE] (Section C) regarding cognitive status, revealed the resident's Brief Interview for Mental Status (BIMS) score was five out of a possible 15, which indicated the resident was severely cognitively impaired. The MDS also revealed the resident received antipsychotic medication. The MDS quarterly assessment dated [DATE] revealed the BIMS was a score of seven out of 15, which indicated the resident was severely cognitively impaired. The medical record Care Plan dated 7/5/17 revealed [MEDICAL CONDITION] drug use due to [MEDICAL CONDITION]. The Care Plan dated 7/5/17 revealed the resident had a cognitive deficit with decision making. The medical record Behavior Monitoring forms dated 7/1/17 through present revealed the resident had 19 episodes of delusions, impulsive aggression, purposeful vomiting. The monitoring forms revealed 14 of the episodes had a positive response to non-pharmacological interventions. R#7 was observed in the wheelchair in the dining room on 9/18/17 at 12:40 p.m., eating lunch independently and was further observed in the wheelchair in her room on 9/19/17 at 9:20 a.m., She was not observed exhibiting any behaviors according to the Behavior Monitoring forms documentation. An interview with the Regional Registered Nurse (RRN) on 9/20/17 at 3:30 p.m. verified there were no gradual dose reductions attempted for the [MEDICATION NAME] (an antipsychotic) since the order on 11/19/10. The facility policy regarding Monitoring of Antipsychotics, updated (MONTH) (YEAR) indicated .the continued use of an antipsychotic medication is reassessed monthly by the responsible physician.The gradual dose reduction is attempted with all patients who receive antipsychotic medications. 2. Review of the medical record for R#52 revealed [DIAGNOSES REDACTED]. The medical record current Physician order [REDACTED]. There were no attempted gradual dose reductions since the medication had been ordered. The medical record quarterly MDS assessments date 5/9/17 and 8/4/17 revealed the BIMS (Section C) was unable to be performed due to the resident was unable to respond. In (Sections D and E) which reflect mood and behavior, indicated the resident had hallucinations and delusions, however exhibited no mood or behaviors and was rarely or never understood. The medical record Care Plan dated 8/16/17 revealed .the resident should be monitored for side effects related to [MEDICAL CONDITION] side effects. The care plan dated 8/16/17 indicated .the resident had a cognitive deficit associated with dementia evidenced by the inability to communicate. The care plan dated 8/16/17 revealed .the resident had a self-care deficit that required total care by the staff for activities of daily living. Observations of R#52 were made on 9/18/17 at 12:30 p.m., in the dining room. The resident was in a cushioned high back chair being fed a pureed lunch by the staff. The resident was eating without difficulty. The resident was in the high back cushioned chair in her room on 9/19/17 at 9:15 a.m. Very little verbalization then she shut her eyes. On 9/20/17 at 10:30 a.m., an interview with the RRN verified the Behavior Monitoring forms for (MONTH) (YEAR) through present revealed the resident had nine episodes of reaching for things in front of her that were not there. The Behavior Monitoring forms indicated there were non-pharmacological interventions which had a positive effect on the resident. She verified there had been no gradual dose reductions since the order on 4/29/15. R#52 was observed on 9/20/17 at 11:30 a.m., in the high back cushioned chair in her room with her eyes closed. The Licensed Practical Nurse (LPN) AA spoke to the resident about glucose testing and insulin administration. The resident spoke a few words that were not comprehensible. The resident closed her eyes after receiving the insulin. An interview with LPN AA at 11:40 a.m., revealed the resident had a pleasant demeanor and preferred to sleep. The resident was observed on 9/20/17 at 12:20 p.m., in a chair in the dining room at the table. An aide was sitting next to the resident feeding her the pureed lunch. The resident was observed to be cooperative and did not speak. The facility policy regarding Monitoring of Antipsychotics, updated (MONTH) (YEAR) indicated .the continued use of an antipsychotic medication is reassessed monthly by the responsible physician.The gradual dose reduction is attempted with all patients who receive antipsychotic medications. 2020-09-01