cms_SC: 123

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
123 ELLEN SAGAR NURSING CENTER 425012 1817 JONESVILLE HIGHWAY UNION SC 29379 2019-11-10 686 D 0 1 NAMT11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and medical record review, the facility failed to identify and treat a wound on the coccyx as a pressure ulcer for one of two residents reviewed for pressure ulcers (Resident #82). The findings included: On 11/09/19 at 11:30 AM, wound care was observed on Resident #82 with Registered Nurse/Wound Care (RN #21) and Certified Nurse Assistant (CNA #53). The wound was located on the coccyx with an open area on the right buttocks. The skin surrounding the open area showed scarring from a healed pressure ulcer. The open area was approximately 3 centimeters (cm) long x 0.25 cm wide X 0.02 cm deep. The area on the left buttocks was superficial but reddened. RN #21 applied a skin barrier ointment to the area. No drainage or odor were noted. When asked if the resident felt pain at the site, she stated, It's pretty sore. An interview with RN #21 on 11/09/19 at 1:35 PM revealed that she identified the wound as shearing rather than a pressure ulcer. She stated that the resident stayed up in her wheelchair most of the day. She stated that she encouraged the resident to stay off of that area as much as possible by lying down in bed instead of in her wheelchair. She stated that she had tried multiple forms of treatment based on standing orders. She stated that she had discussed it with the physician and the nurse practitioner but neither of them had visualized the wound. The wound was first noted on 09/24/19. RN #21 stated that she became aware of the open area when the resident asked her to look at her buttocks because she was having pain. RN #21 stated that she had not asked the physician or the nurse practitioner to observe the wound. She stated that there was no order or policy for when the physician or nurse practitioner should be asked to visualize the wound when it was not improving. A second interview with RN#21 on 11/10/19 at 10:40 AM revealed that Resident #82 had been put on the list to be seen by the nurse practitioner the following day when making rounds. She also stated that the resident had a cushion in her WC before the breakdown occurred, but a different type was ordered after the breakdown. An interview was done with the Director of Nursing (DON) and the nursing home administrator (NHA) about the wound on 11/09/19 at 2:20 PM. The NHA is also an RN. Both the NHA and the DON stated that they had not observed the wound on Resident #82. A review of the medical records showed the following physician orders [REDACTED].#21 and signed by either the physician or the nurse practitioner: 09/24/19 - Apply Duoderm to right buttocks/sacral area. Change q (every) 5 days and PRN (as needed) soiled. 09/26/19 - 1) Discontinue PRN order for buttock wound care. 2) Start: Apply foam dressing to open wound and secure (with) tape/bandaid, change every 3 days and PRN if soiled. 3) Place Geomat 4 WC (wheelchair) cushion in WC. 10/02/19 - 1) Discontinue prior R (right buttock wound orders. 2) Start: Clean with saline and pat dry. 2) Apply skin prep to periphery. Apply small border foam drsg (dressing). Change on shower days and PRN if soiled or non-occlusive. 3) Continue 4 Geomat WC cushion when in WC. 10/06/19 - Body wedge for positioning and coccyx pressure relief while in bed. 10/09/19 - 1) Discontinue all previous wound care. 2) Start: Wound care to buttocks every 3 days and PRN if soiled. Clean with saline and pat dry. Apply [MEDICATION NAME] (cut to size) to each area. Secure with [MEDICATION NAME] tape. 3) Start wound care to left anterior lower every 7 days and PRN if non-occlusive. Clean with NS (normal saline) and pat dry. Apply skin prep to periphery. Apply [MEDICATION NAME]. 4) Left elbow healed - maintain [MEDICATION NAME] x 1 wk (week) then DC. 10/16/19 - D/C previous tx (treatment) to buttocks. Tx to (upper) buttocks fold: Duoderm q 7 ds (days) and PRN soiled. 11/07/19 - 1) Discontinue all prior wound care to buttocks. 2) Start 2xday (twice a day): Clean areas with soap and water. Pat dry. Apply [MEDICATION NAME] paste. 3) Cont care to RLE (right lower extremity) as ordered. Most recent wound documentation sheet stated: 11/07/19 - location L & R buttocks areas on both sides of natural fold. Will use barrier cream as no success with [MEDICATION NAME]. Resident encouraged to stay off back and to take breaks from WC during the day. Wound type: shearing. Exudate: serous. Wound bed: normal for skin. Surrounding skin color: Normal for skin. Wound Edges/Surrounding tissue: Harness/induration. Weekly Nursing Summary: 10/27/19 Skin Condition: Pressure Ulcers (was checked), Location: BLE (bilateral lower extremities). 10/16/19 Area identified (upper) buttocks fold Description: R (right) 6 cm x 4 cm 'crusted'/open area, L (left) 1) 3 cm x 2 cm blistered area 3) 3 cm x 2 cm blistered area 2) 2.5 cm x 2 cm blister. 10/09/19(left side buttock marked) shearing 0.5 x 0.5 x 0.0; no odor, wound bed gray, surrounding skin dark red/purple blanchable Wound edges/surrounding tissue hardness/induration. 10/09/19 (right buttock marked) wound is macerated. Shearing and pinching (buttock to buttock) keeping area agitated. Encouraged resident to get out of WC q2h (every 2 hours) and to sleep on her side at night. She has a wedge for positioning. Cleaned and [MEDICATION NAME] applied/secured with [MEDICATION NAME] tape. Wound bed - slough yellow Wound Edges/Surrounding tissue - Hardness/induration, maceration. 09/26/19 (right buttock marked) - R of natural fold on buttock. Open area unchanged. Area just below is soft this AM (morning). Underside of right thigh and buttock does have a bruised appearance this AM. Foam bandage every 3 days and PRN. Will use 4 Geomat in WC. The most recent quarterly Minimum Data Set (MDS), dated [DATE], was not coded for a pressure ulcer. It was coded Moisture associated skin damage. 2020-09-01