cms_SD: 140

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
140	TEKAKWITHA LIVING CENTER	435038	6 E CHESTNUT	SISSETON	SD	57262	2017-08-24	315	E	0	1	V4R811	NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review, observation, interview, and policy review, the provider failed to prevent the reoccurrence of urinary tract infections [MEDICAL CONDITION] for two of two sampled residents (8 and 9) with a catheter by ensuring: Personal care was provided as per care plan or as provider's policy. Drainage bags were kept in a position to promote urine flow by gravity. Findings include: 1. Review of resident 8's complete medical record revealed: She was admitted on [DATE]. Her [DIAGNOSES REDACTED]. Her current care plan stated: -To check and change her brief every two hours and as needed. -To provide incontinence care after an incontinence episode. -Position foley catheter bag below the bladder. She was always incontinent of stool due to her MS and often had smears with peri-care. She leaked urine around her catheter tubing. Her certified nursing assistant (CNA) flow sheet did not mention catheter care. Observation on 8/22/17 at 12:45 p.m. with resident 8 revealed: CNA [NAME] emptied her foley catheter drainage bag and did not use an alcohol swab to clean the spout. Her foley catheter bag had been hanging on the footboard of the bed above her bladder. LPN G changed her adult brief, and she had a small bowel movement. No peri-care or catheter care was done. LPN G wiped her anal area. Observation on 8/23/17 at 9:20 a.m. with resident 8 revealed: LPN G had changed her coccyx dressing. The foley catheter bag had laid on the end of the bed, even with her bladder. Staff had left the room with the bag laying on the end of the bed between the resident's legs. Observation on 8/23/17 at 2:00 p.m. and at 3:30 p.m. with resident 8 revealed the foley catheter bag had been laid at the end of her bed between her legs. Observation and interview on 8/24/17 at 9:05 a.m. in resident 8's room with CNA F revealed she: Had emptied the urine out of the drainage bag. Had not used an alcohol swab to clean the end of the spout. Stated the resident's adult brief was dry. Had been hired in (MONTH) (YEAR). Stated the resident's catheter bag had always hung at the end of the bed, on the footboard, in a black drainage bag cover. Was not instructed to use an alcohol swab when emptying urine out of the drainage bag. Could not find alcohol wipes stored in the resident's room. Observation and interview on 8/24/17 at 9:20 a.m. in resident 8's room revealed: LPN G had changed the dressing on her coccyx wound. LPN G and CNA F were getting her adult brief and pants pulled up. When asked by this surveyor if her brief had been wet they took off her pants again and changed her brief. The brief was wet. No peri-care was done. Observation and interview on 8/24/17 at 9:45 a.m. of resident 9 revealed: The drainage bag was hanging on the footboard of her bed. -The tubing was threaded through her pant leg. CNA H stated: -She had emptied her drainage bag every two hours. -Her drainage bag would have hung on the end of the bed, on the top of the footboard, in the black drainage bag cover. -The tubing and the bag was higher than the resident's bladder. Interview and observation on 8/24/17 at 3:40p.m. of LPN G in resident 8's room revealed: She stated the foley catheter bag usually hung on the end of the bed on the foot board. She stated it was probably a little below the bladder. She agreed that it probably was not low enough. The tubing was threaded through the resident's pant leg. Her physician did not test for UTIs or treat them anymore, because she always had one. The tubing was not long enough to hang below her bladder level. 2. Review of resident 9's complete medical record revealed: Her [DIAGNOSES REDACTED]. She had been hospitalized in (MONTH) (YEAR) for a UTI that had grown out Pseudomonas. -She was lethargic. Family had mentioned to the physician that her foley catheter bag was not always BEING IN A DEPENDENT POSITION-ESPECIALLY WITH TRANSFERS. -The physician had written the above in her progress notes on 6/30/17. On 6/23/17 her physician had ordered Foley catheter care every shift, three times daily. Her care plan directs foley catheter care with every shift, three times daily. Foley catheter care was not documented thirty-three out of sixty-nine shifts in (MONTH) (YEAR) on the resident's CNA flow sheet. Observation on 8/22/17 at 8:15 a.m. with resident 9 revealed her Foley catheter bag had been laid at the end of her bed between her legs. Observation on 8/23/17 at 8:00 a.m. with resident 9 revealed her catheter bag had been laid at the end of her bed between her legs. Interview on 8/23/17 at 4:20 p.m. with CNA L revealed: The residents received peri-care in the morning and before bed. Usually did not have any care during the day with resident's with catheters. Review of the provider's undated Perineal Care policy revealed the nursing staff would have provided perineal care to residents twice daily and after each incontinence episode. Review of the provider's undated Care of Indwelling and Suprapubic Catheters revealed: The catheter tubing must have been placed so the urine could flow unobstructed. They were to ensure that the tubing had been above the level of the drainage bag. The drainage bag must have always stayed lower than the bladder to prevent back flow of urine into the bladder. Use an alcohol swab to cleanse the spout after having drained the bag. Cleanse around the catheter insertion area daily and at each brief change. Thoroughly cleanse the perineum after all bowel movements to prevent infection.	2020-09-01