cms_DE: 83

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.

This data as json, copyable

rowid facility_name facility_id address city state zip inspection_date deficiency_tag scope_severity complaint standard eventid inspection_text filedate
83 BRANDYWINE NURSING & REHABILITATION CENTER 85004 505 GREENBANK ROAD WILMINGTON DE 19808 2017-07-19 279 D 1 1 ZBS111 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on clinical record review and interview it was determined that the facility failed to develop and implement a comprehensive person-centered care plan for one (R204) out of 55 residents sampled, that includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment. The facility failed to identify that R204 was at risk for dehydration and they failed to care plan accordingly. Findings include: Review of R204's clinical record revealed the following: 12/29/16 - R204 was admitted to the facility with [DIAGNOSES REDACTED]. 12/29/16 - The admission Nutritional Assessment stated, .Estimated Nutritional Requirements: Fluid (ml) 1400-1700 (amount required per 24 hours) .no nutritional problems at present .Current diet regular/thins/NAS .Resident dines independently with % meal completion 75%. Per nursing, appetite good . 12/29/16 - The nursing admission assessment stated R204 appeared well nourished, had a good appetite, and was alert, but uncooperative and combative. 12/29/16 - A care plan for the problem Unable to do own ADLs without assistance stated R204 required supervision while eating and nursing was to assist the resident with meal tray and feeding if necessary. Additionally, a care plan for the problem Resident at nutritional risk was developed which included approaches to provide diet/meals as ordered, monitor food and fluid preferences, encourage food and fluid intake, provide assistance as needed with food/fluids, and monitor for signs of diet intolerance. 1/4/17 - The admission MDS assessment stated R204 had short and long term memory problems, was moderately impaired for daily decision making skills (decisions poor; cues/supervision required), and was exhibiting behaviors daily. Additionally, the MDS stated R204 required extensive assistance of one staff person for walking in her room and corridor, dressing, toilet use, hygiene and bathing. R204 was identified as requiring supervision and set up help for eating. Although the CAA summary did not trigger the area of dehydration/fluid maintenance as a potential problem area, the facility failed to identify that R204 was at risk for dehydration due to her declining cognitive status and they failed to care plan accordingly. 1/5/17 3:19 PM - A nurse's progress note stated the resident had a new order to encourage fluids every shift. Review of the corresponding MAR indicated [REDACTED]. This order did not identify how much fluid was to be encouraged, nor was there any consistent documentation as to whether R204 was accepting fluids and how much? A care plan was not developed for R204's risk for dehydration. Findings were confirmed by E1 (NHA) and E2 (DON) during an interview on 7/17/17 at approximately 4:20 PM. 2020-09-01