cms_GA: 10533

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
10533 HARALSON NSG & REHAB CENTER 115431 315 FIELD STREET BREMEN GA 30110 2009-08-26 225 D     FH9411 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and staff interview the facility failed to ensure that injuries of unknown origin and allegations of abuse were immediately reported to the facility Administrator and to the State survey and certification agency, and that these allegations were thoroughly investigated for two residents (#1 and "A") of twenty four (24) sampled residents. Findings include: 1. Observation of resident #1 on 8/25/09 at 3:20 p.m. during a skin assessment revealed that Certified Nursing Assistants (CNA) "AA" and "BB" identified that the resident had an extensive, deep purple bruise between the fourth and fifth toe on the right foot. It extended behind the toes on the bottom of the foot and on the top of the foot. The CNA's indicated that they did not know how or when this injury occurred. They added that they discovered the bruise while getting the resident out of bed yesterday (8/24/09) and reported it to Licensed Practical Nurse (LPN) "DD" as soon as it was discovered. Record review revealed that there was no mention of the bruise in the nurses notes for 8/24/09. LPN "CC", the Unit Manager, located a Nurse/Physician Communication Record dated 8/24/09 included documentation of "Client has bruised area to right little toe area, ran over toe when rolling in wheel chair". This Communication Record was signed by LPN "DD". A telephone interview with LPN "DD"on 8/25/09 at 4:50 p.m. revealed that he had not witnessed the event but had been told by the Risk Manager that she had witnessed the event. An interview with the Risk Manager on 8/25/09 at 5:05 p.m. revealed that she had seen the resident with his foot behind the wheel of the wheelchair mid-morning on 8/24/09. She was aware that the CNA's had discovered the bruise before the resident got up for the morning on 8/24/09. She added, that she did not witness the resident's foot being run over with the wheel chair and acknowledged that this was an unwitnessed injury of unknown origin that should have been reported to the State agency and investigated. 2. Review of the clinical record for resident "A", who was assessed on the Minimum Data Set ((MDS) dated [DATE] as cognitively intact, revealed a Nurses' Note dated 7/21/09 at 3:30 p.m. which documented the resident went to the nurses' station and reported she sustained a skin tear during an incontinent episode in the resident's bathroom. The note also referred to the discovery of a large skin tear to the lower left outer leg which was treated. A Nurse/Physician Communication Record dated 7/21/09 documented the resident received a large skin tear during a transfer. Further review of the record revealed a Post-Incident 72-Hour Follow-up record that described the incident by documenting the resident came to the desk stating "that boy grabbed my leg and pulled the hide off of it". The Director of Nursing (DON) was interviewed on 8/26/09 at 2:15 p.m. and stated she interviewed the Certified Nursing Assistant (CNA) the following day who assisted the resident and he was not aware an injury had occurred while he was assisting her, but stated it was possible when he picked up her legs to clean the floor. The DON was not aware of the documentation on the 72-Hour Incident Follow-up Record, but stated she would have treated it as an allegation of abuse had it been reported to her. The Risk Manager was interviewed on 8/26/09 at 2:00 p.m. and the Unit Manager was interviewed at 8:20 a.m. that morning. Both stated they were not aware this statement had been made, but both agreed they would have considered it an allegation of abuse. Five different nursing staff members signed and documented assessments of the resident during the 72-Hour Follow-up and did not report the incident as possible abuse to anyone in administration. 2014-04-01