cms_GA: 5829

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
5829 WESTBURY CONYERS, LLC 115469 1420 MILSTEAD ROAD CONYERS GA 30012 2015-01-15 332 D 0 1 2C2411 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, staff and Pharmacist interview, the facility failed to ensure the medication error rate was less than five per cent (5%). There were three (3) errors observed with twenty-seven (27) opportunities by one (1) of four (4) nurses on one (1) of eight (8) halls, for a med error rate of eleven and eleven one-hundreds per cent (11.11%). Findings include: On 01/14/15 at 8:57 a.m., Registered Nurse (RN) AA was observed preparing resident #6's morning medications on the Terrace Unit, and the following concerns were noted: 1. After giving resident #6 the oral inhalation medication, [MEDICATION NAME], RN AA was observed to wait only eight seconds before giving a different oral inhalation medication, [MEDICATION NAME]. After exiting the resident's room at 9:26 a.m., RN AA was asked how long she waited between giving puffs of the [MEDICATION NAME] and [MEDICATION NAME], and she responded a few seconds. 2. RN AA was observed to give resident #6 one tab of Oyster Shell Calcium with Vitamin D. Later review of the physician's orders [REDACTED]. 3. RN AA was observed to give resident #6 one drop to each eye of [MEDICATION NAME] Lubricant eye drops. Later review of the physician's orders [REDACTED]. Interview with RN AA on 01/14/15 at 1:30 p.m., she verified that the eye drops order for resident #6 was for [MEDICATION NAME] Balance solution, and that she gave [MEDICATION NAME] Lubricant eye drops. Upon further interview, she stated the [MEDICATION NAME] must have come from the facility's stock supply, as it did not have a Pharmacy label on it. RN AA verified that the calcium she gave to resident #6 contained Vitamin D, and was unable to locate any Calcium without Vitamin D in her medication cart. Observation of the facility's central medication room on 01/14/15 at 1:47 p.m., revealed the only [MEDICATION NAME] eye drops they stocked was the [MEDICATION NAME] Lubricant; this was verified during interview with Central Supply employee CC. Observation of the Terrace Unit medication room with Central Supply employee CC on 01/14/15 at 2:14 p.m., she pointed out that a bottle of Oyster Shell Calcium without Vitamin D was available for staff to use. Interview with Pharmacist DD on 01/14/15 at 2:05 p.m. revealed that [MEDICATION NAME] Balance eye drops had a higher concentration of the active ingredient than [MEDICATION NAME] Lubricant eye drops, and therefore should not be used interchangeably. Review of the facility's Westbury Senior Care Pharmacy Policies and Procedures noted the following for Oral Inhalation Administration: Wait one (1) to two (2) minutes (after giving an inhaled medication) before administering the next inhaled medication. Interview with the Director of Nursing on 01/14/15 at 3:03 p.m., she stated that nurses should wait three to five minutes between inhaled medications. 2018-05-01