cms_HI: 23

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
23 KULA HOSPITAL 125003 100 KEOKEA PLACE KULA HI 96790 2017-04-21 281 D 0 1 1M3411 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, staff interview and policy review, the facility failed to ensure the services being provided meet professional standards of quality according to accepted standards of clinical practice for 2 of 23 residents (Residents #43 and #76) in the Stage 2 sample. Finding includes: 1) During Resident #43 (R #43's) room observation on 4/10/17 at 2:42 PM, it was noted that she received enteral nutrition via [DEVICE] feedings (GTF). The enteral nutrition (EN) bag that was hanging on the IV pole but not being infused at the time was Fibersource HN. On the bag's label, it had the resident's handwritten name as initials. It was also dated 4/10/17 and 370 cc/hr written on it. There was no start time written on the label when the initial EN infusion began. R #43's physician's orders [REDACTED]. Review of the facility's policy on Enteral Tubes was provided on 4/12/17, but it did not address how the EN formula bags were to be labeled. On 04/13/2017 at 7:25 AM, a room observation was done with Staff #108 for R #43. The resident's EN bag that was hanging on the IV pole had the resident's handwritten name as initials, and 4/12 1300 on it. Staff #108 said, It's missing the feeding order. Staff #108 further said their policy says the EN bag should be labeled with the amount of the flow rate on it. Staff #108 stated, it's not acceptable, and also verified the way staff had labeled the EN bag per surveyor's 4/10/17 observation by omitting the start time was not acceptable. The State Agency references the American Society for [MEDICATION NAME] and Enteral Nutrition (ASPEN), The Journal of [MEDICATION NAME] and Enteral Nutritional Practice Recommendations, Bankhead, R., et al., [DATE], pp. 129-130: D. Labeling of Enteral Nutrition .Practice Recommendations .3. All EN labels in any healthcare environment shall express clearly and accurately what the patient is receiving at any time .4. The EN label should be compared with the EN order for accuracy and hang time or beyond-use date before administration. For R #43, there was a failure by staff to label the EN bag following acceptable standards of clinical practice as the labeling did not include the start times according to the physician's orders [REDACTED]. 2) On 4/20/2017 a record review found the following conflicting documentation for Resident #76: 12/14/2016 admission: Skin Assessment: superficial open area overlying coccyx; no surrounding [DIAGNOSES REDACTED] or discharge, excoriation and [DIAGNOSES REDACTED] in the coccyx 0.5 cm x 0.5 cm dry; 12/18/2016 EZ graph Stage 2, 1 cm x 1 cm to coccyx, open area red/flaky skin. physician notified obtained order for [MEDICATION NAME] boarder till physician can evaluate.; 12/21/2016 glueteal excoriation almost completely closed, physician order [REDACTED]. On 4/11/2017 at 3:15 PM interviewed Staff #14. Staff #14 was asked if Resident #76 was admitted with a pressure ulcer and if the ulcer had become a Stage 2 in 4 days then healed in 3 days. Staff #14 stated the doctor codes the ulcers, nurses are not trained to do the assessment. A concurrent record review was done with Staff # 14, who stated looks like Res #76 came in with an excoriation, a nurse assessed it and called it a Stage 2 then when the doctor came in he correctly called it a healed excoriation. This may have been an error on the staging by the nurse. A review of the facility guideline for staging found that nurses are able to do pressure ulcer assessment using the National Pressure Ulcer Advisor Panel, [DATE]th edition, found in the Clinical Nursing Skills Basic to Advanced Skills by [NAME] Duel, Martin. Incorrect pressure ulcer staging may potentially cause unnecessary treatment delivery to the resident. 2020-09-01