cms_HI: 33

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
33 KULA HOSPITAL 125003 100 KEOKEA PLACE KULA HI 96790 2019-05-31 657 D 0 1 IFL211 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, record review (RR) and observation, the facility failed to revise/update changes in the care plan for three of 18 residents (R16, R6, and R279) in a timely manner. Care planning drives the type of care a resident receives. Because of this deficient practice, interventions and monitoring to promote effective continuity of care to safeguard against adverse events may not have occurred. This has the potential to affect all other residents in the facility. Findings include: 1)Interview on 05/29/19 at 09:09 AM with resident (R)6 who states sometimes my bowel movement is like a golf ball and sometimes I drop one or two and sometimes I go six or seven times a day and it is like golf balls . They are not giving me anything for the bowel movement. Record Review (RR) on 05/30/19 at 09:19 AM reveals doctors orders for 1) [MEDICATION NAME] evacuation 10 mg suppository. 2) Milk of Magnesia (Mom) in evening if not adequate bowel movement for to days. 3) Enema use one rectally whenever necessary if no/inadequate bowel movement for two days. RR and concurrent interview with Nurse manager, staff(S)2 on 05/31/19 at 10:02 AM shows no care plan was developed for constipation. This was confirmed with S2. 2) RR of R16 revealed she was taking an anticoagulant/blood thinner (Xarelta) for a [DIAGNOSES REDACTED]. She was transferred to an acute care hospital on [DATE] for possible [MEDICAL CONDITION]. The blood thinner was discontinued at that time. R16 was readmitted to the facility on [DATE]. She was restarted on the blood thinner after her condition stabilized on 02/28/19. Review of R16's care plan failed to reveal any goal, interventions, or monitoring for complications related to the blood thinner. On 05/30/19 at 09:23 AM, during an interview with Unit Manager (UM1), queried if R16's care plan included monitoring for complications of a blood thinner. UM1 said, the care plan wasn't updated. UM1 agreed monitoring R16 for complications related to the blood thinner should be in the care plan. On 05/30/19 at 01:51 PM UM1 provided a copy of an updated care plan for R16 that included Risk for Hemodynamic Instability R/T . use of Xarelto. 3) RR revealed R279 had a stroke with left [MEDICAL CONDITION] (loss of some motor function) and needed assistance with activities of daily living. R279's progress notes revealed the following: 05/16/19 at 02:30 PM entry by PT aide, patient found asleep in w/c (wheel chair) with left arm caught in w/c . 05/23/19 at 06:55 AM entry by PT aide, Lap/arm tray put on left arm rest to increase patient safety due to arm (left) getting caught in wheel. Nursing educated on importance of using tray and to only remove for meals RR revealed no progress notes of skin assessment after the two incidents that R16 caught his arm in the wheelchair, and R279's care plan did not include the intervention of the lap/arm tray implemented by PT aide. 05/29/19 an entry was made to R279's care plan, Left arm tray remove at meals. 05/30/19 09:04 AM during an interview with UM1, reviewed R279's progress notes and care plan. UM1stated, theres not an incident report because there was no injury. UM1 also stated, I was not aware of the first incident. On 05/30/19 at 09:45 AM, observed R279 while receiving physical therapy. It was observed that R279 had limited use of his left arm. An interview was conducted at that time with the PT aide (PT) that witnessed R279's arm caught in the w/c. She stated, He (R279) often leans to the left and left arm drops to the side. The lap tray was put on to help prevent this from occurring. When asked what the liklihood was that R279 could dislodge his arm without help, she replied, He probably couldn't. On 05/30/19 at 10:06 AM during an interview with the Occupational Therapy Manager (OT), she stated, I didn't know about it (the incidents R279 caught his arm in w/c) until yesterday. PT is a [MEDICATION NAME] and just started. Nursing is being trained to keep the lap tray on the w/c except at meal time. When asked what should have occurred, OT stated, It should have been reported to me the same day, and we would have monitored him. If not a one-time incident, it should be put in the care plan, and staff educated. 2020-09-01