cms_HI: 34

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
34 KULA HOSPITAL 125003 100 KEOKEA PLACE KULA HI 96790 2019-05-31 686 G 0 1 IFL211 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to intervene in a timely manner when the resident refused to remove compression gloves to left hand for five days. As a result of this deficient practice, R54 out of two sampled residents (R54 and R23) developed a Stage 4 pressure ulcer to the left fifth digit. Findings include: Observation on 05/30/19 at 12:03 PM of R54's dressing change with Staff(S)1. S1 stated, R54 acquired the wound in the hospital and his finger was amputated. R 54 wears compression gloves for [MEDICAL CONDITION] arthritis associated with joint pain in his hands. R54 had compression gloves on and would refuse to take them off or let the nurses monitor his hand and it was too late. Record Review on 05/30/19 at 01:01 PM shows in the past, R54 requested that his 4th finger on left hand be removed due to contracture, pain and a buttonneire deformity. Treatment record of doctors orders written on 01/14/18 to monitor both hands for impaired skin integrity twice a day. (Gloves off 04/13/19). Treatment record comments shows on 4/08/19 the resident declining to remove gloves up until 04/13/19. On 04/13/19, documentation stating wound skin impaired noted to left 5th digit. Doctor notified. From that point on, gloves were off. Progress notes dated 04/13/19 states R54 was complaining of pain to touch to left 5th digit of left hand. Resident did not want to remove gloves at first. Resident removed it later and left 5th digit by flexor/crease with wound open 1.3 centimeter length. Whitish, pink with scant bleeding. Cleansed with normal saline and covered. Called doctor at 10 AM and informed of open wound to left 5th digit. Keep clean and open to air. Further RR reveals doctor visit on 04/13/19 at 1400. Doctors exam confirmed R54's left fifth finger with open wound at proximal interphalngeal (PIP) joint, tendon visible, wound moist, swelling and [DIAGNOSES REDACTED]. Appears to have infection and swelling and [DIAGNOSES REDACTED]. Interview on 05/30/19 at 04:03 PM with S2 who stated There was no documentation from 04/06/19 to 04/13/19 until the wound was discovered at Stage 4. No report or attempt to call the MD about the refusals. I think it should have been reported. He is a man who decide what he wants and does not want. The nurses should have reported. Interview on 05/30/19 at 04:14 PM with S3 who stated The gloves was an ongoing problem and when you would try to remove them, he would get upset. I did not let the doctor know that he was refusing to take the gloves off. He would become agitated with us. I feel that we could have discovered the wound earlier but the amputation was unavoidable. Interview on 05/30/19 at 04:30 PM with medical doctor who stated he has never been very cooperative. He wanted the 5th finger off and he wouldn't cooperate with treatment. It's possible that the pressure ulcer developed within the five days that he refused to take the gloves off. The facility failed to intervene in a timely manner by reporting refusal of treatment for [REDACTED]. 2020-09-01