cms_HI: 59

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
59 HALE MAKUA - KAHULUI 125007 472 KAULANA STREET KAHULUI HI 96732 2017-10-26 329 D 0 1 8L5Q11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, medical record review, staff interview and facility policy review, the facility failed to ensure that the medication regimen for one of five residents, Residents #234, was closely monitored for mood and behaviors. Findings include: Resident #234 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Resident #234 had a physician's orders [REDACTED]. The facility did not provide routine mood and behavior monitoring for Resident #234, making it unclear why he was receiving an antipsychotic medication. A review of Resident #234's medical record on the afternoon of 10/25/17 revealed no documentation of behaviors in the Minimum Data Set (MDS) with Assessment Reference Date (ARD) of 9/8/17 (Admission). A review of the nurse's notes did not find notes titled Behavior or any documentation that indicated he was experiencing mood/behavior issues. Additionally, the facility was not routinely monitoring Resident #234's behaviors. On the afternoon of 10/25/17, a review of a form titled, Behavior Monitoring, dated 10/19/17 revealed Resident #234: Did not display moods during the monitoring period; No behavior symptoms displayed during the monitoring period; Resident was currently taking [MEDICAL CONDITION] medications to address mood/behavior symptoms; Current medications are effective in alleviating mood and/or behavior symptoms; No [MEDICAL CONDITION] side effects observed during the monitoring period; There's a current plan of care with intervention to address the resident's mood and/or behavior symptoms; The interventions in place are effective for the resident's mood and/or behavior symptoms. The form further noted the monitoring frequency was to continue weekly monitoring. The rationale for monitoring frequency was left blank. An interview of Staff #46 on the afternoon of 10/25/17 at 3:53 P.M. found Resident #234 had been transferred to his current unit from another unit in the facility on 10/17/17. Staff #46 reported the resident was doing okay during the evening shifts until 10/24/17. She reported Resident #234 experienced hallucinations on the evening of 10/24/17 when he was distressed and reported seeing his foot detached from his body. Staff #46 further noted the resident was attempting to lift the table to pick up his detached leg from under the table. She informed Resident #234 she didn't see anything and turned his wheelchair around. The resident then attempted to hit the Certified Nurses Aide (CNA) who was standing behind his wheelchair. The resident then attempted to stand and climb over his foot rest. Staff #46 stated that it became unsafe as Resident #234 almost tripped over his foot rest. Staff #46 reported Resident #234's behaviors to the physician and an order was placed for [MEDICATION NAME] 0.25mg every 8 hours as needed for restlessness, hallucinations, and difficulty to redirect. Staff #46 was asked where she documented Resident #234's behaviors. She replied she did not document the behaviors on the evening of 10/24/17 and stated, but I can do a late entry. When asked what the facility's policy was for monitoring residents' behaviors, Staff #46 stated, I don't know the policy. A review of Resident #234's care plan found one for the use of antipsychotic medication related to [MEDICAL CONDITION]. Interventions included, Evaluate indications for usage of antipsychotic medications including specific behaviors and effect of behaviors on resident and/or others. Identify target behaviors and document in clinical record. An interview of Staff #113 on the afternoon of 10/25/17 at 3:55 P.M. found her understanding of behavior monitoring was initial monitoring occurred when a resident was new to the facility, had newly identified mood/behaviors, or changes in [MEDICAL CONDITION] medications. This initial monitoring was done every shift for one week. After the first week, the nurses monitored residents weekly for a total of 8 weeks. After the eighth week, the staff would discontinue behavior monitoring. When asked about Resident #234's behaviors on the evening of 10/24/17, Staff #113 reported they hadn't followed the facility's policy of monitoring behavior every shift after a change in Resident #234's [MEDICAL CONDITION] medications. Additionally, Staff #113 reported that Staff #46 should have entered a nurse's note for Resident #234's behavior on the evening of 10/24/17. An interview of the Assistant Director of Nursing (ADON) on the morning of 10/26/17 at 8:20 [NAME]M. revealed the facility started (10/19/17) routine behavior monitoring for any resident on [MEDICAL CONDITION] medications. The ADON reported the facility was changing their policy to include mood and behavior monitoring every shift for as long as the resident was receiving [MEDICAL CONDITION] medications. The ADON further noted that since this is a recent change in their policy, not all nurses are aware. The ADON reported that Resident #234 should be monitored for behaviors every shift for as long as he is on [MEDICAL CONDITION] medications. A review of the facility's policy titled, Mood and Behavior Management Policy and Assessment Procedure with revision date of 2/16 noted, B. Routine Behavior Monitoring: 1. Initiation of new [MEDICAL CONDITION] medications or changes (whether increasing or decreasing) in current dosage of [MEDICAL CONDITION] medications is made. The facility failed to closely monitor and document Resident #234's behaviors, making it unclear for the rationale of using an antipsychotic medication. 2020-09-01