cms_HI: 86

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
86 MALUHIA 125009 1027 HALA DRIVE HONOLULU HI 96817 2017-06-02 325 D 0 1 HXLB11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, staff interviews and medical record reviews (MRR), the facility failed to ensure that the physician participated in the nutritional assessment, and that a more in-depth nutritional assessment was done to identify nutrition related risks for 1 of 24 residents (R#129) on the survey Stage 2 sample resident list. Findings include: On 06/01/2017 at 12:03 PM observed R#129 eating lunch in the activity/dining room (rm) on the facility's second floor unit. The resident was able to self-feed the pureed meal served on a divided plate. The resident drank all of the fluids served in 6 ounce plastic cups and also the 1/2 cup of applesauce. After finishing all of the liquids of milk, apple juice, water and pureed applesauce, R#129 started to eat spoonfuls of pureed beef mac casserole and chicken rice soup. The resident was sampled for nutrition due to having a body mass index (BMI) of 18.2 and with no physician ordered supplement. On 06/01/2017 at 1:01 PM the MRR on R#129, found that the 2/7/17 speech/swallowing therapy evaluation for swallowing recommendations were for pureed solids and honey consistency liquids with feeding by nursing to observe for actual swallow. The residents weight (wt) on 5/24/17 was 87 lbs; 5/10/17 was 89 lbs in the units weight book. On 06/01/2017 at 1:05 PM interviewed Staff#24 as noted that the last nutritional assessment was done on 2/1/17 after an acute hospitalization for [DIAGNOSES REDACTED] ulcer perforation when R#129 was on GT feeding. Staff#24 stated that R#129 pulled out his/her gastrostomy tube (GT) on 2/14/17, and was put on intravenous (IV) fluids and pureed diet. The R#129 also pulled out the IV. On 2/15/17 the MD recommended not to replace GT/JT because the resident would continue to pull out tubes and would replace if he/she had poor intake. Since 2/15/17 R#129 received a pureed diet and doing well. Staff#24 stated that registered dietitian (RD) was included on interdisciplinary (IDT) meetings and provided documentation for the 2/14/17 IDT meeting on R#129, which the RD noted significant wt loss and resident on TF. Queried Staff#24 if RD did nutritional evaluation after R#129 switched to pureed diet and CN provided that 5/2/17 IDT meeting notes documented, see RD notes 5/2/17, but Staff#24 unable to locate RD notes. Staff#24 called RD and RD had documentation in her office. Continued to do MRR and R#129's care plan (CP) #12 dated 5/9/17, I am underweight related to significant weight loss AEB BMI Queried Staff#24 if supplement should be in treatment record. Staff#24 looked at R#129's treatment record and there was no supplement included. Staff#24 went to the unit's refrigerator and Boost Plus 120 ml was on the nourishment tray for R#129. According to Staff#24, the IDT develops each resident's CP and the resident's supplement should have been on the treatment record. On 06/01/2017 at 2:10 PM interviewed Staff#24 who was find out why the RD didn't reassess R#129 for supplement recommendation after the GT was discontinued on 2/15/17 but she could not provide an explanation. Queried Staff#24, on why supplement was started on 5/17 but sig wt loss was noted at the 2/17 IDT meeting, and she could not provide an answer. The resident's nursing assessment on 3/20/17, documented a wt of 85.2 lbs; and on 3/29/17, wt 85.4 lbs. On 06/01/2017 at 2:16 PM interviewed the RD and she related that on 2/17/17 the resident's niece and family were convincing R#129 to eat because the resident was refusing to eat and on that date started the supplement on a trial basis to see if the resident would drink the supplement. The IDT progress notes dated 2/17/17 Nutrition Follow-up, documented, Boost Plus 240 ml PO TID between meals. On the 5/2/17 IDT conference notes documentation; decreased Boost Plus 120 ml TID btw meals d/t improved intakes. Staff#24 and the RD looked through R#129's medical record and could not find an MD order for the supplement. On 06/02/2017 at 11:01 AM, the MRR on R#129, found a physicians telephone order dated 06/01/17 written with, (late entry for 5/2/17); 1) D/C Boost Plus 240 ml P.O. TID between meals 2) Decrease to Boost Plus 120 ml P.O. TID between meals. T.O. Dr. R. Gries, signed by Staff#24. On 06/02/2017 at 11:42 AM observed R#129's food tray with Staff#24 and Staff#88 in the dining/activity rm. There was a regular spoon on the resident's tray and not a built-up spoon as was ordered by the occupational therapist. According to Staff#24, the resident used the built-up spoon only when dining in-room because they didn't want to misplace the built-up spoon. Staff#88 further stated that R#129 didn't like to use the built-up spoon and would sometimes throw it. Staff#88 went to get the built-up spoon from R#129's rm and stated that she would try to make the resident use it. Discussed with Staff#24 that the use of the built-up spoon should be re-evaluated as resident observed to be using small disposable plastic cups to drink pureed food. The facility failed to provide nutritional care and services consistent with a comprehensive assessesment as the MD did not write the order for nutritional supplements, the built-up spoon was not re-evaluated for use when staff knew that the resident did not want to use it. 2020-09-01