cms_NE: 12661

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
12661 THE AMBASSADOR LINCOLN 285066 4405 NORMAL BLVD LINCOLN NE 68506 2010-12-09 282 D     BMMD11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Licensure Reference Number 175 NAC 12-006.09D Based on to observations, record reviews, and staff interviews; the facility failed to: 1) ensure that qualified nursing staff implemented care plan interventions for oral care and oral suctioning for Resident 20 and 2) failed to ensure safety interventions were followed to prevent falls for Resident 50. The facility census was 80. Findings are: A. Review of the "Record of Admission" revealed that Resident 20 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Review of the MDS (Minimum Data Set, a federally mandated comprehensive assessment tool used for care planning), dated 10/1/10 revealed that the resident was dependent with 1 or 2 plus persons physical assist with activities of daily living. Review of the "Plan of Care", goal date 12/10, revealed that the staff were to provide oral suctioning with routine morning cares, with bed baths, and with brushing teeth. Observation on 12/9/10 at 7:50 AM revealed NA (Nursing Assistant) A suctioned the resident's mouth secretions with [MEDICATION NAME] suctioning. Interview on 12/9/10 at 7:50 AM with NA- A revealed that this was the only resident on the unit who he/she suctioned. Interview on 12/9/10 at 2:30 PM with the DON (Director of Nursing) confirmed that nursing assistants provided routine oral care for the resident which included oral suctioning as care planned. Further interview confirmed that the facility policy and procedure stated that oral suctioning was to be done by the respiratory therapist or licensed nurses and that nursing assistants could remove oral secretions with oral swabs or cloths. Review of the facility policy and procedure "Suctioning - Oropharyngeal", dated 1/1/09, revealed the following: "Policy Statement - To remove secretions from the oropharynx that interfere with normal respiration, and that the patient cannot remove with a spontaneous cough.". "Procedure - 1. Wash hands. 2. Apply gloves. 3. Turn on suction machine. 4. Attach catheter or [MEDICATION NAME] to connective tubing. 5. To suction mouth and posterior pharynx, introduce catheter or [MEDICATION NAME] into the oropharynx and create suction at desired point, intermittently for 15 seconds or less. 6. Withdraw catheter with a rotating movement. 7. Repeat procedure as necessary. 8. Rinse [MEDICATION NAME] and tubing with NaCL Bullet. Discard soiled catheter and gloves. 9. Wash hands. 10. Make resident comfortable. 11. Chart amount obtained, color, consistency of secretions with date and time.". "Responsible staff R.R.T. (Registered Respiratory Therapist), C.R.T. (Certified Respiratory Therapist), R.N. (Registered Nurse), L.P.N. (Licensed Practical Nurse)". B. Review of Resident 50 ' s " Record of Admission " revealed the resident was admitted on [DATE] with [DIAGNOSES REDACTED]. Observation on 12/8/10 at 9:30 AM of Resident 50 revealed the resident was lying in bed asleep with a safety alarm attached to the resident and the resident ' s bed. Review of Resident 50 ' s MDS (Minimum Data Set, a comprehensive assessment tool used for care plan development) revealed the resident was moderately impaired in cognitive skills for daily decision making . Review of Resident 50 ' s care plan dated 4/14/10 revealed the problem at risk for falls due to unsteady gait, intermittent confusion, pain and medication use. Goal: will have no falls throughout the quarter. Interventions included: has pressure alarm for safety and fall prevention. Check every shift for proper functioning. Change batteries monthly per protocol. Review of Resident 50 ' s Fall Risk assessment dated [DATE] revealed the resident scored a " 20 " , total score above 10 represents " high risk " for falling. Review of Resident 50 ' s November and December 2010 MAR indicated [REDACTED]. Interview on 12/9/10 at 12:36 PM with the DON (Director of Nursing) was conducted. The DON verified that the documentation of the alarm battery being changed would be on the MAR. The DON agreed that Resident 50 did not have documention to indicate that the battery for the residents alarm was changed in November or December. Review of facility policy " Safety Alarm " dated 8/2010 revealed " it is the policy of this facility to maintain resident/patient safety with the least restrictive method possible ... ... ...maintenance: ....change battery every 30 days. Battery changes to be documented on MAR (Medication Administration Record) or designated form. 2014-04-01