cms_NE: 12925

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
12925 GOOD SAMARITAN SOCIETY - AUBURN 285112 1322 U STREET AUBURN NE 68305 2010-09-30 309 D     1H8211 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 12-006.09 Based on observations, interviews and record review the facility failed to identify and communicate symptoms of pain to evaluate treatment and control on 1 Resident (Resident 11). Resident sample was 15. Facility census was 72. Findings are: Review of Resident 11's Face Sheet (not dated) revealed that Resident 11 had the [DIAGNOSES REDACTED]. Resident 11 has been on Hospice since 12/08 for end stage dementia (irrecoverable deteriorative mental status). Resident 11 is not able to verbally respond except with moaning. Resident 11 uses non verbal actions like opening eyes, pushing the staff's hands away, and body rigidity to communicate discomfort. Review of Resident 11's MDS (Minimum Data Set - a federally mandated comprehensive assessment tool used for care planning) dated 6/28/10 revealed that Resident 11 was severely impaired with daily decision making, and was totally dependent physically with two person assistance. The pain section of the MDS indicates that Resident 11 has no pain. Review of the Hospice Plan of care dated 8/3/10 reveals that Resident 11 has had weight loss, no purposeful movements/response, and poor skin turgor. The Alteration in Comfort section of Resident 11's Hospice care plan reveals that Resident 11 is on [MEDICATION NAME] 25mcg. (a narcotic pain patch) every 72 hours, and [MEDICATION NAME] .5mg (for resisting cares) three times a day, comfort medications are available. The comments section of the Hospice Care plan for Resident 11 indicates that Resident 11 has no purposeful movements or verbalization. The Hospice Care plan also indicates that Resident 11 shows no nonverbal indications of pain. Review of Resident 11's facility Comprehensive Care Plan dated 7/7/10 reveals that Resident 11 has an alteration in comfort related to the [DIAGNOSES REDACTED]. The facility goal for Resident 11 is that Resident 11 will not show signs of physical or verbal discomfort with transfers and cares. The interventions on this plan of care are for the staff to monitor physical cues of discomfort like facial grimacing, or agitation. The nursing staff (all disciplines) are to evaluate for pain using a pain scale, as the resident is not able to rate the pain. The nursing staff are to chart the nonpharmacological interventions used and their effectiveness on the treatment records. The nonpharmacological interventions for pain are for the nursing staff to offer companionship, repositioning, and massage. The Treatment Record dated 9/1/10 reveals that a pain evaluation is being initialed on the treatment sheet not every shift but at least daily. The Nonpharmacological interventions as listed on the care plan dated 7/7/10, reveals that on the 9/1/10 Treatment Record that 9/17/10 is the only day that the nonpharmacological interventions were used. Observation and interview on 9/29/10 at 9:30am of RA (Restorative nursing assistant) B providing passive range of motion (exercises for joint flexibility) revealed that when RA B adducted Resident 11's arms out at shoulder level, that Resident 11's eyes would open and RA B stated "I can always tell when a movement that I do is uncomfortable because Resident 11 resists what I am doing." RA B said that "there are some extension movements that I don't do any more, because it is obvious that it causes pain." Resident 11 did not grimace, extend the neck or back during any of the other range of motion exercises being provided. Observation on 9/30/10 at 9:50am revealed that NA B and NA C were providing perineal care to Resident 11. Resident 11 was laying supine (on the back). NA B and NA C moved Resident 11's legs apart to position Resident 11 for pericare. There was no grimacing or resisting the movement. Resident 11 was laying without verbal or non verbal response while being positioned for pericare. NA B told Resident 11 that they were going to touch the perineum with a warm washcloth. When NA B separated the labia and wiped the inside of the perineum, Resident 11 grimaced, arched the neck completely back, arched the back and with the stiff contracted clenched fist attempted to hit NA B's hand and arm to move it away from the perineum. These non-verbal actions occurred each time NA B wiped the perineum. NA B and NA C had shown the nurses the perineum when Resident 11 had resisted pericare. Interview with NA B and NA C on 9/30/10 at 10:00am revealed that NA B and NA C stated that Resident 11 has "been grimacing, resisting and arching the neck and back for the last couple of months when pericare is being provided." NA B and NA C were sure that these were signs of pain with pericare. NA B and NA C said that Resident 11 " does not grimace or arch like this when other cares are being provided, unless it's painful." NA B and NA C stated that "We have not told the nurses about the pain with pericare." Interview with RN A on 9/27/10 at 12:20pm revealed that the nursing assistants had not reported that they believed Resident 11 was having pain with Pericare. Interview with the DON on 9/30/10 at 9:30am indicated that the DON would follow up with the Hospice RN to see if there was additional documentation to the Physician regarding perineal pain, and additional documentation of family communication regarding the perineal issues. Interview with the DON on 9/30/10 at 10:00am indicated that there were no other Physician notifications from Hospice, (a note is written from the DON) and that the family had been told about the perineal concerns one time. The Hospice RN told the DON that the facility could use a preventative barrier to assist with comfort. The Hospice RN told the DON that if it had been reported to them that Resident 11 was having pain with pericare that they would have taken the perineal pain to the next level. 2014-02-01