cms_NE: 1343

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
1343 HILLCREST HEALTH & REHAB 285133 1702 HILLCREST DRIVE BELLEVUE NE 68005 2018-05-31 880 D 1 0 Y3V611 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > LICENSURE REFERENCE NUMBER 175 NAC 12-006.17B and 175 NAC 12-006.17D Based on observation, interview, and record review, the facility staff failed to perform hand hygiene to prevent potential cross-contamination of dirty to clean wound dressings for 2 (Resident 5 and Resident 7) of 3 sampled residents. The facility staff identified a census of 119. Findings are: [NAME] A record review of the Facility policy for Non Sterile Dressing Change dated 11/27/2017 revealed; -Ensure any necessary equipment has been disinfected. -Place supplies on a clean field. -Wash hands. -Apply non-sterile gloves prior to removing old dressing. -Discard gloved with old dressing. -Complete hand hygiene and put on new gloves. -Clean wound as ordered. -Remove and discard gloves. -Perform hand hygiene. -Apply medication and/or new dressing per physician order. -Remove gloves and wash hands. A record review of the Facility policy for Hand Washing dated 11/27/2017 revealed that hand washing should last for at least 20 seconds using friction. An observation on 5/31/2018 at 8:12 am to 8:40 am of wound care provided to Resident 7 by Staff A revealed; Staff A entered Resident 7's room to complete the dressing change. Staff A went in to Resident 7's bathroom and preformed washed hands for 6 seconds. Staff A returned to Resident 7's bedside and covered the bedside table with a disposable incontinence protector. Staff A removed gloves from their scrub pants pocket, put the gloves on, scissors were removed from an open package and cleaned with an alcohol wipe. Staff A placed the scissors on the opened package on Resident 7's bed. Using the scissors, Staff A removed the old dressing and discarded the dressing and gloves. Staff A returned to Resident 7's bathroom where they prepared 2 packages of 4 inch by 4 inch gauze (4 X 4) to clean Resident 7's wound. One package was filled with soap and water while the other was filled with only water. At this time Staff A washed their hands for 15 seconds. Following the preparation of the 4 X 4 gauze. Staff A removed gloves from their scrub pants pocket and put them on. Resident 7's wound was then wiped with the soapy 4 X 4 then wiped with the 4 X 4 soaked in water only. Staff A patted the wound dry with a dry 4 X 4. Staff A removed the old gloves and returned to the resident's bathroom. While in the bathroom, Staff A removed a large amount of gloves from the box on the wall and placed them in the pocket of their scrub pants. Following this Staff A washed hands for 20 seconds. Staff A returned to Resident 7 and placed Vaseline gauze into the wound bed, the Vaseline gauze was cut to fit using the scissors that had been used to cut off the old dressing without re-cleaning the scissors. Staff A removed their gloves and disposed of the old gloves. Staff A took gloves from their scrub pants pocket and put them on without hand hygiene. Staff A placed an abdominal pad on the wound securing it with rolled gauze. The rolled gauze was cut with the un-cleaned scissors and taped. The tape was labeled the date and their initials. Staff A placed a compression wrap on Resident 7's leg. Staff A removed their gloves and without hand hygiene put on another pair of gloves. Staff A put on Resident 7's sock and shoe and cleaned up the working area. Staff A washed their hand for 16 second and left Resident 7's room. An observation on 5/31/2018 at 9:54 am to 10:12 am of wound care provided to Resident 7 by Staff A revealed; Staff A entered Resident 7's room to complete the wound care and shut Resident 7's entry door. Staff A entered Resident 7's bathroom and prepared two packages of 4 x 4 gauze. One package was filled with soap and water while the other was filled with only water. Following the preparation of the 4 X 4 gauze, Staff A returned to Resident 7's bedside. No clean field was prepared. Staff A was in a kneeling position and placed the two packages of 4 x 4 on their right thigh. Staff A removed gloves from their scrub pants pocket and put them on. Staff A wiped Resident 7's toes with the soapy gauze followed by wiping the the toes with the water soaked 4 x 4 and dried with a clean 4 x 4. Staff A removed their gloves and disposed of them. Without hand hygiene Staff A put on a new pair of gloves that had been in their pocket. Staff A applied [MEDICATION NAME] to Resident 7's toes and allowed the [MEDICATION NAME] to dry. Staff A returned to the bathroom and washed their hands for 15 seconds. Staff A returned to Resident 7's bedside and applied new gloves. Staff A applied Gentamicyn ointment (an antibiotic ointment) to Resident 7's toes and removed their gloves. Staff A did not complete hand hygiene and put on a new pair of gloves, Staff A put on Resident 7's sock and shoe and removed gloves. B. An observation on 5/31/2018 at 11:00 am to 11:20 am of wound care provided to Resident 5 by Staff A revealed: Staff A entered Resident 5's room to complete the wound care and shut Resident 5's entry door. Staff A set up a clean field using a disposable incontinence pad, including cleaning a scissor with an alcohol wipe. Staff A entered Resident 5's bathroom and prepared two packages of 4 x 4 gauze. One package was filled with soap and water while the other was filled with only water. Staff A washed their hands for 20 seconds and returned to the resident's bedside. Staff A removed the old dressing using scissors and removed their gloves and disposed of them both. Staff A applied hand sanitizer and new gloves. Staff A washed the wound on Resident 5's knee with the soapy 4 x 4 followed by the 4 x 4 with only water and patted it dry with a clean 4 x 4. The wound was rinsed with normal saline. Staff A removed gloves, used hand sanitizer and applied new gloves. Skin prep (a wipe containing a liquid skin barrier) was applied to the inside of the right ankle. Staff A took off the gloves and used hand sanitizer, as Staff A was putting on the new gloves, one glove was dropped on to the floor. Staff A picked up this glove and put it on their hand. Staff A packed medicated packing tape into the wound and cut the packing tape with the scissors that had been used to cut off the old dressing without first cleaning the scissors. Staff A then wrapped Resident 5's leg with rolled gauze, cutting it with the un-cleaned scissors, followed by ace wraps. Staff A removed their gloves and completed hand hygiene. Staff A cleaned up the work area. An interview on 5/31/2018 at 3:00 pm with the Director of Nursing (DON) revealed it is the expectation that during hand hygiene staff will wash their hands for a minimum of 20 seconds. It is the expectation nursing staff wash their hands prior to a wound dressing change, any time staff go from a dirty area to a clean area of a dressing change, at the end of the dressing change and any time that the hands become visibly soiled. The DON expects that scissor are cleaned at the beginning of the dressing change and anytime going from dirty to clean areas. The DON stated that disposable gloves should not be kept in the pocket of staff and be maintained in the manufactures box. The DON described an appropriate clean field is, a clean table with some type of clean barrier (i.e. a clean towel or clean disposable incontinence pad). 2020-09-01