cms_NE: 1381

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
1381 LIFE CARE CENTER OF ELKHORN 285134 20275 HOPPER STREET ELKHORN NE 68022 2018-02-27 758 D 1 1 YXZR11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on record review and interviews, the facility failed to complete behavior monitoring for continued use of [MEDICAL CONDITION] medications for 2 residents (Residents 4 and 82) of 5 residents sampled. The facility staff identified the census at 101. The findings are: [NAME] A review of Resident 4's undated Face Sheet revealed that the resident was admitted to the facility on [DATE] with the [DIAGNOSES REDACTED]. A review of Resident 4's Medication Administration Record [REDACTED]. The resident received the medication on 2-18-18. A review of Resident 4's MAR for (MONTH) (YEAR) revealed the resident received [MEDICATION NAME] (an anti-anxiety medication) on an as needed basis for anxiety. The resident received the medication on 1-1-18, 1-11-18, 1-12-18, 1-15-18, 1-19-18, 1-24-18, 1-26-18, and 1-27-18. A review of Resident 4's Behavior/Intervention Monthly Flow Record for (MONTH) (YEAR) revealed the resident was documented as having no behavior episodes the entire month. A review of Resident 4's Behavior/Intervention Monthly Flow Record for (MONTH) (YEAR) revealed the resident's behaviors were no longer documented after 2-8-18. An interview conducted on 2-22-18 at 1:25 PM with Medication Assistant (MA) [NAME] revealed that the process for giving an as needed anti-anxiety medication was that the MA would notify the charge nurse that the resident had requested a medication or that the resident was having behaviors and the non-pharmacological interventions were not effective. The medication would be given by the MA at the direction of the charge nurse. The MA would document on the MAR indicated [REDACTED]. The charge nurse would document on the Behavior/Intervention Monthly Flow Record for that shift what the behaviors were and what was done for the resident to alleviate the behaviors. B. Record review of a Policy and Procedure for Psychopharmacological (medications used to manage behaviors) Medications dated 8/23/17 revealed the following: - That each resident's drug regimen must be free from unnecessary drugs. An unnecessary drug is any drug when used: without adequate monitoring. - The facility would establish an ongoing process of assessing the resident's behavior indicators, monitoring for adverse consequences, response and efficacy of psychopharmacological medications. - Accurate and thorough assessment of the resident's behavior indicators are fundamental in determining the appropriate utilization of psychopharmacological medications. - Documentation will be noted in the resident's medical record and will include but not be limited to: type of behaviors, new or worsening behaviors, times observed and frequency, interventions provided and resident's response to intervention. Record review of Resident 82's Comprehensive Care Plan (CCP) dated 1/27/18 identified that Resident 82 used [MEDICAL CONDITION] medication (medications used to manage behaviors), an antidepressant and an anti-anxiety medication related to [DIAGNOSES REDACTED]. Resident 82's behavior care plan identified the following behavior problems: physically abusive, socially inappropriate, and sexually inappropriate and resists cares. Target behaviors were identified as: restless, combative, socially inappropriate and sexually inappropriate. Interventions included: Observe behavior episodes, attempt to determine underlying cause and monitor for effectiveness of [MEDICAL CONDITION] drugs. Record review of Resident 82's Physician orders [REDACTED]. Record review of Resident 82's Behavior Intervention Monthly Flow Records dated (MONTH) and (MONTH) (YEAR) revealed target behaviors of combative and fidgety. The Behavior Flow Records did not identify any other target behaviors as were identified in Resident 82's CCP. Review of the (MONTH) and (MONTH) Behavior Flow Records for Resident 82 revealed that behavior monitoring was documented sporadically throughout the month. There were many blank spots on the flow record. Interview on 2/27/18 at 9:48 AM with the Director of Nursing (DON) confirmed that Resident 82's Behavior /Intervention Monthly Flow Sheets were not filled out correctly and there was only sporadic documentation of the monitoring of Resident 82's behaviors. The DON confirmed that not all of Resident 82's target behaviors had been identified on the monthly flow records. 2020-09-01