cms_NE: 8028

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
8028 GOOD SAMARITAN SOCIETY - ATKINSON 285177 409 NEELY STREET ATKINSON NE 68713 2014-02-27 329 D 0 1 03FZ11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview; the facility failed to assure Resident 28's medication regimen was free from unnecessary medications as the resident was receiving [MEDICATION NAME] (a medication used to treat psychotic symptoms) without the appropriate [DIAGNOSES REDACTED]. Furthermore, facility staff failed to monitor the resident's behaviors in an effort to evaluate the appropriateness of use of an antipsychotic medication in treating the resident. Facility census was 45. Findings are: A. Review of the facility procedure titled Psychopharmacological Medications and Sedative/Hypnotics, revised 9/13, included the following: - Prior to administration of non-emergency psychopharmacological and/or sedative/hypnotics, the following must be completed: a. Documentation in the . medical record observations of mood symptoms or behaviors that cause the resident distress and/or endangers the resident or others and response to interventions used. - If, after reviewing the Mood and Behavior Record (GSS #2600), the behavior committee and/or care plan team determines psychopharmacological medications and sedative/hypnotics may be necessary, the reduction committee must be notified. - If the reduction committee determines that a medication is warranted, then the committee nurse will ensure the following is completed: a. Contact the physician and describe the behavior, attempted interventions/alternatives and behavior committee recommendations. b. Obtain an order for [REDACTED]. - If a resident is admitted on psychopharmacological medications and sedative/hypnotics or returns from hospitalization on new psychopharmacological medications and sedative/hypnotics, the following must be completed: a. The reduction committee must be informed. - Throughout the administration of the psychopharmacological medications and sedative/hypnotic drugs, the following must be completed: a. Document on the Mood and Behavior Record (GSS #2600) Behavior documentation must continue in order to indicate the effect the medication has on the behavior. - The reduction committee will review the need for psychopharmacological and sedative/hypnotics at least every three months and document the rationale for continuing the medication. The committee will also need to evaluate: 1) The resident's target symptoms and the effect of the medication on the severity, frequency and other characteristics. - Antipsychotic medication should be used only for the following conditions/[DIAGNOSES REDACTED]. 1) [MEDICAL CONDITION] 2) Schizo-affective Disorder 3) Delusional Disorder 4) Mood Disorders (ie., mania, [MEDICAL CONDITION] disorder, depression with psychotic features and treatment refractory [MEDICAL CONDITION]) 5) Schizophreniform Disorder 6) [MEDICAL CONDITION] NOS 7) Atypical [MEDICAL CONDITION] 8) Brief [MEDICAL CONDITION] 9) Dementing illnesses with associated behavioral symptoms 10) Medical illnesses or [MEDICAL CONDITION] with manic or psychotic symptoms and/or treatment-related [MEDICAL CONDITIONS](ie., thyrotoxicosis, neoplasms, high-dose steroids) B. Review of Resident 28's Minimum Data Set (MDS-a federally mandated comprehensive assessment tool used for care planning) dated 11/27/13 indicated the resident was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. The same MDS indicated Resident 28's Brief Interview for Mental Status (BIMS-a brief screen that aids in detecting cognitive impairment) score was 8 (a score of 8-12 indicates the resident is moderately intact cognitively), the resident exhibited no behaviors other than wandering, and the resident was receiving an antipsychotic medication. Review of the History and Physical dated 11/21/13 indicated Resident 28 was admitted to the facility due to increased wandering and progression of memory loss. Review of the admission physician's orders [REDACTED]. Review of Resident 28's Care Plan, with a revision date of 12/3/13, indicated the resident had behaviors related to dementia that included forgetting where room was located, and wandering around the facility visiting with residents and staff. Nursing interventions included assisting the resident if needing redirection or if lost. Review of Resident 28's medical record revealed here was no documentation of observations of mood or behavioral symptoms that indicated the need for use of an antipsychotic medication. Furthermore, there was no documentation to indicate the resident's use of antipsychotic medication was evaluated by facility staff. Review of Resident 28's Medication Administration Record [REDACTED]. During interview on 2/27/14 at 9:30 AM, Registered Nurse (RN)-I was asked to describe Resident 28's behaviors as related to the use of [MEDICATION NAME]. RN-I indicated the resident had episodes of wanting to leave and inability to locate room. There were no other behaviors indicated in regard to the resident. During interview on 2/27/14 between 9:42 AM and 9:51 AM, the Director of Nursing (DON) verified there was no behavior documentation for Resident 28. The DON further verified behavior documentation was expected to be completed on residents receiving antipsychotic medications. During interview on 2/27/14 at 12:10 PM, the facility Administrator was questioned in regard to responsibilities of the reduction committee referenced in the facility procedure for use of psychopharmacological medications. The Administrator verified the facility did not have an actual committee to fulfill this function. 2017-11-01