cms_NE: 841

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
841 MONUMENT REHABILITATION AND CARE CENTER 285095 111 WEST 36TH STREET SCOTTSBLUFF NE 69361 2019-05-28 626 G 1 1 3V0011 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Licensure Reference Number: 175 NAC 12-006.05 (5b) Based on record reviews and interviews, the facility failed to allow one sampled resident (Resident 89) to return to the facility following hospitalization to stabilize the resident's condition. The failure resulted in an extended hospital stay for the resident who no longer required hospital level of care. Facility census was 85. Sample size included 7 residents discharged from the facility to an acute care hospital setting. Findings are: Record review of an Admission Record for Resident 89 printed on 5/8/18 revealed the resident was admitted to the facility on [DATE]. Among the medical [DIAGNOSES REDACTED]. Record review of a Discharge- return anticipated MDS (Minimum Data Set, a federally mandated assessment and tracking tool) completed on 1/29/19 revealed Resident 89 had been discharged to an Acute hospital on [DATE] and the facility expected the resident to return when stabilized. Record review of Resident 89's electronic Progress Notes revealed on 1/29/19 the resident's physician was notified at 10:11 a.m. regarding the resident's aggression and anxiety and informed the the resident was either going to be put under an EPC (Emergency Protective Custody) or admitted to an available behavioral facility. At 1:39 p.m. the facility phoned the local police department, resident's physician, and resident's psychiatrist to inform them the resident was being sent EPC from the facility. At 1:53 p.m. the resident was escorted off the unit by the police department. At 1:56 p.m. an attempt was made to notify the resident's Sibling-[NAME] At 2:51 p.m. the facility received a call from the resident's psychiatrist who stated will let the psychiatrist know the resident was being EPC'd from the facility. An entry on 2/1/19 at 2:17 recorded by the facility SSD (Social Services Director) recorded an emergency contact, Sibling-B, was called and a message left that the resident was being admitted to a behavioral unit. There were no other progress notes regarding the resident after the admission to the behavioral health unit. Record review of Resident 89's closed record documents revealed: There was no discharge summary completed by the facility regarding Resident 89's discharge, nor was there any evidence the resident was notified in writing by the facility indicating the facility initiated discharge. Record review of a document dated 2/14/19 received by Certified Mail at the facility on 2/21/19 revealed a General Counsel attorney for the local hospital sent correspondence to the facility. The corresponding letter recorded Resident 89 was admitted to the hospital's Behavioral Health Unit at the request of the facility and law enforcement for short term care. The patient is now stabilized and ready for discharge back (to the facility). However when (the hospital) contacted (the facility) to make arrangements for discharge, we (the hospital) were advised by (the facility) that it would not accept the patient back from (the hospital) citing behavioral issues with the patient. The correspondence goes on stating: You (the facility) have advised on the telephone that you will not accept the patient back because of behavior issues. We hereby request copies of the medical records that document or substantiate these behavior issues . As you know, we (the hospital) are a short term Behavioral Health Unit. We are not a long-term behavioral health facility. We are not equipped to house nursing home residents on a long-term basis. Request is made for (the facility) to accept the patient back as a resident. Interviews with the hospital General Counsel attorney were conducted in person on 5/21/19 at 1:05 p.m. and by phone on 5/22/19 at 11:00 a.m. The General Counsel attorney verified that Resident 89 was admitted for acute care following an EPC request from the facility on 1/29/19. The resident's condition was stabilized and the facility informed the facility the resident was ready for re-admission. The facility denied the re-admission stating issues with the resident's behavior. The attorney stated the facility had not come to the hospital to evaluate the resident's stable condition at the time of the request. The denial of re-entry by the facility prompted the attorney's formal correspondence to the facility sent and verified as received on 2/21/19 by certified mail. The hospital never received any documentation as requested regarding the behavioral issues or medical records supporting the facility's decision not to re-admit the resident. Further interview by phone revealed the resident remained in the hospital's Behavioral Health acute care unit until 4/9/19 when the hospital found suitable placement for Resident 89 in a facility in Colorado. Record review of a facility policy entitled Transfer and Discharge from the Facility Policy, created in (MONTH) of (YEAR), included the following policy statements: - It is the policy of this facility that each resident has the right to remain in the facility and not transfer or discharge a resident. The policy identifies exceptions to this which included: . resident's needs cannot be met in the facility . - Should a resident's need (s) not be met by the services provided by the facility, the facility staff will reevaluate the resident's care plan to determine if changes to the care plan will help meet the resident's needs. If the facility cannot provide for the resident's needs, the resident may have to be transferred to another healthcare facility that can provide the services needed . - The resident and representative will receive timely notification, adequate preparation, orientation and information to make the transfer as orderly and safe as possible. The notice contain information about the transfer and information about resident's appeal rights . The resident will not be discharged during the appeal process. If the transfer is due to an emergency, the notice will be issued as soon as practicable . - The objective of the transfer/discharge policy is to ensure that the resident is informed of an impending discharge and their right to appeal the discharge . - Overview Of Regulatory Requirement Components for This Policy recorded Facility requirements The facility must permit each resident to remain in the facility and not transfer or discharge the resident unless-- (A) The transfer or discharge is necessary for the resident's welfare and the residents needs cannot be met in the facility . Record review of the facility's Facility Assessment Tool updated on 5/9/19 revealed the facility offered and was licensed for care in both an Advanced Alzheimer's unit of 22 beds and an Alzheimer's unit of 20 beds. The assessment identified Services and Care We offer Based on our Residents' Needs which included: Mental health and behavior- Manage the medical conditions and medication-related issues causing psychiatric symptoms and behavior, identify and implement interventions to help support individuals with issues such as dealing with anxiety, care of someone with cognitive impairment, care of individuals with depression, trauma/[MEDICAL CONDITIONS], other psychiatric diagnoses, intellectual or developmental disabilities . Interview with the facility Administrator on 5/21/19 at 11:30 a.m. confirmed Resident 89 was admitted to the facility in (MONTH) of (YEAR) and resided in one of the locked Alzheimer's care units at the facility during the resident's stay. The Administrator verified the resident's behavioral episodes escalated and experienced nine episodes of aggression toward other residents in a short period of time. The facility attempted various interventions and involved both the resident's physician and psychiatrist in attempting to treat the resident. Due to failure in stabilizing the resident, the resident was EPC'd to an acute Behavioral Health facility on 1/29/19. The Administrator verified the facility determined it was not safe to allow the resident to return and the facility denied re-admission after the hospital had notified the facility the resident's condition stabilized and the resident was ready for discharge back to the facility. The Administrator verified the facility had no documentation supporting why they chose not to allow the resident to return. The resident was not given a notice of discharge or allowed an appeal to the decision. The resident's psychiatrist and medical practitioner had not been involved in the decision or provided any supportive documentation why the resident's needs could not be met by the facility. The Administrator verified that the facility does admit and care for both Alzheimer's residents and those with psychiatric [DIAGNOSES REDACTED]. The Administrator verified the decision to not re-admit the resident to the facility was based on the resident's condition at the time of transfer and not based on any evaluations of the resident at the time the hospital described the resident's condition was stable and appropriate for return to long-term care management. 2020-09-01