cms_NH: 4

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
4 GREENBRIAR HEALTHCARE 305005 55 HARRIS ROAD NASHUA NH 3062 2018-03-05 656 D 0 1 6C1411 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview and review of the facility Comprehensive Person-Centered Care Plan policy and procedure the facility failed to develop and implement a person-centered comprehensive care plan for 5 residents in a survey sample of 43 residents. (Resident identifiers are #15, #49, #80, #93 and #152.) Findings include: Resident #152. Record review on 3/5/18 of the Physical Therapy Plan of Care for Resident #152 dated 1/28/2018 revealed in the section titled Medical History Related to Diagnosis/Condition: . R (right) BKA (below knee amputation) due to osteo[DIAGNOSES REDACTED] 6/2105 . Record review on 3/5/18 of the PT (physical therapy) - Therapist Progress note for Resident #152 dated 2/26/18 revealed The pt (Resident #152) continues to have deficits in ROM (range of motion) in B LE (bilateral lower extremities), which limit pt's ability to stand upright on LLE (left lower extremity) and prepare for ambulation via prosthesis due to limited ROM in R knee .barrier is that the pt. (Resident #152) does not currently have a functional prosthesis, as .socket does not fit despite use of shrinker nearly 24/7. PT has been working with prosthesis to obtain a new socket . Interview and review, on 3/5/18 at approximately 12:30 pm. with Staff [NAME] (Registered Nurse), of the comprehensive care plan for Resident #152 revealed no documented evidence of care plan indicating a below knee amputation with interventions for Resident #152. Staff [NAME] reported that if you read this care plan and had not seen .(Resident #152) you wouldn't know that .had a [MEDICAL CONDITION]. Resident #49 who was admitted to the facility on [DATE] has a comprehensive plan of care initiated on 9/26/17 which states that this resident is able to make (his/her) own health care decisions at this time. Interviews on 3/2/18 and 3/5/18 with respectively Staff L ( Social Services Director) and Staff D (Unit Manager, RN) revealed that Resident #49 was not competent upon their admission to make his/her own health care decisions. In addition both Resident #49's admission MDS assessment of 9/25/17 and quarterly MDS assessment of 12/18/18 coded Resident #49 as being severely cognitively impaired. Record review revealed that Resident #49's care plan states Resident #49's Advance directives are not on file. Staff L stated in a 3/2/18 interview that there wasn't either any guardianship or durable power of attorney documents on file at the facility for Resident #49 since Resident #49's admission on 9/18/17. A 3/5/18 interview with Staff L revealed that a New Hampshire Durable Power of Attorney Form for Resident #49 appointing his/her son as Resident #49's durable power of attorney had been found on 3/5/18 among Resident #49's admission paperwork. A review of this Durable Power of Attorney revealed that it is only for financial matters and states that this document does not authorize the Attorney-in-Fact to make medical decisions for the Principal Resident #49. Resident #93 Review on 03/02/18 of Resident #93's medical record revealed that Resident #93 has dementia. Review of Resident #93's the care plan on 03/05/18 reveals Resident #93 is an extensive assist with a shower. Review of Resident #93's activities of daily living task for showers revealed that during the time frame of 2/3/18-3/5/18 he/she only received one shower since 2/3/18. He/she refused a shower on 2/17/18. Interview on 3/2/18 with Staff N, (Licensed Practical Nurse) revealed that he/she is to be re-approached on another day to receive a shower for the week that he/she missed. There is no documentation that showes that Resident #93 was reapproached and Resident #93 only received a bedbath. Resident #80 Observation of Resident #80 on 3/2/18 at 10:15 a.m. during interview revealed the resident's right foot was not resting on the foot platform of their wheelchair and the resident's slipper was dangling from their foot. There was towel wrapped on the foot platform. Interview with Resident #80 on 3/2/18 at 10:15 am. revealed that when Resident #80 was admitted , the resident had brought an electric wheelchair from home that was no longer taking a charge so was now using a facility manual wheelchair. Resident #80 also revealed that the resident had limited range on motion of the right hip and knee. Review of Resident #80's current care plan on 3/5/18 at 9:09 a.m. revealed there were no interventions for positioning or limited range of motion for the resident's lower right extremity. Interview with Staff M (Assistant Administrator) on 3/5/18 at approximately 10:30 a.m. confirmed there were no care plan interventions for positioning or range of motion. Resident #15 Review of medical record on 3/2/18 at approximatley 10:15 am revealed that Resident #15 had a [DIAGNOSES REDACTED]. Review of Resident #15's care plan revealed that there was no care plan for communication or [MEDICAL CONDITION]. Interview on 3/2/18 at approximatley 11:45 am with Staff G (Unit Manager building 5-3) confirmed that resident has a communication deficit and uses gestures and yes and no answers to communicate with staff and that there is no care plan in place for communication or [MEDICAL CONDITION]. 2020-09-01