cms_NH: 48

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
48 GREENBRIAR HEALTHCARE 305005 55 HARRIS ROAD NASHUA NH 3062 2018-12-19 755 D 1 1 P2R411 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on observation, record review, interview and facility policy and procedure the facility failed to ensure accurate reconciliation of controlled narcotic medications for two residents resulting in the actual loss of the prescribed narcotic medications. (Resident identifiers are #30 and #48.) Findings include: Review on 12/14/18 of the facility policy and procedure titled Inventory Control of Controlled Substances with revision date of 1/1/13 revealed the following: Applicability: This Policy 5.4 sets forth the procedures for inventory control of controlled substances. Procedure: 1. With respect to Schedule II controlled substances . 1.2 Facility should ensure that the incoming and outgoing nurses count all Schedule II controlled substances and other medications with a risk of abuse or diversion at the change of each shift or at least once daily and document the results in the 'Controlled Substance Count Verification/Shift Count Sheet' set forth . 1.2.1 Reconcile the total number of controlled medications on hand , add newly received medications to the inventory and remove medications that are completed or discontinued from the inventory, pursuant to the Controlled Substance Verification Count Sheet and 1.2.2 Reconcile the number of doses remaining in the package to the number of remaining doses recorded on the Controlled Substance Verification Count Sheet. 1.2.3 The Facility should routinely reconcile the number of doses remaining in the package to the number of remaining doses recorded in the Controlled Substance Verification/Shift Count Sheet, to the medication administration record. Observation on 12/14/18 at approximately 7:30 a.m. showed Staff Y (Licensed Practical Nurse) and Staff Z (Registered Nurse) doing a shift change narcotic count. Observation showed Staff Y. oncoming nurse, holding individual resident narcotic packaged medications and verbally confirming the number of doses left in the medication package. Staff Z, outgoing nurse, verbally confirmed the number of doses left from the narcotic count sheet. Staff Y and Staff Z failed to visualize each of the individual residents' medication packages with the number listed in the narcotic count log to confirm the correct count. Interview on 12/14/18 at approximately 7:50 a.m. with Staff Z revealed that Staff Z verbally reports the number of narcotic doses left from the narcotic record for each individual resident to Staff Y. Staff Y verbally confirms the number of doses left in each individual resident narcotic package. Staff Z reported that visualization of the each individual resident narcotic packaged medication was not done. Staff Z reported confirmation of number of medication doses left were verbally confirmed by Staff Y and Staff Z. Review on 12/14/18 of a Narcotic Book at approximately 2:00 p.m. for Resident #48 on page #3 dated 10/28/18 revealed [MEDICATION NAME] 5 mg. (1/2 tab) 19 tablets as amount left. This medication was documented as MEDICATION TRANSFERRED to Page 26 Review on 12/14/18 of the Narcotic Book at approximately 3:00 p.m. for Resident #48 on page #26 dated 10/28/18 transferred from page #3 revealed 18 tablets of [MEDICATION NAME] not 19 tablets as indicated on page #3. Further review of page #26 for Resident #48 showed three entries on 10/29/18, three entries on 10/30/18 and two entries on 10/31/18 indicating [MEDICATION NAME] being dispensed to Resident #48 with the incorrect [MEDICATION NAME] count from 10/29/18 through 10/31/18. Interview on 12/14/18 at approximately 2:00 p.m. with Staff [NAME] (Director of Nursing) confirmed after review of the Narcotic Book listed above that the [MEDICATION NAME] narcotic count for Resident #48 was incorrect. Staff [NAME] reported that this discrepancy of the incorrect count was missed when audit was done. Review on 12/14/18 at approximately 1:30 p.m. of the facility reported missing narcotic medication on 10/31/18 for Resident #30 and Resident #48 revealed 11 missing [MEDICATION NAME] pills for Resident #48 and 24 missing [MEDICATION NAME] pills for Resident #30. Interview on 12/14/18 at approximately 2:30 p.m. with Staff C (Administrator) and Staff [NAME] (Director of Nursing) confirmed that the reported 11 missing [MEDICATION NAME] medications for Resident #48 and the 24 missing [MEDICATION NAME] medications for Resident #30 were investigated and never found. Staff [NAME] reported that the above listed incorrect [MEDICATION NAME] count for Resident #48 was missed when audit was done during the investigation for the missing [MEDICATION NAME] medications for Resident #48 and Resident #30. 2020-09-01