cms_NV: 62

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
62 LEFA SERAN SNF 295001 1ST AND A ST/ PO BOX 1510 HAWTHORNE NV 89415 2019-10-16 756 D 0 1 LI3Z11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review, document review and interview, the facility's attending physician failed to document a review and/or a course of action rationale of the monthly pharmacy medication regimens reviews for 2 of 12 sampled residents (Resident #7 and #14). Findings include: Resident #7 Resident #7 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. A physician order [REDACTED]. A Pharmacist Progress Note dated 08/10/19, documented a recommendation to discontinue [MEDICATION NAME] and initiate [MEDICATION NAME] due to chronic use of [MEDICATION NAME] increasing the risk of infections. Resident #7's physician visit dated 09/13/19, documented the resident's medications were last reviewed 05/20/19. Resident #7's clinical record lacked documented evidence the facility's attending physician reviewed and/or acted upon the pharmacist's recommendations dated 08/10/19. On 10/16/19 at 11:51 AM, the Director of Nursing (DON) confirmed Resident #7's clinical record lacked documented evidence the attending physician documented a review and/or a course of action rationale for the monthly pharmacist medication regimen review dated 08/10/19. The DON confirmed the facility policy, requiring the attending physician to document a review of the monthly medication reviews, had not been followed. Resident #14 Resident #14 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. A Pharmacist Progress Note dated 07/30/19, documented Resident #14 was taking [MEDICATION NAME] 150 microgram (mcg) daily for [MEDICAL CONDITION]. Most recent labs, dated 07/23/19, revealed low [MEDICAL CONDITION] Stimulating Hormone (TSH) (0.302, normal 0.340-4.820 milli-International units/milliliter (uiu/ml). The recommendation was to consider reducing [MEDICATION NAME] to 125mcg daily with a follow up TSH /Free T 4 test in six weeks. Resident had [MEDICATION NAME] 5 mg daily for [MEDICAL CONDITION] since 10/2018. Per GOLD (YEAR) guidelines (Global Initiative for [MEDICAL CONDITION]), oral glucocorticoids had no role in the chronic daily treatment in [MEDICAL CONDITION] due to the risk for systemic complications (bone loss, immunodeficiency, hypertension, fluid retention) combined with demonstrated lack of benefit in prevention of exacerbations. The recommendation was to slow taper [MEDICATION NAME] to prevent adrenal crisis. Would taper to [MEDICATION NAME] 2.5 mg daily for 1 month then discontinue. Resident #14's physician visit dated, 08/08/19, documented the resident's medications were reviewed on 08/30/18. Resident #14's Medication Administration Review (MAR) for (MONTH) and (MONTH) 2019, documented the Resident had been administered [MEDICATION NAME] 150 mcg one tablet by mouth every day and [MEDICATION NAME] tablet 5 mg by mouth daily. A Pharmacist Progress Note dated 08/27/19, documented Resident #14 was recently started on [MEDICATION NAME] 100 milligram every night at bedtime for pain. Care plan note dated 08/20/19, reported Resident #14 was experiencing increased sedation following initiation of [MEDICATION NAME]. Resident was currently receiving the lowest available dosage. The physician/nursing recommendation indicated to consider reevaluating risk versus benefit of continuing the medication. Resident #14's physician visit dated 09/13/19, documented the resident's medications were last reviewed 08/30/18. Resident #14's MAR for (MONTH) and (MONTH) 2019, documented the Resident had been administered [MEDICATION NAME] 100 mg every night at bedtime. Resident #14's clinical record lacked documented evidence the Resident's attending physician reviewed and/or acted upon the pharmacist's recommendations dated 07/30/19 and 08/27/19. On 10/16/19 at 11:55 AM, the DON confirmed Resident #14's clinical record lacked documented evidence the attending physician documented a review and/or a course of action taken for the monthly pharmacist medication regimen review dated 07/30/19 and 08/27/19. The facility policy titled, Drug Regimen Review, effective 04/01/03, documented it was the attending physician's responsibility to document a review of the pharmacist medication regimen review in the resident's clinical record. 2020-09-01