cms_NV: 89

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
89 LAS VEGAS POST ACUTE & REHABILITATION 295006 2832 S. MARYLAND PARKWAY LAS VEGAS NV 89109 2018-05-11 690 D 0 1 QB3511 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to follow physician's order for changing a Foley catheter and failed to provide accurate and consistent documentation regarding Foley catheter care for 1 out of 18 sampled residents (Resident #19). Findings include: Resident #19 Resident #19 was admitted on [DATE], with [DIAGNOSES REDACTED]. On 05/10/18 at 8:30 AM, the resident indicated being admitted with a Foley catheter due to a stage four pressure ulcer on his sacrum. The resident verbalized having a history of urinary tract infections [MEDICAL CONDITION] due to prolonged Foley catheter use. The resident communicated needing a Foley catheter due to being a quadriplegic. The resident verbalized the original order for the Foley catheter was french 16 with 10 cubic centimeter (cc) balloon. The resident confirmed having a french 20 Foley catheter due to clogging from sediments. A physician's order dated 08/11/17, documented Foley catheter size french 16 with 10 cubic centimeter (cc) balloon to gravity drainage with justification sacral wound. The Foley Catheter Flowsheet (August (YEAR)) documented the Foley catheter was changed on 08/20/18, using french 18 with 5cc balloon. A nurses note dated 08/20/17, documented Foley catheter changed, inserted french 18 with 5 cc balloon. The Foley Catheter Flowsheet (September (YEAR)) documented catheter care every shift on a Foley catheter french 18 with 5 cc balloon. The Foley Catheter Flowsheet (October (YEAR)) documented catheter care every shift on a Foley catheter french 18 with 10 cc balloon. The Foley Catheter Flowsheet (December (YEAR)) documented catheter care every shift on an unspecified Foley catheter. A physician's order dated 02/22/18, documented indwelling catheter french 16 with 10 cc balloon. Physician orders dated (MONTH) 1, (YEAR) to (MONTH) 31, (YEAR), documented indwelling catheter french 16 with 10 cc balloon. The Foley Catheter Flowsheet (March (YEAR)) documented catheter care every shift on a french 18 with 5 cc balloon. The document revealed a Foley catheter exchange on 03/20/18 with no corresponding nurses notes. A nurses note dated 03/14/18, documented Foley catheter changed inserted 20 french. The exchange was not documented on the Foley Catheter Flowsheet. Physician orders dated 04/01/18 to 04/30/18, documented indwelling catheter french 16 with 10 cc balloon. The Foley Catheter Flowsheet (April (YEAR)) documented catheter care on a Foley catheter french 18 with 5 cc balloon. A physician's telephone order dated 04/04/18, documented to change Foley catheter due to clogging for sediments. There was no additional information on the telephone order. A nurses note dated 04/04/18, documented Foley catheter changed to french 20 with 5 cc balloon due to clogging. The exchange was not documented on the Foley Catheter Flowsheet. On 05/09/18 at 2:16 PM, a Licensed Practical Nurse (LPN) #1 indicated when receiving a Foley catheter order from a physician, she would expect a justification and specification in size (french) and balloon amount (cc). LPN #1 verbalized Foley catheter care was documented in the Foley Catheter Flowsheet. On 05/09/18 3:54 PM, LPN #2 provided a document titled Physician's Order for Indwelling Catheter. The document contained provisions for the following information : 1) Date, 2) Supporting diagnosis, 3) Foley catheter size (french) and balloon amount (cc), 4) Standing orders for catheter care, 5) Signature of Nurse Receiving Order and date and 6) Signature of Physician and date. LPN #2 explained nurses were expected to fill out this document when receiving an order from a physician for a Foley catheter insertion or if there was a change from previous order. LPN #2 verbalized Foley catheter care was documented in the Foley Catheter Flowsheet. On 05/10/18 at 11:30 AM, the Director of Nursing (DON) indicated the facility nurses are expected to utilize the Physician's Order for Indwelling Urinary Catheter form. The DON explained this document was filled out on admission and/or when there was a change from a previous order such as a catheter size. The DON was shown the physician's telephone order dated 04/04/18 which documented to change Foley catheter due to clogging for sediments. The DON confirmed this telephone order was insufficient and unacceptable as it did not specify the Foley catheter size and balloon amount to use. The DON confirmed the resident's clinical records lacked documented evidence of a physician's order every time the Foley catheter was changed. The DON acknowledged inaccuracies and inconsistencies in documentation regarding Foley catheter care. The DON confirmed this was not acceptable practice. 2020-09-01