cms_OR: 12

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
12 LAURELHURST VILLAGE 385010 3060 SE STARK STREET PORTLAND OR 97214 2019-02-27 880 D 1 1 71NL11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > 1. Based on observation, interview and record review, it was determined the facility failed to assess and perform dressing changes to an intravenous (IV) access line for 1 of 2 sampled residents (#312) reviewed for infections. This placed residents at risk for infection. Findings include: The Centers for Disease Control and Prevention Section VI: Central Venous Catheters outlined the following procedures: B. Peripherally Inserted Central Catheters (PICCs) *Frequency of dressing change: -Transparent dressing: change every five to seven days unless soiled or loose. The Facility's Catheter Insertion and Care Policy and Procedure for central line dressing changes (no date) specified the following: -Change central and midline catheter dressing 24 hours after catheter insertion, every seven days, or if it is wet, dirty, not intact, or compromised in any way. Resident 312 admitted to the facility in 1/2019 and was discharged at the end of the month with a return to the facility anticipated. Resident 312 returned to the facility in 2/2019 with [DIAGNOSES REDACTED]. Review of the 2/2019 TAR indicated no documentation of PICC dressing changes. Review of Resident 312's Progress Notes indicated no documentation related to ongoing assessment and monitoring of the PICC for infection such as redness, warmth, tenderness, soilage, drainage and infiltration (leakage of medication into tissue). An observation on 2/19/19 at 10:12 AM was made of Resident 312's right arm. A PICC with clear dressing dated 2/7/19 was observed on Resident 312's right upper arm. There was no bleeding or redness observed at the PICC insertion site and the dressing was clean, dry and intact. In an interview on 2/19/19 at 10:12 AM, Resident 312 stated she/he received IV medication for a bone infection. She/he stated staff did not change the PICC dressing as often as they should and verified the 2/7/19 date on the dressing. She/he stated this is my lifeline because I have no veins left and denied pain at the PICC site. On 2/20/19 at 12:33 PM, Staff 4 (LPN) was observed to set up and start [MEDICATION NAME] IV medication through the PICC. The PICC dressing was observed and the dressing was clean, dry and intact and dated 2/19/19. In an interview on 2/20/19 at 12:43 PM, Staff 4 (LPN) stated on 2/19/19, she instructed the evening shift nurse to change the PICC dressing because it looked like the PICC dressing was dated 2/7/19. Staff 4 could not locate a physician's orders [REDACTED]. In an interview on 2/20/19 at 12:56 PM, Staff 5 (RNCM) stated she would expect the PICC dressing change order to be on the TAR and confirmed there was no order. She stated the facility PICC protocol was to change the PICC dressing every seven days. Staff 5 stated the facility staff should know the location of a resident's IV access from day one of admit. In an interview on 2/26/19 at 3:51 PM, Staff 2 (DNS) confirmed Resident 312 had a PICC and expected the PICC site to be assessed and monitored and the dressing changed every seven days per protocol. Staff 2 stated education was provided to nursing staff regarding frequency of dressing changes to prevent infection. 2. Based on observation and interview, it was determined the facility failed to implement appropriate hand hygiene during medication administration for 1 of 9 staff (#7) observed during medication administration. Findings include: The 8/2018 Facility Medication Administration Policy and Procedure specified the following: -Handwashing and Hand Sanitization: The person administering medications adheres to good hand hygiene, which includes washing hands thoroughly: * Before beginning a medication pass, * prior to handling any medications, * after coming into direct contact with a resident, * at regular intervals during the medication pass such as after each room . On 2/25/19 at 11:32 AM, Staff 7 (RN) performed capillary blood glucose (CBG) checks and Insulin administration to three residents and was observed in direct contact of each resident. Staff 7 did not perform hand hygiene before or after direct contact of each resident. On 2/25/19 at 11:43 AM, Staff 7 (RN) stated she should be performing hand hygiene between each resident and confirmed she did not wash her hands or use alcohol based hand rub. On 2/27/19 at 11:55 AM, Staff 2 (DNS) stated hand hygiene should be performed between every resident and not doing so was unacceptable. 2020-09-01