cms_OR: 41

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
41 REGENCY GRESHAM NURSING & REHAB CENTER 385015 5905 SE POWELL VALLEY RD GRESHAM OR 97080 2017-09-26 204 D 1 0 5RH111 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on interview and record review it was determined the facility failed to provide post discharge resources and document a safe plan for a resident with intent to leave the facility against medical advice for 1 of 3 sampled residents (#9) reviewed for discharge. This placed residents at risk for lack of medical treatment. Findings include: Resident 9 was admitted to the facility in (YEAR) with [DIAGNOSES REDACTED]. The 6/1/17 hospital Inpatient Progress Note indicated Resident 9 was chronically homeless and was admitted to the hospital for failure to thrive. The resident was brought to the hospital due to public concern for the resident's safety. The note indicated the resident was in the emergency department for the third time in one month. The resident left against medical advice on one emergency room visit. The resident was assessed to have a non-healing ulcer to the left heel likely related to diabetes. It was unknown how long the resident had the ulcer. The resident was on medications including a blood thinner for an irregular heart beat. The 6/9/17 Admission MDS and associated CAAs indicated it was anticipated the resident would be discharged to the community. The resident was previously homeless and not able to care for her/his heel wound. The resident was assessed to be cognitively intact and independent with all ADLs except for transferring. The resident required the use of a mechanical lift in order to prevent the resident from putting pressure on the heel. The Care Plan initiated on 6/5/17 indicated Resident 9 discharge plan was to discharge to congregate housing (independent living). The resident had [DIAGNOSES REDACTED]. The [DIAGNOSES REDACTED]. The interventions included staff were to provide community resources to support independence post-discharge. The 6/7/17 Progress Note indicated the resident's discharge plan was not determined. The note indicated the resident was previously homeless and lived in her/his truck. The 6/7/17, 7/12/17, 7/17/17, 7/26/17, 8/2/17, 8/14/17 Physician Assistant Progress Notes indicated Resident 9 reported the plan was to live in her/his truck but the resident acknowledged it was not safe. The notes indicated it was not safe for the resident to discharge to her/his truck and staff were to work with the resident to ensure there was a safe discharge plan in place. The Progress Notes for the interdisciplinary team meetings dated 6/21/17, 6/26/17, 7/5/17, 7/12/17, 7/19/17, 7/26/17 and 8/2/17 indicated the resident's state case worker worked on finding housing or a adult foster home for the resident at a lower level of care. The Social Service notes dated 7/6/17 indicated Witness 6 (State Transitional Case Worker) was in the process of looking for a lower level of care after skilled services ended. The 8/18/17 note indicated Staff 5 (Social Services) spoke with the resident about a lower level of care. The resident became upset and did not want to pay for a lower level of care and would leave the facility against medical advice. The note indicated staff would address discharge plans with the resident at a later time. The 8/23/17 note indicated the resident reported she/he would leave the facility before she/he paid for a lower level of care. The 8/7/17 Progress Note by Staff 20 (LPN) indicated the resident started to pack her/his belongings, the RNCM was notified and Staff 5 spoke with the resident. There was no note from Staff 5 to indicate what was communicated with the resident. The 8/28/17 Progress Note by Staff 20 (LPN) indicated Resident 9 reported she/he planned to leave on 8/29/17. The resident reported she/he planned to stay in her/his truck. There was no documentation to indicate staff attempted to educate the resident on a safe discharge, provide community resources and or provide the resident with alternative options. On 9/18/17 at 12:34 pm Staff 20 indicated the resident reported she/he planned to leave the facility because the resident did not want to pay the facility. Staff 20 indicated she asked the resident what she/he would do for wound care and the resident did not respond. Staff 20 indicated Resident 9 was difficult to teach and the resident made her/his own appointments. Staff 20 indicated she reported the resident's verbalization to leave to Staff 5. The 8/29/17 Social Service note indicated staff assisted the resident into her/his truck after the resident signed documents to indicate the resident was leaving against medical advice. The note indicated the resident was last seen sitting in her/his truck to warm it up. The 8/29/17 Progress Note indicated the resident left the facility against medical advice at 8:00 am. There was no documentation to indicate the resident was provided education on wound care or how to follow up with the physician to ensure prescribed medications were continued after discharge. The Discharge Against Medical Advice Release and Waiver dated 8/29/17 and signed by Resident 9 indicated the resident left the facility by choice and the resident left without a discharge order and written authorization by the physician. On 9/18/17 at 9:20 am Staff 5 (Social Services) indicated the resident was homeless prior to admission to the facility. The resident was pleasant at times but other times the resident was not cooperative. The resident was strong willed and only wanted care performed when the resident chose. The staff were aware the resident was likely to leave the facility against medical advice. Staff 5 indicated he communicated with the resident options for care outside of the facility but indicated it was not documented what was presented to the resident. Staff 5 indicated the day the resident left the facility Staff 5 assisted the resident to the resident's truck. The resident was able to self transfer from the wheel chair to the truck. Staff 5 did not see the resident drive away and was not able to determine if the resident drove in a safe manner. Staff 5 indicated the wound nurse may have communicated with the resident in regards to post discharge wound care. Staff 5 indicated he saw Resident 9 to have a state issued card but was not sure if it was a current drivers license or an identification card. On 9/18/17 at 12:50 pm Staff 21 (RN/Staff Wound Nurse) indicated he worked with Resident 9 and assessed the resident's wound weekly. Staff 21 indicated when Resident 9 verbalized a plan to leave the facility against medical advice he educated Resident 9 regarding self care of the ulcer. Staff 21 indicated there was no progress note to confirm education was provided. On 9/15/17 at 10:20 am Staff 22 (RN) indicated staff knew for weeks the resident wanted to leave the facility. Staff 22 indicated she asked the resident how she/he would be able to care for her/himself and the resident did not respond. On 9/18/17 at 9:10 am Witness 5 (Resident 9's State Case Manager) indicated he initially assessed Resident 9 while the resident was still in the hospital to ensure the resident qualified for services. Witness 5 indicated he did not communicate with the facility regarding Resident 9. Witness 5 indicated Witness 6 (Resident 9's State Transitional Care Manager) worked with Resident 9 regarding a post-facility discharge. On 9/18/17 at 11:13 am Witness 6 indicated he visited the resident at the facility at least six times during the resident's facility stay. The resident verbalized she/he would likely leave the facility against medical advice to live in her/his truck. Witness 3 indicated he reported Resident 9 comments to Staff 5. Witness 6 indicated the facility did not call him to ask about the discharge plan and did not inform him when Resident 9 left the facility against medical advice. On 9/15/17 at 1:00 pm Staff 2 (DNS) indicated from the day the resident was admitted to the facility the staff knew the resident would likely go against medical advice. The resident did not want to pay the facility. Staff 2 indicated Staff 5 worked with the resident for a safe discharge. A request was made to Staff 2 to provide documentation to indicate the facility provided Resident 9 education and alternative community services to ensure a safe discharge. No additional information was provided. The 9/1/17 hospital emergency room dictation indicated Resident 9 was brought to the hospital by ambulance. The resident was observed by police to be driving erratically. The resident drove on curbs and back onto the road. The resident was identified to have a low blood pressure and an irregular heart beat. The resident was dehydrated, had altered mental status and had signs of infection. The resident was admitted for treatment. 2020-09-01