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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
270 CENTRO MEDICO WILMA N VAZQUEZ SNF 405025 ROAD 2 KM 39 5 BO ALGARROBO VEGA BAJA PR 693 2015-06-18 281 F 0 1 1RD011 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, review of ten clinical sample records, medication administration records (MAR) and interviews, it was determined that the facility failed to ensure the appropriateness of blood glucose monitoring and medication administration nursing standard of practice for 7out of 10 resident sample. (Resident #1 ,#2, #5,#6, #7, #8 and #9) Findings include: 1. A mechanism to ensure that healthcare professionals follows the best practices during continuous glucose monitor procedures with finger stick blood samples was not performed accordingly with these findings identified during survey procedures on 6/16/15 through 6/18/15: a. Resident #6 is an [AGE] years old male who was admitted on [DATE] with a [DIAGNOSES REDACTED]. The clinical record was reviewed on 6/16/15 at 10:48 am and provided evidence that physician order [REDACTED]. Accordingly with information provided by the director of nursing (employee #5) on 6/17/15 at 9:55 am continuous glucose monitor procedures with finger stick blood samples must be taken by licensed practical nurses and that results of the sample must be informed to the register nurse in charge of the resident. Continuous glucose monitor finger stick blood samples are taken by licensed practical nurses since physician order [REDACTED]. On 5/12/15 at 7 pm physician order [REDACTED]. On 6/16/15 at 4 pm blood glucose fingerstick blood sample results are 212 mgs/dl and accordingly with sliding scale 3 units of regular insulin subcutaneous must be administered however no insulin was administered when sugar reach a level for which physician establish in the insulin control/sliding scale. 2. A mechanism to ensure that healthcare professionals follows the best practices while administering medications and use Pyxis automated medication dispensing system was not performed accordingly with findings identified during survey procedures on 6/16/15 through 6/18/15: a. Resident #1 is an [AGE] years old female who was admitted on [DATE] with a [DIAGNOSES REDACTED]. While performing the resident assessment of drug therapies on 6/16 /15 at 2:30 pm it was identified that on 6/11/15 when resident was admitted a telephone order for [MEDICATION NAME] 20 mgs daily PO was taken by a register nurse at 5:40 pm. On 6/12/15 at 9:00 am it was identified on the Medication Administration Record [REDACTED]. On 6/12/15 at 7 pm an order for [REDACTED]. A clarification document was sent by pharmacy indicating that [MEDICATION NAME] 20 mgs daily PO was not available at the pharmacy. Director of nursing (employee #5) stated on interview that [MEDICATION NAME] 20 mgs daily PO signed as administered by a nurse on 6/12/15 at 9:00 am are not available on the Pyxis automated medication dispensing system and that the nurse administer [MEDICATION NAME] 25 mgs PO the medication who was available on the Pyxis automated medication dispensing system, but sign [MEDICATION NAME] 20 mgs daily PO. 3. A mechanism to ensure accuracy of patient weight procedures was not performed accordingly with these findings identified during survey procedures on 6/16/15 through 6/18/15: a.Resident #6 is an [AGE] years old male who was admitted on [DATE] with a [DIAGNOSES REDACTED]. The clinical record was reviewed on 6/16/15 at 10:48 am and provided evidence that resident was weighted during admission on 6/10/15 with a lift scale and weight 190 pounds. A week later resident was weighted on a wheelchair scale but standing and weight 186 pounds, no information was found documented on the weight chart related with the circumstances were the resident weight was taken ( with shoes, clothes and coat on 6/16/15 ) ( with linens, clothes and without shoes on 6/10/15). There is no explanation for the 4 pounds difference between resident weight on 6/10/15 and 6/16/15. The difference of four pounds was not evidence as informed to register nurse in charge of resident, dietitian or physician. Resident stated on interview on 6/16/15 at 11:00 am that he was eating well since his admission and that he does not believe that had been losing weight. On the nursing progress notes and daily flowsheets reviewed from 6/10/15 through 6/17/15 it was identified that resident was eating 100% of his Diabetic 1,800 kclas 60 grams of protein and 87 meq of salt low fat diet. 5. Resident #7 is a [AGE] years old female who was admitted on [DATE] with a [DIAGNOSES REDACTED]. The clinical record was reviewed on 6/17/15 at 1:00 pm. and provided evidence that physician order [REDACTED]. every day. The ''diabetic chart'' provides evidence that the procedures with finger stick blood samples must be taken by licensed practical nurses accordance of physician order [REDACTED]. However, accordingly with the nursing director (employee #5 ) the continuous glucose monitor procedures is taken by the licensed practical nurse and that results of the sample must be informed to the register nurse in charge of the resident and the register nurse countersigned the licensed practical nurse signature. However the ''Diabetic Chart '' reveled that is only signed by the licensed practical nurse and no evidence that licensed practical nurses inform the results of the finger stick blood sample to the register nurse in charge of the resident. On 6/12/15 at 6:00 am the licensed practical nurse perform the blood glucose finger stick and reveled a result of 203 mgs/dl and on 6/14/15 at 4:00 pm. the glucose finger stick blood sample reveled result of 277 mgs/dl and on 6/15/15 at 4:00 pm. the glucose finger stick blood sample reveled result of 248 mgs/dl however, no evidence on the nurses notes documentation related to the results and did not notified the physician of this test results. On 6/15/15 at 6:00 pm. the physician ordered insulin control/sliding scale to perform adjustment in the blood sugar treatment therapy that resident is receiving. On 6/16/15 at 4:00 pm blood glucose finger stick was performed by the licensed practical nurse and blood sample results are 234 mgs/dl and on 6/17/15 at 2:00 pm. blood glucose finger stick was performed by the licensed practical nurse and blood sample results are 248 mgs/dl, accordingly with sliding scale 3 units of regular insulin subcutaneous must be administered however no insulin was administered when sugar reach a level for which physician establish in the insulin control/sliding scale. The medication record was reviewed on 6/17/15 at 2:00 pm and reveled the insulin control/sliding scale. No evidence of insulin administration on the medication record accordingly of physician order [REDACTED]. The resident was interview on 6/17/15 at 3:15 pm. and she stated: ''I was operated on (MONTH) 8 at Hospital Hermanos(NAME)and I had a bad experience during my stay. I was admitted here on (MONTH) 11 and I have no complaints. They perform all sugar samples but they have not administered insulin.'' 4. Random sample resident #5 is a [AGE] years old male who was admitted on [DATE] with a [DIAGNOSES REDACTED]. During the record review performed on 6/16/15 at 11:00 am it was found that the physician ordered by telephone on 6/8/15 at 7:00 pm [MEDICATION NAME] 160 microgram (mcg)/ 4.5 mcg 2 pump Bid with an abbreviate of (PS). Interview with the nurse (employee #1) on 6/18/15 at 1:00 pm related to the abbreviation (PS) she stated that PS mean Patient Suminister. Review of the Medication Administration Record [REDACTED]. During interview with resident #5 on 6/16/15 at 4:05 pm he state that he has the medication with him and he administered the [MEDICATION NAME] 2 puff at bed time. On 6/17/15 at 9:00 am during interview he state that from the admission on 6/8/15 at the present he administered the [MEDICATION NAME] only one time due to that he stay in the hospital he do not need it. The facility failed to ensure appropriated medication standard of nursing practice due to nursing sign the [MEDICATION NAME] puff administration without ensuring that resident auto administrated them. 6. A mechanism to ensure that healthcare professionals follows the best practices during continuous glucose monitor procedures with finger stick blood samples was not performed accordingly with these findings identified during survey procedures on 6/16/15 through 6/18/15: a. Resident #2 is an [AGE] years old female who was admitted on [DATE] with a [DIAGNOSES REDACTED]. The clinical record was reviewed on 6/16/15 at 2:00 pm and provided evidence that physician order [REDACTED]. Accordingly with information provided by the director of nursing (employee #5 ). Continuous glucose monitor finger stick blood samples are taken by licensed practical nurses since physician order [REDACTED]. On 6/15/15 at 4 pm blood sugar level test by finger stick was not performed to the resident. b. Resident #9 is a [AGE] years old male who was admitted on [DATE] with a [DIAGNOSES REDACTED]. The clinical record was reviewed on 6/17/15 at 1:00 pm and provided evidence that physician order [REDACTED]. Accordingly with information provided by the director of nursing (employee #5) on 5/17/15 at 9:55 am continuous glucose monitor procedures with finger stick blood samples must be taken by licensed practical nurses and that results of the sample must be informed to the register nurse in charge of the resident. Continuous glucose monitor finger stick blood samples are taken by licensed practical nurses since physician order [REDACTED]. On 6/16/15 at 4:50 pm physician order [REDACTED]. On 6/16/15 at 4 pm blood glucose finger stick blood sample result is 331 mg/dl and accordingly with sliding scale 3 units of regular insulin subcutaneous must be administered. On 6/16/15 at 8 pm blood sugar glucose finger stick blood sample result is 313 mg/dl and accordingly with the scale 3 units of regular insulin subcutaneous must be administered, however no insulin was administered when sugar reach a level for which physician establish in the insulin control/sliding scale. c. The facility failed to ensure that staff register in the diabetic chart the amount of insulin administer to the resident accordingly with the control/sliding scale. 3. Resident #8 is a [AGE] years old female who was admitted on [DATE] with a [DIAGNOSES REDACTED]. The clinical record was reviewed on 6/18/15 at 10:30 am and provided evidence that physician order [REDACTED]. On 6/15/15 the 4:00 pm blood glucose finger stick sample is not documented. a. The facility failed to ensure the appropriateness of blood glucose monitoring. 2018-10-01