cms_PR: 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.

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
41	RYDER MEMORIAL HOSPITAL INC	405018	355 AVE FONT MARTELO	HUMACAO	PR	792	2018-08-16	909	E	0	1	88RA11	Based on observation, record review and staff interview, the facility failed to conduct regular inspection of all the bed rails to the bed rails were maintained. This deficient practice affected five (R8, R9, R7, R13 and R16) of 11 residents sampled for the use of bed rails. Findings include: 1. On 08/13/18 at 10:21 AM Resident (R) 8 was observed in bed with metal half bed rails in the raised position on the upper portion of the bed. The bed rails were loose and moved side to side and rocked at a 45-degree angle parallel with the bed mattress. On 08/15/18 at 1:10 PM the bed rails on the same bed were in the raised position and were inspected with the Director of Nursing (DON). The bed rails were loose and moved/rocked back and forth parallel to the bed when little pressure was placed on the rails. The DON verified the metal bed rails on each side of the bed were loose. 2. On 08/13/18 at 2:05 PM, R9 was observed in bed with the bed rails in the raised position on each side of the bed. On 08/14/18 at 9:39 AM, R9 was observed in bed with metal bed rails in the raised position on both sides of the bed. The bed rail on the right side of the bed was noted to be loose and to move back and forth parallel with the bed when light pressure was applied to the rail. On 08/15/18 at 1:10 PM the bed rails were checked with the assistance of the DON. At the time of the inspection the bed rails were in the raised position. The bed rails on each side of the bed rocked back and forth when little pressure was applied to the rails. The rails were connected to the metal bed frame with a bracket located in the bottom middle of the rail. 3. Observation on 08/14/18 at 01:53 PM of R7 was in bed with the half metal bed rails in the raised position. Observation on 08/15/18 at 1:10 PM, the DON confirmed R7 had metal bed rails were loose and could shift parallel with the side of the bed. 4. Observation on 08/14/18 at 1:22 PM of R13 was in bed with the metal half side rails in the raised position at the head of the bed. Interview at that time with R13 and her family revealed she was alert and oriented and used the side rails for positioning. Observation on 08/15/18 at 1:10 PM, the DON confirmed R7 had metal side rails were loose and could shift parallel with the side of the bed. 5. Observation on 08/14/18 at 02:07 PM, R16 was in bed with the metal half bed rails in the raised position at the head of bed. Observation on 08/15/18 at 1:10 PM, the DON confirmed R16 had metal bed rails that were loose and could shift parallel with the side of the bed. On 08/15/18 at 3:26 PM, the Administrator and the Biomedical Employee were interviewed about the use and maintenance of the side rails. The Biomedical Employee stated he oversaw the maintenance of the entire facility. The Administrator stated all the residents' beds are equipped with half-bed rails on the upper portion of the bed. She stated the facility did not have a policy, schedule or system in place to ensure the bed rails were properly attached to the bed and tight. She stated if there was an issue with the functioning of the bed rails maintenance would be notified. The Biomedical Employee stated he had never had the loose bed rails reported to him. At the time of the interview the manufacturer's information was requested for each of the types of bed rails the facility had in use. On 08/15/18 at 4:00 PM the Biomedical Employee stated he was not able to locate manufacturer's information for any of the bed rails used in the facility. He also confirmed the facility did not have any preventative maintenance policies related specifically the preventative maintenance of the bed rails. On 8/16/18 at 9:28 AM the DON stated they did not have a protocol or policy for ensuring the bed rails were maintained in safe condition and stated if the employees caring for the residents notice the bed rails were loose they tighten them up. She stated they do not routinely check the bed rails to ensure they are not loose. She also stated bed rails were in use on all the resident's beds. Review of the facility's policy titled Use of bed rails with a last updated date of 07/14/16 was reviewed. Under the Standard section of the policy it stated, the beds in the Skilled Nursing unit will have only two bed rails elevated (in the superior part or the head of the bed) with the purpose of the resident helping themselves to position in bed. No resident will have four bed rails elevated on their bed except those who have a medical justification. Under the procedure portion of the policy it stated the nurse or medical professional would educate the resident or family about the standard use of bed rails. During daily rounds, the supervisor would ensure each resident's bed only had the two side rails at the head of the bed up. The policy was silent to the preventative maintenance of the bed rails to ensure the bed rails were maintained in a safe functioning manner.	2020-09-01