cms_SC: 6254

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
6254 SALUDA NURSING CENTER 425081 581 NEWBERRY HIGHWAY SALUDA SC 29138 2014-04-30 309 D 0 1 0D6111 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the Recertification Survey, based on record review and interview, the facility failed to follow physician orders [REDACTED].#5, (1 of 1 resident reviewed for [MEDICAL TREATMENT] and 1 of 1 resident reviewed with a fracture.) The facility did not comply with a physician's orders [REDACTED].# 4 physician's orders [REDACTED]. (1 of 3 sampled resident's reviewed with orders not followed related to the use of pressure relieving boots.) The findings included: The facility admitted Resident #5 with current [DIAGNOSES REDACTED]. On 4/29/14 at 2:17 PM, review of the monthly physician orders [REDACTED]. On 4/30/14 at 9:28 AM, review of the facility I & O sheet(s) revealed the resident's intake was greater than 1200 ml on 26 of 29 days in April, 28 of 31 days in March and 27 of 28 days in February. Review of the Medication Administration Record [REDACTED]. There was no documentation in the Nurse's Notes or in the [MEDICAL TREATMENT] Communications that the [MEDICAL TREATMENT] provider had been informed of the excess fluid intake. Further review of the record at 9:28 AM on 4/30/14 revealed a note by the dietician related to communicating with the [MEDICAL TREATMENT] dietician concerning the resident's nutrition and elevated potassium level but there was no mention of the excess fluid intake. The care plan stated the resident was non-compliant, at times with the restriction. There was no documentation in the nurses notes of the resident's non- compliance, or of notification to the physician or the [MEDICAL TREATMENT] provider of non-compliance. The care plan indicated nurses having problems (with) fluid restrictions (with) res(ident's) meds (medications). The care plan further indicated a change had been made to the resident's medication regimen to adhere to fluid restrictions. During an interview on 4/30/14 at 10:18 AM, Registered Nurse (RN) #4 confirmed the resident's daily intake was usually greater than 1200 ml per day. The RN further confirmed the medication had been changed to aid with complying with the restriction. RN #4 also confirmed s/he had not received any reports of the resident being non- compliant. Two meal observations were made during the survey, on 4/29/14 at 1:15 PM and 4/30/14 at 12:30 PM, that revealed Resident #5 received 360 ml of fluid with his lunch tray. Review of the MAR indicated [REDACTED]. There was no documentation that this was communicated to the physician or to the [MEDICAL TREATMENT] center. The [MEDICAL TREATMENT] Monthly Nutrition Report Card dated 1/14/14 revealed Average Fluid Gain and indicated Needs Improvement. On 4/30/14 at approximately 9:20 AM, nurses were overheard discussing a fracture Resident #5 had sustained. Review of the current medical record had not revealed the results of an x-ray indicating the resident had a fracture. A copy of the incident report was requested and provided by the Director of Nursing (DON). Review of the incident report revealed a fax to the physician dated 4/24/13 that Resident #5 was complaining of L(eft) leg/ ankle pain at [MEDICAL TREATMENT]. (also on 3rd shift last night). Dr. at [MEDICAL TREATMENT] assessed the ankle and sent a note to you regarding his thoughts. Ankle is swollen and warm to touch. Resident states it hurts when (s/he) stands on it. On the bottom of the fax, the physician had written: ORDER: 4/25/13 Agree I saw this earlier & (and) it seems by exam to intensified Obtain x-ray ankle, Venous flow for [MEDICAL CONDITIONS]. The fax stamp indicated the order was faxed to the facility on [DATE] at 15:23 (3:23 PM). Further review revealed the x-ray was not performed until 5/6/13 which indicated Recent bimalleolar fracture left ankle with slight subluxation anteriorly of the tibia on the talus. At 11:19 AM on 4/30/14, the DON confirmed the physicians order was dated 4/25/13 and that the x-ray was not obtained until 5/6/13. The DON was unable to explain why the x-ray was not done until 5/6/13 but further stated that when the order was discovered, the nurse immediately obtained the x-ray and and an incident report was completed. The facility admitted Resident #4 with [DIAGNOSES REDACTED]. Record Review of the physician's orders [REDACTED].#4 on 4/28/2014 at 2:40 PM and on 4/29/2014 at 9:02 AM, 10:55 AM and 12:25 PM revealed the resident was not wearing the Bunny Boot as ordered. On 4/29/2014 at 3:38 PM, Registered Nurse #3 verified Resident #4 was not wearing the device as ordered by the physician. 2018-04-01