cms_SD: 11

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.

Data source: Big Local News · About: big-local-datasette

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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
11	AVANTARA MILBANK	435009	1103 SOUTH SECOND STREET	MILBANK	SD	57252	2018-10-03	609	D	0	1	LZ7K11	NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Surveyor: Based on observation, interview, record review, and policy review, the provider failed to ensure investigations had been completed for 3 of 3 incidents for 1 of 14 sampled residents (37) for potential verbal, mental, and physical abuse. Findings include: 1a. Observation and interview on 10/2/18 at 3:00 p.m. with resident 37 shared her concerns including the following: She stated the staff reminds me of one big [NAME]s and she does not need that in her life. She did not want those people in her life, and when she asked to have other staff assist her she was told she had to accept whoever was assigned. She stated staff did not answer her call light for hours and sometimes not at all. She was seated on her bed with a tray table in front of her. Her wheelchair was located across the room and pushed under the sink. She was unable to use her right hand due to a previous stroke. At 3:16 p.m. she pressed her call light. At 3:22 p.m. this surveyor went into the hall to ensure the light had been activated and the light was on. At 3:35 p.m. an unidentified male staff person came into the room and told her he would get someone else to assist her. At 3:38 p.m. the director of nursing (DON) entered the room, stated she did not usually help her but would do her best, and used the standing lift to assist her to the commode. Review of resident 37's medical record revealed: b. On 06/23/18 at 1:33 p.m. a progress note by the DON revealed the resident had told staff she had blisters on her left hand. The DON had documented: -Firm blisters on the knuckles of the left thumb, index, 3rd and 4th fingers. Thumb being the largest. Skin on the back of hands is very ruddy and red. On 06/25/18 an incident follow-up notation completed by the DON revealed: -Discussed by (interdisciplinary team), resident is known to run hot water for long periods of time, up to 2-4 hours to wash her hair and this is what she has been doing. No amount of verbal counseling will change this as it is part of her ([MEDICAL CONDITION]) ([NAME]D) behavior, she has a need to rinse her hair multiple times. Maintenance will. Handwritten by the DON verify the water temp is in safe range in the room. On 06/25/18 at 1:45 p.m. she was seen by the Certified Nurse Practitioner (CNP): I am making 60 day rounds for (resident 37's physician). (Resident 37) has multiple health problems. She does have a history of [NAME]D. She was washing her hair and this is quite an extensive chore for her and it usually takes quite a long time. She burned both of her hands from washing her hair. She has been applying vitamin D. And she has been drinking more[NAME]water to help her hands. Bilateral hands are [DIAGNOSES REDACTED]tous (red) she has blisters on 1,2, and 3 (fingers) of both hands. No drainage present. -Handwritten note by the DON only (left) hand had blisters-doesn't use (right) hand. R/[MEDICAL CONDITION](related to stroke). A 06/26/18 at 11:04 p.m. weekly skin check revealed: Only new skin concern is that (resident) has some [MEDICAL CONDITION] bilateral fingers that are being (treated) with Vit E.[MEDICAL CONDITION] drying up, has been blistered. Appear to be healing nicely. 06/26/18 an incident follow-up notation completed by the DON revealed: -Maintenance checked the water (temperature) and it is 117.7 (degrees Fahrenheit), this is below the recommended 125 (degrees Fahrenheit). Resident also thinks that someone flushed a toilet making the water hotter, it is explained to her that in a household that can happen but that the plumbing in the facility does not work that way. A weekly skin check on 07/3/18 at 4:55 a.m. revealed she was complaining of pain related to [MEDICAL CONDITION] left thumb and first finger. c. On 08/24/18 at 12:00 midnight a progress note by licensed practical nurse (LPN) A revealed she had overheard an unidentified assistive personal (UAP) was in the room with resident 37, the UAP had bumped resident 37's foot two times during a transfer. Resident 37 got upset and was yelling at the UAP. The UAP put her on the commode and left the room. -LPN A entered the room to assess the foot and resident 37 was still upset. -LPN A noted This nurse told resident when she stopped screaming and calling staff names, and calmed down that some(one) would come and assister her off commode. This (LPN A) then left room. Resident did calm down, was assisted off commode and is now on her bed eating popcorn. Interview on 10/3/18 at 4:45 p.m. with the social services designee revealed he: Only took care of grievances. Did not take care of any complaints or investigations. Thought the administrator did those investigations. Interview on 10/3/18 at 6:00 p.m. with the DON revealed she: Confirmed the above medical record review documentation. Stated she had determined [MEDICAL CONDITION] been caused by resident 37. Stated the blisters had healed in one day. Was not aware of the incident on 08/24/18 and stated the resident had always sat on the commode for a long length of time. The nurses had not been trained to start an investigation. They were to have called the DON or administrator. Interview on 10/3/18 at 6:30 p.m. with the administrator revealed she: Was not aware of the above incidents. Signed off on the DON's investigations. Was aware of the requirement of investigations and reportable incidents. Review of the provider's (MONTH) (YEAR) Abuse, Neglect, and Exploitation policy revealed: The Abuse coordinator in the facility is the Director of Nursing, Administrator, or facility appointed designee. Report allegations or suspected abuse, neglect or exploitation immediately to: -Administrator -Other Officials in accordance with State Law -State Survey and Certification agency through established procedures. Investigation of Alleged Abuse, Neglect, and Exploitation. When suspicion of abuse, neglect, or exploitation, or reports of abuse, neglect or exploitation occur, an investigation is immediately warranted. Once the resident is cared for and initial reporting has occurred, an investigation should be conducted. Components of an investigation may include: -Interview the involved resident -Interview all witnesses separately. Include staff members in the area. -Document the entire investigation chronologically.	2020-09-01