cms_SD: 16

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
16	AVANTARA HURON	435020	1345 MICHIGAN AVENUE SW	HURON	SD	57350	2018-02-07	657	D	0	1	TWBV11	NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, record review, and policy review, the provider failed to ensure care plans had been revised and updated to reflect the individual care needs for two of seven sampled residents (13 and 62). Findings include: 1. Review of resident 13's 11/21/17 Minimum Data Set (MDS) assessment revealed: Her Brief Interview for Mental Status score was three indicating her cognition was severely impaired. She had not demonstrated any physical behaviors. Verbal behaviors directed towards others had occurred one-to-three days. Other behavioral symptoms not directed toward others had occurred one-to-three days. No rejection of care had occurred. She had wandered one-to-three days. She required extensive assistance of two staff members to transfer. She required supervision with assist of one staff member for eating. She required extensive assistance of one staff member for bathing. Her [DIAGNOSES REDACTED].>-Hypertension. -[MEDICAL CONDITION]. -[MEDICAL CONDITION]. -Other fracture. -[MEDICAL CONDITIONS]. -Non-Alzheimers dementia. She had a weight loss of 5% or more in the last month or loss of 10% or more in the last six months. Observation on 2/5/18 from 5:35 p.m. through 6:00 p.m. of resident 13 revealed: She had been sitting in the dining room waiting for supper at 5:35 p.m. She was getting agitated and speaking loudly to the two male residents at the table. At 6:03 p.m. she hit one of the male residents on his hand while yelling at him. She then picked up her silverware and pulled her arm back as if to throw them at him. She swore at him several times calling him a name. Earlier she had been yelling across at the other male resident about his glasses. At 6:06 p.m. she again started to call the male resident names. There had been no staff that intervened. Observation on 2/5/18 at 6:13 p.m. of resident 13 revealed: She was served her food. She stated she did not want it. She raised her voice to staff and told them to take it away which they did. The staff member asked if she wanted ice cream, and she took that from her. -She ate it with a knife. Observation on 2/5/18 at 6:15 p.m. of resident 13 revealed staff brought her another plate and left it in front of her. She again stated she did not want it and did not eat it. Interview on 2/6/18 at 9:14 a.m. with certified nursing assistant (CNA) A and CNA B regarding resident 13 revealed: She was sleeping in bed. She had her bath today and had not wanted to get up earlier. She had behaviors especially when she got her bath. CNA A stated last time she had given the resident a bath she had been hit a few times. -She developed a bruise on her right underarm and left forearm. She had never liked getting a bath since she had been admitted . One time they had given her a bath in the afternoon, and that went okay. They had not changed her to an afternoon bath. They had attempted to let her wake up on her own, and then gave her bath. CNA A thought she did better if she had time to wake up. She had not liked the water in the tub. Other behaviors had increased in the last month. Interview on 2/6/18 at 1:24 p.m. with an unidentified CNA revealed they had gotten resident 13 up, but she had wanted to go back to bed. She did not want her bath, and she did not want to eat. They had been able to get her to eat ice cream. Observation on 2/6/18 at 3:23 p.m. of resident 13 revealed she was dressed and sleeping in her recliner with music on. Review of resident 13's current undated care plan revealed there had been nothing addressed regarding her behaviors during her bath. Interview on 2/7/18 at 3:42 p.m. with the director of nursing, the administrator, and resident care coordinator (RCC) A regarding resident 13 revealed: They were aware of her having behaviors with her bath. RCC A stated she did not like the water in the bottom of the tub. -She thought it scared her. They stated they had attempted different interventions but had not documented them. They were not aware the behaviors surrounding bath time had not been addressed on the care plan. They stated staff should have intervened on 2/5/18 when she was yelling at her table mate in the dining room. The CNAs would document behaviors in the Kiosk, but they were not resident specific, they were connected to the MDS assessment. There had been no other documentation of other interventions attempted to reduce her anxiety and behaviors at bath time. 2. Review of resident 62's medical record revealed: She had been admitted on [DATE]. Per her fall risk evaluation she had been at high risk for falling. She had fallen on 11/21/17, 12/9/17, and 12/21/17. Her [DIAGNOSES REDACTED].>-Demetia without behavioral disturbances. -[MEDICATION NAME] degeneration. -Major [MEDICAL CONDITION]. Review of resident 62's 10/18/17 Minimum Data Set (MDS) assessment revealed: She had a Brief Interview for Mental Status (BIMS) score of eight indicating her cognition was moderately impaired. There had been no behaviors noted. She required the extensive assistance of one staff person to transfer and to walk in the corridor. She was frequently incontinent of urine and occasionally incontinent of bowel. She was on scheduled pain medications. She had no falls prior to admission. She was on a diuretic and was getting minimal physical therapy. Review of resident 62's 1/2/18 MDS revealed: Her BIMS score was six indicating her cognition was severely impaired. She had two or more falls with injury. Interview on 2/6/18 at 10:18 a.m. with resident 62's son revealed: She had three falls since her admission. He was unsure of the dates, but she had to be sent to the emergency room (ER) once. One other time she had hit her head. She liked to sleep in her recliner due to back pain. She had a current urinary tract infection and was receiving an antibiotic. -He believed she was just finishing up with it. Observation on 2/6/18 at 10:30 a.m. of resident 62 revealed she had been sleeping in her recliner in her room. Review of resident 62's current 1/9/18 care plan revealed: A problem area of high risk for falls included with alteration in activities of daily living initiated on 10/31/17 and reviewed on 1/9/18. The goal was Resident will have no falls. Interventions related to falls had included: -Do not leave alone in bathroom, initiated on 11/1/17. -Keep room uncluttered, initiated on 10/31/17. -Restorative program: active range of motion, initiated on 11/9/17. There had been no other interventions listed for falls on the care plan. Interview on 2/7/18 at 3:42 p.m. with the administrator, the director of nursing, and resident care coordinator A regarding resident 62 revealed: She had been identified at high risk for falls upon admission. They were aware of her visual impairment. After she had fallen on 11/21/17 they stated they had reminded her to wait for help to ambulate. -They agreed residents with dementia might not remember to do that. They had also moved her trash can closer. They had identified interventions after the falls had occurred but had not assessed her environment prior to the falls. 3. Interview on 2/7/18 at 3:42 p.m. with the director of nursing, the administrator, and resident care coordinator A revealed the care plans for residents 13 and 62 had not been updated to reflect their current needs. Review of the provider's 3/9/16 Care Plan - Comprehensive policy revealed care plan interventions were to be designed after careful consideration of the relationship between the resident's problem areas and their causes.	2020-09-01