cms_SD: 27

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
27	AVANTARA HURON	435020	1345 MICHIGAN AVENUE SW	HURON	SD	57350	2016-12-07	329	D	0	1	EGJW11	NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review, interview, and policy review, the provider failed to ensure one of nine sampled residents (11) who received an antipsychotic medication had an appropriate indication for the use of it and had an attempt at a gradual dose reduction (GDR). Findings include: 1. Review of resident 11's (MONTH) (YEAR) physician's orders [REDACTED]. [MEDICATION NAME] 125 milligrams (mg) twice daily (BID); ordered date 12/8/15. Donepezil [MEDICATION NAME] 10 mg one tablet at bedtime; ordered date 12/8/15. [MEDICATION NAME] 50 mg for mood; ordered date 12/8/15. [MEDICATION NAME] 0.25 mg one tablet twice daily (BID) for restlessness and agitation; ordered date 12/8/15. -The targeted behaviors for use of the [MEDICATION NAME]: repetitive verbalizations, smearing feces, agitation, repetitive movements. Review of resident 11's 9/7/16 through 12/6/16 behavior monitoring documentation revealed she had not exhibited any physical, verbal, or other behaviors. Review of resident 11's interdisciplinary progress notes revealed: 7/13/16 Care Conference: She has no mood or behaviors noted during this assessment period. She is receiving [MEDICATION NAME] and [MEDICATION NAME] with dx (diagnosis) Anxiety and Agitation. 7/14/16: Mood essentially stable. Can become easily irritated or flustered and can seem physically aggressive to caregiver however seems more r/t (related to) lack of comprehension and difficulty in expressing self d/t (due to) cog (cognitive) deficits. 9/22/16: Mood fairly stable .has occas (occasional) periods of mild aggression which seems to be r/t inability to express needs effectively. 9/27/16 Care Conference: She has no mood or behaviors noted during this assessment period. She is receiving [MEDICATION NAME] and [MEDICATION NAME] with dx Anxiety and Agitation. Review of physician's progress notes from (MONTH) (YEAR) through 12/7/16 revealed: She was seen every sixty days. No GDR had been discussed or documented. Review of resident 11's consultant Pharmacist's Medication Regimen Reviews from (MONTH) (YEAR) through (MONTH) (YEAR) revealed: 10/16/16; (Resident's name) has an order for [REDACTED]. -The response was (Resident name) is not on [MEDICATION NAME] 0.25 mg PRN. All other monthly reviews read The medication profile was assess and no significant clinical problems were noted. -No GDR had been recommended during the past year by the pharmacist. Interview on 12/7/16 at 9:10 a.m. with the consultant pharmacist regarding resident 11 revealed she: Would have expected a GDR annually unless the resident had a [DIAGNOSES REDACTED]. Had recommended the PRN [MEDICATION NAME] be discontinued as a GDR. -Her records indicated it was still ordered. Had only been the consultant for less than a year, and she thought the previous consultant had recommended the physician give a different [DIAGNOSES REDACTED]. -She would look for that documentation and get back to the surveyor with that information when it was found. -No further information was received by the end of the survey. Interview on 12/7/16 at 8:45 a.m. with registered nurse/resident care coordinator B regarding resident 11 revealed: She had been hospitalized in a behavioral health facility in (MONTH) (YEAR). -That was when she had been started on the above medications; that was over a year ago. -The revised date of 12/8/15 for the start of the medication was because she had been hospitalized for [REDACTED]. The PRN [MEDICATION NAME] had been discontinued in (MONTH) (YEAR). -She was not sure why the pharmacist had that order in her records. -She was not sure why the pharmacist had not seen the note during her (MONTH) review that said the resident did not have a PRN dose of [MEDICATION NAME]. -She would not have considered discontinuing a PRN order that had not been used as a GDR. She confirmed the resident: -Did not have an appropriate indication for the use of the medication. -There was not sufficient documentation to support the behaviors warranted the medications used. They had not pursued a GDR nor discussed it with her physician in the past year. Interview on 12/7/16 at 11:00 a.m. with the director of nursing regarding resident 11 revealed: The resident had not had a GDR in the past year. Their previous consultant pharmacist had always reviewed for GDR, but their new one was apparently not doing that. Review of the provider's 11/12/15 Medication Monitoring and Management policy revealed: The medication regiment is re-evaluated on a regular basis to determine whether prolonged or indefinite use of a medication is indicated. *Antipsychotics. If a resident is admitted on an antipsychotic medication or the facility initiates antipsychotic therapy, the facility must attempt a GDR in two separate quarters (with at least one month between the attempts) within the first year, unless clinically contraindicated. After the first year, a GDR must be attempted annually, unless clinically contraindicated.	2020-09-01