cms_SD: 34

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
34	MONUMENT HEALTH CUSTER CARE CENTER	435032	1065 MONTGOMERY ST	CUSTER	SD	57730	2019-03-13	657	E	0	1	0JC611	Based on observation, interview, record review, and policy review, the provider failed to review and revise care plans to reflect the current needs of 3 of 13 sampled residents (7, 19, and 31). Findings include: 1. Observations and record review of resident 31 revealed: On 3/11/19 from 3:30 p.m. through 4:30 p.m. and from 5:00 p.m. through 5:30 p.m. while in her room she: -Sat in her wheel chair beside her bed. -Made no attempts to move herself out of her wheel chair or leave her room. -Was taken to the dining room at 4:30 p.m. -Was taken to her room by an unidentified certified nurse aide (CNA) after her evening meal. --Continued to sit in her chair and made no attempts to move out of her chair or leave her room. On 3/12/19 from 8:00 a.m. through 11:30 a.m. and again from 2:00 p.m. through 4:30 p.m. she had been in her wheel chair sitting beside her bed or laying in her bed. She made no attempt to self-propel herself, move, or leave her room while in her wheel chair. Review of resident 31's 2/22/19 care plan revealed: A focus area: elopement risk, revised 10/29/16 that stated: I am an elopement risk/wanderer AEB (as exhibited by) history of attempts to leave facility unattended, impaired safety awareness, failed trial on non-secure unit 10-25 to 10-29-2016. -The provider had not had a secured unit for no less than one year. For activities of daily living she required limited to extensive assistance for bed mobility, transfers, locomotion, and to use the bathroom. Review of resident 31's weight record revealed a 10% weight loss change from 8/27/18 through 2/19/19. There had not been a focus area or interventions added to the resident's care plan specific to weight loss. 2. Observation and interview on 3/12/19 at 10:35 a.m. of resident 19 during morning care revealed: CNA A and nurse aide (NA) B transferred her to bed from her wheel chair using the total lift. They both agreed that they routinely used the total lift on resident 19. Interview on 3/12/19 at 11:15 a.m. with physical therapist C regarding resident 19's locomotion and transfers revealed: She had recommended staff use the total lift when transferring her. They had evaluated her recently on 2/19/19. They were currently working with her on strengthening. Review of the 2/19/19 physical therapy evaluation for resident 19 revealed they had advised nursing staff to use the total lift. Review of the provider's 1/1/19 care plan for resident 19 revealed for: Locomotion: she needed limited assistance of one person to extensive assistance of two staff to help her propel her wheel chair or to assist her when using her walker. Transfers: she needed limited assistance. It did not address the use of the total lift. 3. Observation on 3/13/19 at 8:20 a.m. revealed resident 7 was in the main dining room. She was seated at an assisted eating table. She had consumed the majority of her meal. Observation and interview on 3/13/19 at 10:00 a.m. with resident 7 revealed she was awake and lying crosswise on her bed. She was unable to be understood during our conversation. She had a small spoon and a small paper cup she was eating out of. All of the contents of that cup were gone. She was unable to tell me what she had eaten. Review of resident 7's medical record revealed her weight on: 3/8/19 was 118.5 pounds (lb). 2/8/19 was 123.5 lb. 12/4/18 was 132 lb. 9/14/18 was 136 lb. A 4.05% weight loss in 30 days. A 10.61 % weight loss in 90 days. A 12.87% weight loss in 180 days. Review of resident 7's 11/6/18 care plan revealed: Focus: I have a potential nutritional problem for weight loss due to dx (diagnosis) of dementia. I have struggled with maintaining my weight in the past with a history of being on Weight Watchers. Goal: I will maintain adequate nutritional status as evidenced by maintaining weight within 3% of 130 lbs, no s/sx (signs or symptoms) of malnutrition, and consuming of at least 3 meals with Regular diet through the next review date. Interventions: I need adequate eating time. I often leave the dining room before I get my meal. I am hard of hearing and it is hard for me to converse with my tablemates. I often leave and come back to the dining room forgetting whether I ate or not. -Provide, serve diet as ordered. Currently my diet is Regular. I eat at the Assisted Dining Table to help promote my intake. Monitor intake and record q (every) meal. Review of the registered dietitian's (RD) progress notes revealed interventions that had been started included: On 11/8/18: Offer a cinnamon roll in late AM to encourage weight gain/maintenance. On 2/4/19: Resident to move to assisted Dining Table. There had been no monitoring if the above interventions had been successful. She continued to have weight loss. Interview on 3/13/19 at 1:30 p.m. with the dietary manager (DM) and RD revealed: The DM did not monitor residents' weight loss between RD visits. The nursing department monitored them and would have given a list to the DM to communicate with the RD. *The continued weight loss had not been communicated to the DM or RD. 4. Review of the provider's revised (MONTH) 2006 Care Plans Development - Baseline and Comprehensive policy revealed no information on the revision of care plans.	2020-09-01