cms_SD: 37

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
37	MONUMENT HEALTH CUSTER CARE CENTER	435032	1065 MONTGOMERY ST	CUSTER	SD	57730	2019-03-13	880	E	0	1	0JC611	NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, record review, and policy review, the provider failed to ensure proper handwashing, glove use, wound care, and personal protective equipment procedures, and mechanical lift sling maintenance had been followed: For one of one observed certified nursing assistant (CNA) (G) during personal care for resident 41. For one of one observed resident (19) on contact precautions. -Designed for residents known or suspected to be infected with microorganisms that could have been transmitted by direct contact with the resident or environment. For three of three observed registered nurses (RN) (D, E, and H) during topical medication administration and dressing changes for three of three observed residents (9, 19, and 40). Findings include: 1. Interview on 3/11/19 at 5:44 p.m. with RN H regarding resident 9 and what precautions were required revealed: She stated precautions were only required if doing direct resident care. Resident 9 had a history of [REDACTED]. Gloves and gowns were all that would be required during wound care. 2. Observation on 3/12/19 from 7:55 a.m. through 8:55 a.m. of CNA G during personal care for resident 41 revealed: CNA G entered the room and with no hand hygiene she: -Put on the resident's support hose. -Checked to see if her incontinent brief needed to be changed. -She then went and put on gloves then checked the incontinent brief again. -Removed those gloves and did no hand hygiene during the entire observation. Resident 41 was transferred from the bed to her wheelchair with a total lift. -The sling used had come from a storage bag on the lift and was put back in that storage bag after the transfer. Interview with CNA G at 8:40 a.m. revealed there was a shortage of slings, so they were used by multiple residents each day. 3. Observation on 3/12/19 from 8:20 a.m. through 8:30 a.m. of RN H during topical medication administration revealed: RN H entered the resident's room with three small plastic medication cups. -Those cups each contained a different topical medication. -She set them on the bedside dresser. She did not perform hand hygiene before putting on gloves. She went into the bathroom, wet a paper towel, and washed around the resident's mouth. -She applied [MEDICATION NAME] to red areas on the resident's face. Without changing gloves she pulled the blanket down and pulled the resident's pant legs up. -Removed the left heel boot and applied [MEDICATION NAME] lotion to both legs and feet. -Pulled both pant legs down and reapplied the left heel boot. Took her gloves off and with no hand hygiene she went out of the room to the treatment cart. 4. Continued observation from 8:30 a.m. through 8:35 a.m. revealed RN H: Returned one plastic medication cup of a topical medication to the medication cart. Resident 40 was at the treatment cart, and RN H did the treatment on her right little finger. She put on gloves, opened a drawer, and: -Retrieved a bottle of wound cleanser and two 4 by (X) 4 gauze sponges. -Cleansed the resident's right little finger. -Did not change her gloves, retrieved a Band-Aid and a small packet of [MEDICATION NAME] from the treatment cart. -Placed some [MEDICATION NAME] on the Band-Aid and applied it to resident 40's finger. Took her gloves off and did not perform any hand hygiene. 5. Observation on 3/12/19 from 2:00 p.m. through 2:30 p.m. of RN H during a wound care treatment for [REDACTED]. She gathered supplies of an ABD and 4 by (X) 4 gauze out of the treatment cart. Used hand sanitizer, put on gloves, and opened the door to the resident's room. Assisted the bath aide with transferring the resident from the bath chair to the bed. She pushed the bath chair out of the way. With those same gloves on she connected the two ends of the wound vac tubing. Removed her gloves and washed her hands. Put the dressing supplies on the bed with no barrier under them. Put new gloves on, removed the soiled dressing from the right ischial wound, and with those same gloved hands: -Cleansed the wound with sterile water. -Removed her gloves and with no hand hygiene put on a new pair of gloves from where CNA G had placed them on the sheet. -Took the dressing supplies from where she had placed them and put a new dressing on. -Removed her gloves and did not perform any hand hygiene before leaving the room. She then stated Oh, I should have had a gown on. She stated she was not sure where the gowns were located. 6. Review of resident 19's complete medical record revealed: She was positive [MEDICAL CONDITION] in her wounds. She was on contact isolation. -Staff were to glove and gown when providing care. Observation on 3/12/19 at 9:07 a.m. with RN D in resident 19's room revealed: After transferring the resident into his wheelchair his sling was put into the pouch on the back of the total lift. The lift was then taken across the hall to another resident's room. Interview on 3/12/19 at 2:12 p.m. with RN D concerning care as mentioned above revealed: She had put the sling in the pouch on the lift, and it had been taken to another resident's room. The lift was not wiped off with sanitizer wipes. -She agreed that sling should not have left the room, and the lift should have been sanitized. She was aware resident 19 was on contact isolation. Observation on 3/13/19 at 2:38 p.m. with RN [NAME] during dressing changes for resident 19 revealed: She had gloves on but no gown. That resident did not have a Duoderm to her buttocks so she applied one to her opened area on her buttock. She took off a Duoderm on her left hip and applied a new Duoderm to that area. She took off the dressing to the lower extremities. -She changed dressings to the ankle areas on both legs with [MEDICATION NAME] Gentle AG+. She had used a scissors to cut the dressings. No handwashing or glove changes were done during the above dressing changes. She took off her gloves before leaving the room. She put the scissors in the top drawer of the treatment cart without it wiping off. Interview on 3/13/19 at 3:45 p.m. with the director of nursing (DON) concerning resident 19's above care revealed: Her sling should have not been taken out of her room. Handwashing and glove changes should have been done between each dressing change. -The resident had several areas with dressings. The lift should have been completely wiped off with disinfectant when taken out of the resident's room. Gowns and gloves should have been worn when entering the contact isolation room. 7. Review of the provider's (MONTH) 2004 Handwashing policy revealed to hand wash before and after contact with body fluids. Review of the provider's (MONTH) 2003 Dressing Change policy revealed: Wash hands thoroughly. -Use standard precautions as necessary to shield you and your clothes from wound drainage. Put on non-sterile examination (exam) gloves. Remove dressing and discard in plastic bag. Remove exam gloves, discard in plastic bag. Wash hands thoroughly. Put on non-sterile exam gloves. Perform dressing change. Document dressing change. Review of the provider's (MONTH) (YEAR) Personal Protective Equipment policy revealed: Handwashing was to be preformed: -Before touching a resident. -Before clean procedures. -After resident body fluid exposure risk. -After touching resident's surroundings (faucet, cupboards, drawers, closet) -Before putting on gloves, mask, or gowns. -After removing gloves, mask, or gowns. Gowns should have been worn for all persons entering rooms of residents who were on contact isolation. Review of the provider's undated Isolation Precautions policy revealed: *Contact precautions included: -Wear gloves and gown when entering the room. -Change gloves after having contact with infectious material and between soiled to clean tasks. -Clean and disinfect all commonly used equipment prior to the use for another resident.	2020-09-01