cms_SD: 5105

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.

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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
5105	RIVERVIEW MANOR	435086	611 EAST 2ND AVE	FLANDREAU	SD	57028	2011-01-05	279	E			UUM911	NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review, policy review, and interview, the provider failed to develop comprehensive collaborative care plans for three of three sampled residents (4, 10, and 11) receiving hospice services. Findings include: 1a. Review of resident 4's Minimum Data Set ((MDS) dated [DATE] revealed: It was an admission assessment. He/she was on hospice. Review of resident 4's care plan dated 12/30/10 revealed: He/she was terminally ill. Hospice services were identified as an approach. The care plan did not address: -How often hospice services were provided. -What services were to be provided by hospice. -How the provider and the hospice were going to coordinate and divide up the provision of services and care for the resident. Review of resident 4's entire medical record revealed: There were two separate binders that included documents regarding resident 4's care. -One of those binders included the provider care. -The second binder contained documentation made by the hospice provider. Interview on 1/4/10 at 11:15 a.m. with licensed practical nurse E revealed she was unaware the second binder for resident 4 contained only hospice documentation. Review of the hospice's contract with the provider dated 7/20/04 revealed "The hospice and the home will develop a mutually acceptable overall plan of care for the resident." b. Review of resident 11's nurses notes from 12/16/10 through 1/4/11 revealed the resident had repeated bouts of [MEDICAL CONDITION], redness, and shiny, taut skin on his/her right shin. At times he/she complained of pain in his/her shin. It was documented hospice was notified several times about that. There was no reference to the physician being notified. Review of resident 11's care plan dated 12/7/10 revealed: The resident had a potential for pain related to arthritis and a neck fracture. Hospice services were provided for debilitation. A problem related to maintaining his/her weight with a hospice care approach. There were no specific approaches to address what hospice was going to provide regarding the pain or weight. A problem related to occasional [MEDICAL CONDITION] of legs and feet. The approaches were check and lotion skin in the morning and evening and report any redness, irritation, or open areas. There was no approach regarding hospice care of the [MEDICAL CONDITION] in the legs. Interview on 1/5/11 at 10:30 a.m. with registered nurse (RN) A and hospice licensed practical nurse (LPN) C revealed: LPN C revealed she had contacted the hospice RN regarding the redness and [MEDICAL CONDITION] of resident 11's shins and was told the family had opted to not medically treat it. As part of their hospice plan they would not notify the physician, but keep the resident comfortable. LPN C and RN A agreed the care plan did not address the treatment preferences and limitations in place for resident 11 as part of his/her advanced directives. They agreed the care plan did not specify what services hospice provided to resident 11 and how the provider and hospice coordinated those services. They agreed a new nurse would not be able to access this information by looking at the provider's care plan. c. Review of the provider's February 2008 hospice policy did not address the collaboration of care between the provider and hospice as part of an individualized care plan for a resident receiving hospice services. Review of the providers July 1981 Resident Care Plan policy revealed: The care plan should "Insure individualized rather than routine care. It serves as a guide in carrying out resident care. The plan involves all facets of the residents' care during their stay, step by step, beginning with small achievable goals or activities. The interdisciplinary team, i.e. director of nursing, (DON), food service supervisor, restorative care coordinator, activity director, and social services designee shall indicate specific steps the staff will perform in order to implement the care plan." 2. Review of the quarterly MDS dated [DATE] and the annual MDS dated [DATE] for resident 10 revealed the resident was coded for Hospice. Review of the medical record revealed resident 10 had been on Hospice since 2/16/10. Review of the care plan for resident 10 dated 11/10/10 revealed: Problem #15 was terminal illness, end stage [MEDICAL CONDITION], Hospice services. -Approach (1): "Assist to reposition every 2 hours with oral care and back rub, pain medication as ordered." -Approach (2): "Hospice services and follow through (F/T) on recommendations." -Approach (3): "Promote comfort through repositioning and medications, promote choices and privacy, listen and allow venting of feelings, be supportive, keep family and doctor informed." Problem #17 was Hospice intervention requested. -Approach (1): "Family's choice contacted for hospice consult." -Approach (2): "Per family request notebook left in room for hospice to document visits." -Approach (3): "RVM (provider) staff aware of hospice support." -Approach (4): "Hospice kept informed of any changes." Interview with social service director F on 1/5/11 at 9:25 a.m. revealed: There were two separate binders that included documents for resident 10's care. One binder was the faciliy's medical record for resident 10 that included the care plan. The second binder was for the documentations and care plans by the hospice provider. Interview with hospice licensed practical nurse C on 1/5/11 at 10:35 a.m. revealed: The nurse came 1 to 2 times per week. The hospice aide usually came 5 times per week. She confirmed there was a separate plan of care by the hospice team, but their services were not identified into one facility plan of care for the resident. She stated the hospice nurse and aide left documentation on each visit as to what they had provided. She pointed out the most recent hospice team plan of care dated 12/14/10 that was in the separate hospice binder.	2014-04-01