cms_SD: 54

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
54	MONUMENT HEALTH CUSTER CARE CENTER	435032	1065 MONTGOMERY ST	CUSTER	SD	57730	2018-09-13	692	D	0	1	YYKW11	NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, record review, interview, and policy review, the provider failed to ensure one of one sampled resident (50) who was on Hospice services had an appropriate and timely assessment to ensure nutritional parameters were maintained. Findings include: 1. Observation on 9/11/18 at 11:30 a.m. of resident 50 revealed: He ate at an assisted table during the noon meal. His daughter was feeding him. Review of resident 50's 9/11/18 physician's orders [REDACTED].>He was receiving Hospice services since his admission on 6/26/18. His [DIAGNOSES REDACTED]. He was on a regular diet with pureed texture. Review of resident 50's weights revealed: On 6/26/18 he weighed 183.5 pounds (lb). On 7/6/18 he weighed 177.9 lb. No further weights had been obtained. Review of resident 50's 7/10/18 dietary progress note revealed: Weight 7/6/18 176.5 lb. Weight on admission 183.5 lbs. Decrease of 7 lbs. 3.8% decrease. Diet is regular. Resident dines with supervision at meals. Intake at meals 2 breakfast refusals, averaging 75% at meals. BMI (Body Mass Index) = 27.6. %IBW (Ideal Body Weight) 119. Resident has open areas on left side from tumors. Resident is on Hospice. Written by registered dietitian (RD). There were no further dietary assessments. Review of resident 50's 7/20/28 care plan revealed: Focus: I have nutritional problem r/t (related to) [DIAGNOSES REDACTED]. Goal I will maintain adequate nutritional intake to support weight maintenance by participating in 3 meals a day. Interventions addressed: a calm environment, inviting to activities that promoted additional intake, and serving the diet that was ordered by the physician. Interview on 9/12/18 at 3:18 p.m. with the consulting registered dietitian and the dietary services manager regarding resident 50 revealed: He was on Hospice that meant he received palliative care. They confirmed there had not been a weight on him for over two months. -They could not say for sure why that had been. --Sometimes weights were just not done by nursing, so they have no record. --She agreed they could ask for the staff to get his weight, but they had not done that. There had been no laboratory tests done either to monitor his nutritional status. Usually the RD monitored residents on admission, quarterly, or more often if there was a problem. She agreed that because he was on Hospice would not mean he would not have been monitored. A review of her facility weight record that listed all the residents noted: -His only two weights had been yellowed out. --There were no further weights after July. -She yellowed out weights when there was a variance in weights, such as noting his 7 lb weight loss from admission until July. The RD confirmed it would have been difficult to monitor if his weight was being maintained if they were not weighing him. Interview on 9/12/18 at 11:09 a.m. with the director of nurses (DON) regarding resident 50 revealed: They should have weighed all residents at least weekly. -It would not matter if he was on Hospice. At that time a request was made to the DON to have the resident weighed. Interview on 9/12/18 at 2:00 p.m. with the DON regarding resident 50 revealed he had been weighed, and his current weight was 164 lb. That was a 19.5 lb weight loss since his admission on 6/26/18. Interview on 9/13/18 at 8:30 a.m. with resident 50's physician revealed: The resident had been new to him since he was admitted in June. He was admitted on Hospice with a [MEDICAL CONDITION] diagnosis. With that being said they should still have been monitoring all the things that kept him comfortable. -That would include his skin condition, appetite and food intake, etc. They might not send him to the hospital or do laboratory tests, but they would keep him comfortable. Review of the provider's undated Facility Nutrition Program revealed: A facility Dietitian will help assess the nutritional needs and risks of all residents and patients in the facility, and help the facility assure that it provides appropriate meals and other nutritional interventions. Review of the provider's (MONTH) 2009 Resident Nutrition Services policy revealed: 1. The multidisciplinary staff, including nursing staff, the Attending Physician and the Dietitian will assess each resident's nutritional needs, food likes, dislikes and eating habits. *8. Significant variations from usual eating or intake patterns must be recorded in the resident's medical record. The Nurse Supervisor and/or Unit Manager shall evaluate the significant of such information and report it, as indicated, to the Attending Physician and Dietitian. Review of the provider's Dietary Consultant Agreement policy revealed The dietitian agrees to visit and counsel residents and chart, as needed to complete/monitor nutritional assessments, develop nutritional care plans, or instruct the residents on therapeutic diets.	2020-09-01