cms_SD: 66

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
66	AVERA MARYHOUSE LONG TERM CARE	435034	717 EAST DAKOTA	PIERRE	SD	57501	2017-05-24	280	E	0	1	43OZ11	NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, record review, interview, and policy review, the provider failed to update care plans to reflect the current needs for 5 of 13 sampled residents (6, 7, 9, 10, and 13). Findings include: 1. Review of resident 9's complete medical record revealed: He was admitted on [DATE]. He received blood thinning medication. He had [DIAGNOSES REDACTED]. No skin diagram and progress note was found in the skin documentation book. Review of resident 9's 5/16/17 wound care nurse's recommendations revealed: Zinc oxide paste currently being used seems to have difficulty adhering to the open sores of the sacral area. [MEDICATION NAME] paste to be used in place of zinc oxide. A thick layer should be placed several times a day and with every incontinent episode. Cleanse the top layer of the [MEDICATION NAME] but do not attempt to clean off all of the [MEDICATION NAME] prior to every re-application. An alternating low air loss mattress. A pressure redistribution cushion to his wheelchair. Resident to be up to the chair for meals and therapy, otherwise in bed to relieve pressure off his sacrum. Frequent repositioning is also necessary as he is quite immobile. Heel lifts are in place to bilateral feet. Pillows to be used to off-load pressure from the heels and for repositioning, at least every two hours, with micro turns in between. Review of resident 9's 5/11/17 care plan revealed: A problem area of Skin integrity. A goal of Skin integrity - improve. The following interventions: -Heel protectors at all times. -[NAME] hose should be on during the day and removed at night. -Pressure redistributing cushion in chair. -Pressure redistributing mattress. -[MEDICATION NAME] is to be reapplied with every incontinent episode - thickly so that covers the complete area that is open. Foaming wash needs to be used to cleanse buttock - do not scrub the [MEDICATION NAME] off. -Monitor deep tissue injury to sacrum area daily until healed. -Braden Scale LTC (long term care). -Skin Basic Assessment LTC. Observation on 5/23/17 at 10:24 a.m. with certified nursing assistants (CNA) A and B with resident 9 revealed: The CNAs had transferred the resident with the Hoyer lift from his wheelchair to his bed. He was incontinent of bowel and bladder. After they had cleansed the sacral wound a thick layer of barrier cream was applied. He was repositioned on his left side and supported with pillows. His bilateral heel protectors were on. No [NAME] hose were on his legs. Lower legs had [MEDICAL CONDITION]. Observations on 5/23/17 of resident 9 at the following times revealed: At 12:05 p.m. he was sitting up in his wheelchair. At 2:00 p.m. he was on his back in bed with heel protectors on. At 4:30 p.m. his position was unchanged. Interview on 5/23/17 at 10:50 a.m. with CNA A regarding what was to be done for resident 9 for his skin issues revealed: He was to lie down as often as possible. The barrier cream was to be globbed on. Interview on 5/23/17 at 4:20 p.m. with licensed practical nurse (LPN) D regarding resident 9's skin assessment revealed: A head to toe assessment was done on admission and weekly. If consulted the wound care nurse would assess skin, recommend treatment, and do dressing changes. Interview on 5/24/17 at 8:15 a.m. with registered nurse (RN) [NAME] regarding resident 9's skin assessment revealed: It was done weekly during bath time. Documentation of all skin irregularities were done on the skin diagram sheet along with a progress note in the electronic medical records. Interview on 5/24/17 at 8:30 a.m. with CNA C regarding resident 9's skin integrity interventions revealed: He was to be checked for incontinence of bowel and bladder. His sacral wound was to be cleansed without rubbing. He was to be repositioned every couple hours. Lotion was to have been applied to dry skin. 2. Review of resident 13's complete medical record revealed she: Was admitted on [DATE]. Had [DIAGNOSES REDACTED]. Review of resident 13's 4/10/17 minimum data set assessment (MDS) revealed she preferred the following activities: Listen to music. Keep up with the news. Do things with groups of people. Do favorite activities. Participate in religious services. Review of resident 13's 5/22/17 care plan interventions for activity involvement revealed: A problem area of Activity Involvement potential for decline in activity involvement related to NH (nursing home) stay. A goal of Activity Involvement - Maintain. The following interventions: -Assess for changes in support - LTC. -Evaluate family support. -Spiritual assessment - LTC. Spiritual care to visit routinely. Chaplain available upon request. -Restorative evaluation - LTC. -Current lifestyle - LTC. Observation on 5/22/17 at 4:15 p.m. of resident 13 during initial tour revealed she was in her wheelchair in front of her television that had music playing on it. Observation on 5/24/17 at 7:30 a.m. of resident 13 revealed she was in bed and music was playing on her television. Interview on 5/24/17 at 4:05 p.m. with the administrator and director of nursing (DON) regarding care plans revealed: They agreed the above residents' care plans were not complete. They would have expected all residents' care plans to have been individualized to reflect the current needs of each resident. 3. Review of resident 7's medical record revealed: She had been admitted on [DATE]. She had been started on [MEDICATION NAME] on 4/5/17 due to wandering behaviors. She had been admitted into Hospice care on 4/12/17. Review of resident 7's 4/26/17 care plan revealed: There were no non-pharmacological interventions for her behaviors. The integrated Hospice plan had not been documented on the care plan. Interview on 5/24/17 at 4:45 p.m. with the administrator and the director of nursing regarding resident 7 revealed: There had been no documentation on the care plan regarding her wandering behavior. They had not attempted or documented any non-pharmacological interventions before starting the [MEDICATION NAME]. -They agreed those should have been on the care plan. They agreed the specific responsibilities regarding being on Hospice had not been included in the care plan. 4. Interview on 5/23/17 at 11:00 a.m. with resident 10 revealed: She had a stroke and was admitted into the transitional care unit on 1/7/16. She then transitioned into the long term care side of the facility. She wanted to be in an assisted living center instead of in the nursing home. She bathed herself and took care of herself. Review of resident 10's 4/10/17 MDS assessment revealed she was independent with all activities of daily living. Review of resident 10's 1/26/17 care plan revealed there had been no interventions or goals for discharge planning. Interview on 5/24/17 at 11:30 a.m. with the Social Worker Associate and the administrator regarding resident 10 revealed: They had not been actively doing discharge planning with the resident. They both knew she had wanted to live somewhere else. They stated they felt her blood sugars were unpredictable. They had no documentation they had attempted to educate her about her blood sugars. Review of the provider's 9/13/16 Care Plan policy and procedures revealed: It is the philosophy of Avera Longterm Care to communicate effectively with all staff providing care for our residents. By ensuring a standardized care plan process we are ensuring staff is getting the needed information for resident's care. Resident's Plan of Care: The Meditech Plan of care includes all medications, physician's orders [REDACTED]. Interdisciplinary team in conjunction with the resident, resident's family, surrogate, or representative, as appropriate, will develop measurable objectives for the highest level of functioning the resident may be expected to attain, based on the comprehensive assessment, the MDS 3.0. Resident care plans are generated on the computer and updated by designated staff. *The care plan must reflect intermediate steps for each outcome objective if identification of these steps will enhance the resident's ability to meet his/her objectives.	2020-09-01