cms_SD: 68

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

This data as json, copyable

rowid	facility_name	facility_id	address	city	state	zip	inspection_date	deficiency_tag	scope_severity	complaint	standard	eventid	inspection_text	filedate
68	AVERA MARYHOUSE LONG TERM CARE	435034	717 EAST DAKOTA	PIERRE	SD	57501	2017-05-24	329	D	0	1	43OZ11	NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, record review, and policy review, the provider failed to attempt non-pharmacological interventions and have a documented justification for starting an antipsychotic medication for one of one sampled resident (7). Findings include: 1. Random observations on 5/23/17 from 7:55 a.m. through 5:00 p.m. of resident 7 revealed she had been in bed. Surveyor: Interview on 5/23/14 at 2:15 p.m. with resident 7's son revealed: His mother has been feisty all of her life. -He had not seen a change in his mother's personality concerning her cooperation with staff. He visited often, as he worked nearby. She recognized him and had called his name. Surveyor: 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 behaviors. She had been put into hospice care on 4/12/17. -They had requested the [MEDICATION NAME] be discontinued on that date. -The physician had not discontinued it. On 5/3/17 the [MEDICATION NAME] had been discontinued. Review of resident 7's interdisciplinary notes revealed: On 3/31/17 Is combative with cares at times. On 4/1/17 Once she had it in her mouth she put a tissue up to her mouth and removed the medications. 'I am not going to take this[*]' On 4/2/17 Spit out most of the medication at 1700 and refused hs (bedtime) medications and became very vocal. On 4/2/17 Found during the night to have gotten up independently and walked across the hall and sit on another residents bed. On 4/3/17 Angry with the pressure of the BP (blood pressure) cuff and then pushes me away and will not let me continue my assessment. There had been no other documentation regarding behaviors or what non-pharmacological interventions had been attempted. Review of resident 7's 4/6/17 physician's visit note revealed: The patient has not voiced complaints, is minimally verbal. Staff reports that she has become occasionally belligerent in the evenings. She will not cooperate with transfers and requires the assistance of two. Yet at 10:00 p.m. in the evening typically she will get up and start walking the halls looking for a bathroom. She is alert enough to take her TABS (personal alarm) device off and staff is concerned that she may wander and leave the building. She sometimes fights staff when it comes time to reorient her, the staff finds that she is not always re-orientable. The patient (resident) voices no complaints, very hard of hearing and quite demented. Late-stage dementia with sundowning phenomenon. The patient is at risk of harming self. Start [MEDICATION NAME] 0.5 mg at hs and we will monitor for effect. -There had been no documentation to support she had been at risk for harming herself. There had been no documentation of non-pharmacological interventions attempted or other medications attempted prior to starting [MEDICATION NAME]. Review of resident 7's 1/26/17 care plan revealed there were no individualized behaviors listed. There were no non-pharmacological interventions listed for her behaviors. Interview on 5/24/17 at 4:45 p.m. with the director of nursing revealed: There had been no other documentation regarding resident 7's behaviors justifying the need for the [MEDICATION NAME]. She had not liked the order and was not sure why something else had not been attempted. She agreed non-pharmacological interventions should have been attempted prior to starting the [MEDICATION NAME]. Review of the provider's (MONTH) (YEAR) Psychopharmacological Medications policy revealed: Inadequate indicators for the use of antipsychotics were: -Wandering. -Poor self care. -Restlessness. -Impaired memory. -Mild anxiety. -[MEDICAL CONDITION]. -Unsociability. -Inattention or indifference to surroundings. -Fidgeting. -Nervousness. -Uncooperativeness. -Verbal expressions or behavior that is not due to the conditions listed and do not represent a danger to residents or others.	2020-09-01