cms_TN: 14257

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
14257	BORDEAUX LONG TERM CARE	445033	1414 COUNTY HOSPITAL RD	NASHVILLE	TN	37218	2010-03-30	157	D			DJ8011	NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Complaint #TN 194 Based on policy review, medical record review and interview, it was determined the facility failed to ensure the physician was notified of a low blood sugar (BS) for 1 of 30 (Resident #30) sampled residents. The findings included: Review of the facility's "Protocol: [DIAGNOSES REDACTED]" documented, "...Risk for Injury related to insufficient glucose to meet metabolic needs. Blood glucose less than or = (equal) 60 mg/dl (milligrams per deciliter) and are symptomatic. Notify MD (Medical Doctor)... 2. treatment of [REDACTED].=60 mg/dl (complete a - (through) f below ASAP (as soon as possible) a. Check glucostick b. If less than or equal to 60 mg/dl then treat resident based on level of consciousness and notify medical staff for further instructions. c. If after hours contact house supervisor who will in turn notify medical staff. 1. If responsive, give juice, milk, ensure or Insta Glucose and recheck blood glucose within 15 min. (minutes). If blood glucose continues to be = or < (less than) 60 mg/dl then give the [MEDICATION NAME] IM (intramuscular) and recheck blood glucose in 15 min. If blood glucose continues to be = or <60 mg/dl repeat IM [MEDICATION NAME], recheck blood glucose in 15 minutes. If resident continues not to respond to treatment then start process to send resident out for evaluation and treatment..." Medical record review for Resident #30 documented an admission date of [DATE] with [DIAGNOSES REDACTED]. Review of Resident #30's diabetic monitoring flow sheet documented "BS for 1/22/09 - 1600 (4:00 PM) BS= (result) 40 food/juice given." Review of a progress note dated "1/22/10-1600- Res (resident) c/o (complained of) not feeling well, asked for feet to be put on bed, BS (checked) earlier was 40. Food and drink given, family present. 1700 (5:00 PM) Res c/o (not) feeling well still... 1740 (5:40 PM) Res called for assistance. Wanted her legs off bed. Still appears tired... Will continue to monitor. 1815 (6:15 PM) Found Res in w/c (wheelchair) in room, unresponsive, attempted to revive c (with) out success. Called for assistance to put in bed. 1822 (6:22 PM) Code Blue called D/T (due to) unresponsiveness..." There was no documentation Resident #30's BS was being checked every 15 minutes after the initial blood sugar of 40. The next documented BS on the diabetic monitoring flow sheet was at 6:30 PM with a BS of 161. There was no documentation the MD was notified of the low BS. During an interview in the conference room on 3/30/10 at 8:20 AM, the Director of Nursing (DON) stated, "Less than 60 MD or medical staff should be notified. Give juice, milk, food or Instant glucose. Recheck BS in 15 minutes, still not up give IM [MEDICATION NAME] recheck in 15 minutes, still not up repeat IM [MEDICATION NAME]. If not responding need to go out." The DON was asked what should have been done for this resident. The DON stated, "Should have been checked (referring to BS) again in 15 minutes and the doctor should have been notified."	2014-02-01