cms_VT: 59

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
59 BURLINGTON HEALTH & REHAB 475014 300 PEARL STREET BURLINGTON VT 5401 2018-12-04 687 D 1 0 UZ5V11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on observation, record review and confirmed by staff interview the facility failed to ensure that 1 applicable sampled resident (Resident #5) received proper treatment to maintain good foot health to prevent complications from the resident's health conditions. The findings include the following: Per review of medical record for Resident #5, identifies [DIAGNOSES REDACTED]. Physician orders dated 11/22/17, direct staff to conduct Diabetic Foot Care/Check daily observation of feet, toes ankles, soles noting any alteration in skin integrity, color, temperature and cleanliness. Inspect shoes for proper fit and excessive wear, check pedal pulses every night shift. Physician orders also identify, evaluation/treatment for [REDACTED]. Podiatry consult for mycotic nail debridement and treatment dated 5/11/16 as needed. Per review of the Treatment Administration Records (TAR) for the past three months, evidence that the nightly reviews have been conducted. Nurses progress notes reviewed back to (MONTH) (YEAR) document the following: -10/23/18: right foot nails thick/long and sore to touch, middle toe is twisted and into the back of toe. Left foot great toe thick/long and sore to touch, able to trim other four toes; -10/26/18: Diabetic Foot Care daily observation completed; -11/9/18: Diabetic Foot Care daily observation completed; -11/14/18: Care Plan meeting minutes: Identify that family had concerns related to toenails need clipping, podiatry appointment scheduled and was evaluated by attending physician, who sent notes to podiatry; -11/21/18: Licensed Practical Nurse (LPN) spoke with the attending physician relating family concern for the need for more immediate care for toe nails and feet assessment then the (MONTH) podiatry appointment. MD suggested family contact podiatry; -11/21/18: Family notified of Nurse Practitioner (NP) clipping of Resident #5's toe nails that will take place on 11/27/18 and family plan to keep (MONTH) podiatry appointment; -11/27/18: Family update regarding toe clipping. NP clipped nails except right fourth toe, identified possibility of a diabetic ulcer. Family requests a plan for regularly scheduled podiatry visits; Per review of physician progress notes [REDACTED]. Assessment questions diabetic ulcer, needs referral to foot clinic, needs debridement, and ulcer. Per review of NP progress note dated 11/27/18 at 9:45 AM, identifies toe nails trimmed successfully. Right 4th toe avoided, secondary to underlying possibility of ulcer on the tip of that toe connected adjacently to her thickened nail. Assessment identified severe Onychomycosis and diabetic history. Needs regular foot care. Per review of Resident #5's care plan that was last updated on 8/10/18, identifies the need for assistance for bathing, grooming and personal hygiene, who is a diabetic and requires a daily foot check. There is no evidence of a focus on the management of Onychomycosis, the possibility of a Diabetic ulcer and/or the need for regular foot care. Confirmation was made by the Unit Manager and the unit nurse on 12/3/18, that the unit secretary attempted to make an earlier podiatry appointment but was unsuccessful. There are few Podiatrists in the area and they are scheduling beyond the (MONTH) appointment. The UM had little knowledge regarding the foot problems of Resident #5 and required the assistance of the nurse who was included in the interview. Neither nurse identified that a referral had been scheduled to a foot clinic as suggested by the attending progress note dated 11/13/18. Per review of the Foot Care policy dated 3/1/18 identifies that the facility will provide foot care and treatment in accordance with professional standards of practice to prevent complications from the resident's medical condition(s). Per review of the facility policy titled Toe Nail Trimming, dated 3/1/18 identifies that toe nail trimming for those residents with diabetes, neurological disorder, [MEDICAL CONDITION] or [MEDICAL CONDITION] may only be conducted by a physician, mid-level provider, or a podiatrist. 2020-09-01