cms_AK: 89

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
89 PROVIDENCE TRANSITIONAL CARE CENTER 25018 910 COMPASSION CIRCLE ANCHORAGE AK 99504 2017-06-22 314 D 0 1 NLCD11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview and policy review the facility failed to prevent a pressure injury for 1 resident (#5) out of 7 sampled residents. The failure to prevent a Stage II pressure injury caused the resident unnecessary pain and resulted in an increased risk for infection, delayed healing, and poor medical outcome. Findings: Resident #5 Record review from 6/19-22/17 revealed Resident #5 was admitted to the facility with [DIAGNOSES REDACTED]. Review of the most recent MDS (Minimum Data Set-a federally required nursing assessment), an admission assessment dated [DATE], revealed the Resident was coded as having short and long-term memory loss; severely impaired cognitive skills for daily decision making; incontinence of urine; requiring extensive assistance with bed movement and transfers; and at risk for developing pressure injuries. Further review revealed the Resident was coded as not having any pressure injuries. Record review on 6/20-22/17 of Resident #5's Comprehensive Care Plan (CCP) dated 5/8/17, revealed Problem .at risk for skin breakdown related to: decreased mobility, incontinence and diabetes . Further review revealed Braden score (an assessment tool that helps predict pressure injury risk) of 13. A Braden score of 13 represents a moderate risk for skin injury. Review of the Residents Daily Care Plan (RDCP) dated 4/25/17 with updates on 5/18/17, 5/23/17, 6/1/17, 6/8/17, and 6/14/17 revealed, Positioning .float heels when in bed . Review on 6/20/17 at 10:30 am of Resident #5's Admission and Readmission body check dated 5/23/17 revealed no indication of right heel skin injury. Review on 6/20-22/17 of the Certified Nurse Assistant (CNA) charting from 4/25/17 to 6/22/17 under the section, .SKIN OBSERVATION revealed no documentation of the right heel skin injury. Further review revealed no documentation that the Resident's heels were floated. Nursing Notes Review on 6/20-21/17 of Resident #5's nursing notes revealed the following: * 6/15/17 at 3:36 pm - Time Discovered 15:29 (3:29 pm) .possible pressure injury Wound Location: Right heel .PAIN identified? Yes Contributing Factors: Pressure-immobility .PTCC wound team notified . * 6/15/17 at 3:41 pm - .right heel appears to have a pressure injury. It has a blackish/purplish hue. When I applied pressure (he/she) jerked and said ouch. (His/her heel feels soft to touch in the raised area of (his/her) heel. WCT (wound care team) notified. Both legs elevated . * 6/15/17 at 6:40 pm - .received new wound care orders. Patient has an allevyn (thin protective foam) dressing to the right heel. Prevalon (soft Velcro boots used to keep pressure off the heels) to be worn at all times while in bed . Record review on 6/20-21/17 of the provider's note, dated 6/15/17 at 4:10 pm, revealed Resident #5 had a recent weight loss, new stage II pressure injury on right heel which was discovered by nursing staff on 6/15/17. In addition, the new pressure injury was described as a 2.5 cm x 1.5 cm fluid filled blister . Review of the physician orders [REDACTED].Nutrition consult DX: New pressure injury, weight loss .Prevalon boots to B/L (bilateral leg) heels while in bed DX: Stage 2 pressure injury . During an interview on 6/20/17 at 2:50 pm, the DON (Director of Nursing) confirmed Resident #5's acquired a Stage II pressure injury while at the facility. Review on 6/21/17 at 2:00 pm of the facility's protocol Standards of Patient Care for Nursing with a revision date of (MONTH) 2013 revealed, Skin Care Monitor skin when providing care, paying special attention to pressure areas such as heels .report any changes in skin . Review on 6/28/17 of the Braden Scale Interventions Algorithm at https://www.clwk.ca/buddydrive/file/braden-scale-interventions-algorithm revealed Braden scores of 13 to18 list of interventions included .elevate heels off the bed at all times, even with therapeutic support surfaces .inspect skin when repositioning, toileting & assisting with ADLs (activities of daily living) .use elbow and heel protectors . According to the National Pressure Ulcer Advisory Panel, accessed 6/27/17 at www.nouap.org A pressure injury is localized damage to the skin and/or underlying soft tissue usually over a bony prominence or related to a medical or other device. The injury can present as intact skin or an open ulcer and may be painful. The injury occurs as a result of intense and/or prolonged pressure or pressure in combination with shear. The tolerance of soft tissue for pressure and shear may also be affected by microclimate, nutrition, perfusion, co-morbidities and condition of the soft tissue .Definition and Stages .Stage II Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough. (MONTH) also present as an intact or open/ruptured serum-filled blister . 2020-09-01