cms_AL: 93

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
93	SENIOR REHAB & RECOVERY AT LIMESTONE HEALTH FACILI	15024	1600 WEST HOBBS STREET	ATHENS	AL	35611	2018-02-15	690	D	0	1	EZGG11	NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation of incontinent care on 02/14/18, medical record review, staff interviews, and review of facility policies titled Urinary Catheter Care, and a facility document titled Perineal/Catheter Care, the facility failed to ensure the Certified Nursing Assistant (CNA) properly cleaned Resident #33's catheter tubing. Further, the CNA failed to clean Resident #33's perineal area of fecal matter, prior to the completion of care. These failures were observed during one of one catheter and incontinence care observations. Findings Include: A review of a facility policy titled: Urinary Catheter Care with an effective date of (MONTH) 16, 2014 documented: . PURPOSE: Urinary catheter care helps to prevent urinary tract infection . PR[NAME]ESS: . II. Catheter Care . c) Wash the catheter itself by holding on to the catheter at the insertion site; wash with one stroke downward . A review of a facility document titled: . Perineal/Catheter Care . with a date of 12/18/16 documented: . CATHETER CARE . 2 . Gently . to expose meatus . A review of RI #33's Quarterly Minimum Data Set with an assessment reference date of 11/22/17 revealed RI #33 was severely impaired in cognition, incontinent of bowel and dependent upon staff for hygiene. A review of the hospital DISCHARGE SUMMARY dated 01/04/2018 documented: . DISCHARGE Diagnosis: [REDACTED]. RI #33 was readmitted to the facility on [DATE] with [DIAGNOSES REDACTED]. On 02/14/2018 at 5:45 p.m., Certified Nursing Assistant, Employee Identifier (EI) #7 provided incontinent care for RI #33. The resident rolled his/her self to left side and EI #7 wiped the buttock area three times front to back, using a clean wash cloth with each wipe. Bowel movement was visible on each wash cloth used. RI #33 had a foley catheter in place. EI #7 then cleaned the catheter tubing toward the residents perineum. RI #33 rolled onto his/her back. Without changing the soiled gloves or washing her hands, EI #7 then placed a clean brief under RI #33 and put a clean gown on the resident. EI #7 wiped down the left side of the outer perineal area and across. EI #7 then wiped down the right outer perineal area and across. EI #7 fastened the brief, removed the (soiled) gloves and without washing her hands, she applied clean gloves. At the completion of care, the surveyor asked EI #7 if she had visualized the perineal area. EI #7 said no. EI #7 then unfastened the brief, separated the perineal area, and wiped front to back three additional times (using a clean wash cloth each time). Additional bowel movement was apparent on the wash cloth each time. On 02/14/2018 at 6:00 p.m., EI #7 was asked which direction had she wiped the catheter. EI #7 said, she had wiped (incorrectly) back to front (from the residents perineum down the catheter tubing), and she should not have because of contamination. EI #7 was asked why it was important to ensure all bowel movement was removed from the perineal area. EI #7 explained it was necessary to avoid infection and skin breakdown. When asked if she had washed her hands after changing the soiled gloves, EI #7 said no. EI #7 said she should have changed the gloves, due to contamination. EI #7 was asked if she should she have handled the clean brief, clothes and clean linen with soiled gloves. EI #7 said no, due to the contamination of those items. On 02/15/2018 at 5:37 p.m., an interview was done with EI #2, the Director of Nursing/Infection Control. EI #2 stated the staff should wash their hands after taking off soiled gloves and before putting on clean gloves in order to prevent the spread of infection. EI #7 said staff should never touch clean items/linen with soiled gloves so as to prevent the spread of infection. EI #7 was asked what was the facility's policy on catheter care. EI #7 said staff were to wipe front to back, and always visualize the perineal area because you do not want germs near the urinary tract.	2020-09-01