cms_AZ: 6

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
6	THE TERRACES OF PHOENIX	35003	7550 NORTH 16TH STREET	PHOENIX	AZ	85020	2019-10-17	578	D	0	1	EJUZ11	NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on clinical record review, resident and staff interviews, and policy review, the facility failed to ensure 1 of 15 sampled residents (#35) code status was consistent in the clinical record. The deficient practice could result in residents receiving services which are not in accordance with their wishes. Findings include: Resident #35 was admitted to the facility on (MONTH) 28, 2019, with [DIAGNOSES REDACTED]. Review of a nursing health status note dated (MONTH) 28, 2019 revealed the power of attorney (POA) for the resident would be signing the admission paperwork the next day. The note included the resident was willing to sign the paperwork but was unable to. A physician's orders [REDACTED]. Review of the care plan regarding advance directive initiated (MONTH) 28, 2019 revealed the resident and the resident family stated preference is that in the event cardiac function stops initiate CPR. The goal was that the resident preference will be honored in the event of a cardiac emergency. An intervention included that in the absence of breathing and pulse to call 911 and begin CPR. The admission Minimum Data Set (MDS) assessment dated (MONTH) 30, 2019 revealed a Brief Interview of Mental Status (BIMS) score of 15 which indicated the resident had intact cognition. However, a Statement of Treatment Preferences signed (MONTH) 8, 2019 by the POA and the facility representative revealed a request that while a resident at the facility the resident will be designated a do not resuscitate (DNR). Per the form, it is understood this means no cardiopulmonary resuscitation will be employed in the plan of treatment, if necessary. A Pre-Hospital Medical Care Directive dated and signed (MONTH) 8, 2019 by the POA, Licensed Health Care Provider, and a witness revealed that in the event of cardiac or respiratory arrest, the resident refuses any resuscitation measures including cardiac compression, endotracheal intubation and other advanced airway management, artificial ventilation, defibrillation, administration or advanced cardiac life support drugs and related emergency medical procedures. Further review of the clinical record revealed no evidence the physician order [REDACTED]. During an interview conducted with the resident on (MONTH) 15, 2019 at 8:49 a.m., the resident stated that he did not want CPR. In an interview conducted on (MONTH) 16, 2019 at 12:13 p.m. with a registered nurse (RN/staff #49), she stated advance directives are completed upon admission. She stated that if the resident is a full code, the nurses will fill out the advance directive form with the resident and make sure that the electronic clinical record reflects the goals stated on the form. She further stated that if the resident's code status is DNR, the nurse will explain the DNR status before the resident, nurse and a witness signs the form. The RN stated that the physician will be notified that the resident is a DNR and will complete the pre-hospital medical care directive form with the resident. She stated the nurse that completes the form is expected to update the advance directives in the electronic clinical record. The RN stated that the day shift will usually tell the supervisor who will update the care plan, but the other shifts will update the care plan themselves. She states that this resident's code status was a mistake because the paper clinical record should be the same as the electronic clinical record, and that this could be a problem as most nurses would check the electronic clinical record and not the paper clinical record. An interview was conducted with the Director of Nursing (DON/staff #4) on (MONTH) 16, 2019 at 12:38 p.m. The DON stated that whoever put the DNR status in the paper clinical chart would be expected to change the status in the electronic clinical record as well. The DON stated that she remembers the resident's POA made this change and that it should have been updated in the electronic clinical record. Review of the facility's policy for Advance Directives revised (MONTH) (YEAR), revealed advance directives will be respected in accordance with state law and facility policy. The plan of care for each resident will be consistent with his or her documented treatment preferences and/or advance directive. The Care Plan Team should be informed of changes or revocations of a directive so appropriate changes can be made in the care plan. The DON or designee will notify the physician so that appropriate orders can be documented in the clinical record. The policy also revealed that if the resident or the resident representative refuses treatment, the facility and care providers will modify the care plan as appropriate.	2020-09-01