cms_GU: 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.

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
93 GUAM MEMORIAL HOSPITAL AUTHORITY 655000 499 NORTH SABANA DRIVE BARRIGADA GU 96913 2010-09-17 325 D 0 1 7DPX11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and document review the facility failed to ensure the maintenance of acceptable parameters of nutritional status for 1 of 10 sampled residents (Resident 2). Failure to maintain acceptable parameters of nutrition can contribute to weight loss and low protein levels which may delay wound healing. Finding includes: Resident 2 is a [AGE] year old male admitted on [DATE]. His primary [DIAGNOSES REDACTED]. He experienced the stroke on 7/26/10 but had made some recovery from a previous vegetative state. His medical record indicated he developed a sacral pressure ulcer prior to admission in to the facility and that the pressure ulcer was debrided on 9/02/10. Wound care was observed on 9/16/10 and the nurse described the stage IV wound to be improving after the debridement. On 8/17/10, his diet was ordered as Ensure 1 can every 6 hours via gastric tube. On 8/24/10, his diet was changed to "Fiber-source one can every 6 hours then increase to 1 can every 3 hours as tolerated, then change to 2 cans every 6 hours 2 days prior to discharge." On 8/26/10, his diet gastric tube feeding was changed again to Fiber-source 1 can every 6 hours. On 9/02/10, his diet was changed to Fiber-source 1 can every 6 hours. On 9/15/10, during a tube feeding observation, and concurrent interview, LN6 (licensed nurse) stated Resident 2 was still receiving Fiber-source 1 can every 6 hours. LN6 acknowledged Resident 2 had not been tolerating the increasing volume of the Fiber-source and had residual gastric contents and therefore his tube feedings had never advanced as described in the physician orders. The medical records were reviewed on that same date and LN6 acknowledged Resident 2 had a low [MEDICATION NAME] level. She continued to indicate that the physician had been informed of all lab results. LN6 validated that the [MEDICATION NAME] level on 8/18/10 was sub-therapeutic at 2.8 gm/dl (normal is 3.4 to 5.0 gm/dl) and confirmed that throughout Resident 2's admission his [MEDICATION NAME] level remained sub-therapeutic. On 9/15/10, his [MEDICATION NAME] level was 2.7 gm/dl. On 9/16/10, the medical record was reviewed with the registered dietician (RD). Her documentation recognized Resident 2's sub-therapeutic [MEDICATION NAME] levels. She indicated the reason the diet had been initially changed was because Fiber-source had higher [MEDICATION NAME] content than Ensure. She stated Resident 2 had not been tolerating the increasing volume of Fiber-source and supplemental [MEDICATION NAME] sources had not been ordered since they were not on the current formulary. The RD agreed increasing the [MEDICATION NAME] level may promote Resident 2's pressure ulcer wound healing. 2014-12-01