cms_ID: 10

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
10	ST LUKE'S ELMORE LONG TERM CARE	135006	895 NORTH 6TH EAST	MOUNTAIN HOME	ID	83647	2017-07-27	309	D	0	1	V9TA11	NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and staff interview, it was determined the facility failed to ensure physician orders [REDACTED]. This was true for 1 of 7 residents (#2) reviewed for physician orders. The physician orders [REDACTED]. This deficient practice had the potential for harm if Resident #2 experienced high or low blood glucose levels. Findings include: 1. Resident #2 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Resident #2's Physician order [REDACTED]. Blood glucose testing 30 minutes before meals and at bedtime [MEDICATION NAME], 50 units each morning * HumaLog insulin based on the pre-meal blood glucose results: Less than or equal to 150 mg/dL(milligrams per deciliter) = no insulin 151-200 mg/dL give 2 units 201-250 mg/dL give 4 units 251-300 mg/dL give 6 units 301-350 mg/dL give 8 units Greater than 350 mg/dL give 10 units Resident #2's orders also included the following: *[MEDICATION NAME] injection 1 mg intramuscular every 15 minutes as needed for low blood sugar. The Physician orders [REDACTED]. According to the American Diabetes Association, Standards of Medical Care in Diabetes - (YEAR), from the Diabetes Care Journal, Volume 39 Supplement 1, documented older adults with diabetes in a long term care (LTC) facility were at higher risk of experiencing hypoglycemic episodes, and providers should be called immediately in case of hypoglycemic episodes or when BG levels were less than 70 mg/dl. A position statement from the American Diabetes Association documented LTC facilities should increase the frequency of glucose monitoring, call the practitioner, and confirm high glucose values by laboratory testing. These steps were to be completed if residents experienced BG's greater than 300 during all or part of 2 consecutive days. (Munshi, M. N., Florez, H.,[NAME] E. S., et al. Management of Diabetes in Long-term Care and Skilled Nursing Facilities: A Position Statement of the American Diabetes Association. Diabetes Care, vol. 39, Feb. (YEAR), pp. 308-318.) Resident #2's medical record, dated (MONTH) (YEAR), did not document blood glucose levels lower than 70 mg/dL or greater than 400 mg/dL. On 7/25/17 at 10:30 am, Resident #2 stated the facility was doing a great job managing his diabetes. Resident #2 stated his blood sugars have been good. On 7/26/17 at 2:10 pm, the facility provided a 7-page document titled Provider Orders. This document provided the physician multiple order choices for diabetic management and included nursing to notify provider if blood glucose is less than 70 or if greater than 400. Administration Staff #2 stated, The physicians' have been given the Provider's Order set to use, but, they have not been utilized by the physicians. The facility will be making changes. On 7/27/17 at 8:30 am, LN #1 was asked what she would do if a resident had high or low blood glucose levels. She stated she would address the resident needs and notify the physician.	2020-09-01