cms_NH: 31

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
31 GREENBRIAR HEALTHCARE 305005 55 HARRIS ROAD NASHUA NH 3062 2019-10-28 756 D 0 1 TYS711 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview and review of the pharmacist reports for irregularities in medications, it was determined that the facility has failed to act upon the reports in a timely manner for 2 residents in a final survey sample of 35 residents. (Resident identifiers are: #17 and #31.) Findings include: Resident #31 Review on 10/25/19 of Resident #31's medical record revealed a pharmacy review report showing a irregularity on 9/6/19. Review on 10/26/19 of Resident #31's pharmacy Consultation Report dated 9/6/19 with a Recommendation Please discontinue Montelukast. Rationale for Recommendation Due to a lack of adequate testing, guidelines do not recommend the use of leukotriene receptor antagonists for [MEDICAL CONDITIONS]. Use may be appropriate in the presence of allergic rhinitis or asthma-[MEDICAL CONDITION] overlap syndrome Physician's Response: I accept the recommendation(s) above, please implement as written: This was dated 10/2019 and signed by the physician. Interview with Staff B (Director of Nurses) on 10/26/19 was asked what day was it signed and Staff B stated just now the 26th. Review on 10/26/19 of the MAR (Medication Administration Record) revealed both (MONTH) and (MONTH) have orders that state Montelukast Sodium Tablet 10 MG Give 1 tablet by mouth at bedtime for [MEDICAL CONDITION] which have been given daily since the pharmacy report stating Please discontinue Montelukast. Resident #17 Review on 10/25/19 of Resident #17's medical record revealed that the pharmacist did an MRR (medication record review) on 9/3/19 with the following recommendation: Please attempt a gradual dose reduction (GDR) to quetiapine 50 mg (milligrams) HS (hour of sleep) while concurrently monitoring for reemergence of target behaviors and/or withdrawal symptoms. Physician's Response: I accept the recommendation(s) above, please implement as written. (signed 9/30/19) Review on 10/25/19 of Resident #17's Medication Administration Record [REDACTED] Quetiapine 12.5 mg by mouth one time a day, dated 11/13/18 and Quetiapine 50 mg by mouth at bedtime, dated 10/21/2018. Interview on 10/25/19 at approximately 1:00 p.m. with Staff K (Licensed Practical Nurse) confirmed that the MRR that was done on 9/3/19, signed by the physician on 9/30/19 but Resident #17 was still receiving the 12.5 mg of Quetiapine that was ordered to be stopped on 9/30/19. Review on 10/28/19 of the MRR dated, 10/11/19 revealed the following: (pronoun omitted)'s prescriber accepted a pharmacy recommendation to decrease dose of quetiapine on 9/30/19, but the order has not yet been processed. Review on 10/28/19 of the facility's policy and procedure titled Medication Regimen Review, effective date 12/1/07 revealed: .Procedure . 6. Facility should ensure that Facility Physicians/Prescribers are provided with copies of the MRRs. 7. Facility should encourage Physician/Prescriber or other Responsible Parties receiving the MRR and the Director of Nursing to act upon the recommendations contained in the MRR. For those issues that require Physician/Prescriber intervention, Facility should encourage Physician/Prescriber to either (a) accept and act upon in the recommendations contained within the MRR, or (b) reject all or some of the recommendations contained in the MRR and provide an explanation as to why the recommendation was rejected. 8. Facility should provide the Medical Director with a copy of MRRs and should alert the Medical Director where MRRs require follow-up. . 2020-09-01