cms_NH: 43

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.

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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
43 GREENBRIAR HEALTHCARE 305005 55 HARRIS ROAD NASHUA NH 3062 2018-12-19 689 E 0 1 P2R411 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and interview, it was determined that the facility failed to ensure that the non-smoking facility is free from accident hazards of smoking by allowing residents to have cigarettes and lighters on their person and not supervising residents when necessary who smoke on the facility's property for 5 of 5 residents in a final sample of 40 residents. (Resident identifiers are #227, #15, #105, #214 and #27.) Findings include: Review on 12/14/18 of the facility's policy titled Tobacco-Free Environment Policy, dated 11/2017, revealed the following: 3. Upon admission the patient/family sign the acknowledgment herein to demonstrate their understanding the patient will not smoke anywhere in the facility or on the premises . 11. The CEO/CCO (Chief Executive Officer/Chief Compliance Officer), ED/DNS (Director of Nursing Services), management and security personnel designate by the CEO/CCO and ED/DNS will enforce the Tobacco -Free policy by: .2) Confiscating tobacco products and light materials found in the facility (and returning such materials to the resident -owner upon the resident's discharge) . Resident #227 Interview on 12/14/18 at 9:31 a.m. with Resident #227 revealed the resident keeps cigarettes and lighter on their person or in their room. Resident #227 also revealed that they were told yesterday by staff (12/13/18) that they needed to smoke up by the street to smoke instead of on the facility property. Resident #227 stated It is dangerous up there and some of the smokers here should not be up there by the traffic. Review on 12/19/18 at 8:14 a.m. of Resident #227's admission packet revealed that on 11/20/2018 Resident #227 signed the following acknowledgment The Resident acknowledges that he/she received, reviewed, and understands the facility's Tobacco-Free Environment Policy and agrees not to use tobacco produces (sic) on the premises of the Center. Resident #15 Interview on 12/13/18 at approximately 10:45 a.m. with Resident #15 revealed that Resident #15 stated that they smoke outside the building, on the buliding premises, and that they keep their own cigarettes and lighter with them at all times. Observation on 12/13/18 at approximately 12:30 p.m. with Resident #15 revealed that the gloves that they wore outside when smoking had multiple burn marks on them. Review on 12/18/18 of Resident #15's Smoking Evaluation, dated 8/9/18, revealed that the question of .Does the resident have any evidence of burn holes on clothing or wheelchair, etc? . was answered Yes. The evaluation also revealed that the sentence .Resident is safe to light own cigarettes with staff supervision . was checked off. Review on 12/18/18 of Resident #15's current care plan revealed that there was no intervention for supervision with lighting cigarettes, no mention of the burn marks in Resident #15's gloves and no intervention regarding Resident #15 keeping their own cigarette and lighter with them. Interview on 12/18/18 at approximately 8:30 a.m. with Staff J (Unit Manager) revealed that Resident #15 was non compliant with returning their cigarettes and lighter to staff. Staff J revealed that staff were supposed to be encouraging Resident #15 to return these items and that they should have been documenting Resident #15's refusal to give them to staff. Staff J confirmed that Resident #15 did not receive supervision with lighting cigarettes and that Staff J was not aware that there were burn marks on Resident #15's gloves. Resident #105 Interview on 12/14/18 at approximately 8:30 a.m. with Resident #105 revealed that Resident #105 stated that they smoke outside the building and that they keep their own cigarettes and lighter with them at all times. Review on 12/18/18 of Resident #105's current care plan revealed that there was no intervention regarding Resident #105 keeping their own cigarette and lighter with them or for staff reminding or encouraging Resident #105 to return cigarettes and lighter to staff after smoking. Interview on 12/18/18 at approximately 8:30 a.m. with Staff J revealed that Resident #105 was non compliant with returning their cigarettes and lighter to staff. Staff J revealed that staff were supposed to be encouraging Resident #105 to return these items and that they should have been documenting Resident #105's refusal to give them to staff. Resident #27 Interview on 12/14/18 at 9:05 a.m. with Resident #27 revealed that Resident #27 was a smoker and the they kept their own cigarettes and lighter on their person and in their room. Resident #27 also revealed that they independently smoke and go outside the facility premises. Observation on 12/14/18 at 9:05 a.m. at Resident #27's room revealed that Resident #27 had an oxygen concentrator turned on and the nasal cannula tubing was at their bedside. Interview on 12/14/18 at 9:06 a.m. with Resident #27 revealed that Resident #27 was using oxygen every night. Resident #27 also revealed that their roommate rummages on their side of the room to look for food and that they constantly have to hide their important belongings including their smoking materials (e.g. cigarettes and lighter). Interview on 12/14/18 at 9:10 a.m. with Staff A (Unit Manager) confirmed that Resident #27 was a smoker. Staff A revealed that the facility was a smoke-free facility and Resident #27 was required to sign out on the LOA (Leave of Absence) book and go out of the facility premises to smoke and that residents that smoke were not allowed to keep their smoking materials (e.g. cigarettes and lighters) with them in the facility. Review on 12/18/18 of Resident #27's current physician orders [REDACTED].#27 has an order for [REDACTED]. Review on 12/18/18 of Resident #27's smoking evaluation revealed that the last documented smoking evaluation was on 7/18/18 which revealed that Resident #27 was a independent smoker and a safe smoker under current facility policy. Interview on 12/18/18 at 9:15 a.m. with Staff A revealed that smoking evaluation was to be done quarterly and then stated that it was not required to be done anymore as the facility has a smoke-free policy. Staff A also revealed that smoking materials were to be kept in the medication room. Observation on 12/18/18 at 9:30 a.m. with Staff S (Licensed Practical Nurse) at the 5-2 unit medication room revealed that smoking materials were kept in the medication room but no smoking materials were found for Resident #27. Interview on 12/18/18 at 9:30 a.m. with Staff S revealed that they do not always get the smoking materials back from the residents who smokes and that Staff S does not document the refusal in the resident records. Staff S also revealed that they should be following up with the residents, who smoke, on their smoking materials to be locked in the medication room and document any refusals. Interview on 12/18/18 at 10:39 a.m. with Staff R (Licensed Nursing Assistant) confirmed that Resident #27 kept their smoking materials on their person and in their rooms and that Resident #27's roommate does rummage on Resident #27 side of the room and other resident rooms as well. Staff R revealed that the residents, who smoke, kept their smoking materials on their person and in their rooms. Interview on 12/18/18 at 11:00 a.m. with Resident #27 revealed that the nurses was asking for their smoking materials to be locked in the medication room and it was their first time hearing about it on 12/18/18. Resident #214 Interview on 12/14/18 at 8:30 a.m. with Resident #214 revealed that Resident #214 was a independent smoker. Review on 12/18/18 of Resident #214's smoking evaluation revealed that the last documented smoking evaluation was on 8/30/18 which revealed that Resident #214 was an independent smoker. Review on 12/18/18 of Resident #214's smoking care plan revealed that smoking policy was reviewed with resident. Interview on 12/18/18 at 10:00 a.m. with Staff R revealed that Resident #214 kept their own cigarettes and lighter on their person and in their room. Interview on 12/18/18 at 10:05 a.m. with Staff A and Resident #214 revealed that Resident #214 kept their own cigarette materials on their person. Staff A had asked Resident #214 about their smoking materials to be handed over but Resident #214 declined and states that it was their first time hearing about handing over their smoking materials. Resident #214 states they have always kept their cigarette materials with them. Staff A was unable to explain what to do when the resident does not follow smoking policy. 2020-09-01