cms_NH: 9

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
9 GREENBRIAR HEALTHCARE 305005 55 HARRIS ROAD NASHUA NH 3062 2018-03-05 689 E 0 1 6C1411 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure that the resident environment remains as free of accident hazards as is possible for all residents with 2 residents identified as smoking in an initial survey pool of 59 residents in a non-smoking facility. (Resident identifiers are #80 and #138.) Findings include: Observation on 2/28/10 at 8:25 a.m. revealed Resident #80 was outside in front of the main entrance smoking. Observation on 2/28/18 at 9:00 a.m. revealed Resident #80 was outside in front of the main entrance bundled up for weather with a bath blanket over legs in a manual wheelchair. Resident #80 had a cigarette that was put out wrapped in tissue paper. Interview with Staff G (5-2 unit manager) on 2/28/18 9:45 a.m. revealed that staff are aware that Resident #80 goes outside to smoke. Interview further revealed that Staff G did not know where Resident #80 gets or stores their cigarettes and if staff see lighters or cigarettes, they are supposed to take and hold them. Observation on 3/1/18 at 8:05 a.m. revealed Resident #80 outside the main entrance smoking. Observation also revealed three old cigarettes butts on the ground near the main entrance. Review of the facility's smoking policy (not titled or dated) revealed that the facility prohibits the use of tobacco and tobacco products on the facility's premises and there are no designated smoking times or locations. Interview on 3/2/18 at 9:07 a.m. with Staff C (Director of Nursing) revealed that they are a non-smoking facility and have always been a non-smoking facility. Interview also revealed that Staff C did not know where Resident #80 gets cigarettes. Interview confirmed the above smoking policy. Interview with Staff C on 3/2/18 at 9:45 a.m. there was a smoking assessment done on 12/29/17 for Resident #80 that looked at the resident's cognitive ability/vision/and functioning. The assessment did not include any observations of smoking. Interview further revealed that they do not do a complete assessment because they are a non-smoking facility. Review on 3/2/18 at 9:35 a.m. of Resident #80's current care plan showed the following smoking goal: (Resident name omitted) wishes to smoke and is assessed for supervision level: Independent. Interview with Resident #80 on 3/2/18 at 10:15 a.m. revealed the resident goes outside to smoke and the resident hides a lighter and the resident's cigarettes in the resident's room. Interview also revealed that Resident #80 was outside smoking and the wheelchair rolled off the curb and the resident fell out of their wheelchair on 2/26/18. Interview with Staff G on 3/2/18 10:30 a.m. revealed there is a sign-out book that residents are to use when they leave the building but residents do not usually use it. Review of the sign-out book with Staff G revealed that Resident #80 had signed out 4 times, once time a month in September, October, November, and (MONTH) of (YEAR). Review on 3/2/18 at 1:33 p.m. of Resident #80's progress notes revealed the following entries: On 7/7/17 at 2:57 p.m.Pt (patient) wears oxygen during the day. Will frequently take it off and wheel herself outside to smoke . On 8/1/17 at 2:25 p.m. Pt (patient) wears oxygen during the day. Will frequently take it off and wheel .outside to smoke . On 10/19/17 at 8:51 a.m. Last night around midnight, I received a phone call from a concerned individual that there's somebody in (sic) the sidewalk in front of the bld. in a wheelchair with blanket and pillow. I went outside immediately to check and found (Resident #80) smoking in (sic) the sidewalk. I asked (pronoun omitted) to come back inside the building with me because it is not safe for (pronoun omitted) to be out there in the middle of the night. (Pronoun omitted) continued to smoke until (pronoun omitted) was done . I explained to (pronoun omitted) that (pronoun omitted)might get hit or . might fall navigating the wheelchair in the incline . Interview on 2/28/18 1:41 p.m. with Resident #138 revealed that he/she is a smoker and has been for [AGE] years and has no intention on giving it up. He/She acknowledged that the facility is a non-smoking facility. Resident #138 stated he/she has been directed by staff to go out back and smoke near the fence if he/she wants to smoke. Resident #138 stated that because he/she can't get up the ramp to get back in the building that he/she goes out on the platform which is under the awning of the building and smokes out there. Resident #138 explained that since staff are not able to push him/her back up the ramp because they are short staffed most of the time, that he/she has no other option for where he/she smokes. Resident #138 stated that he/she does keep his/her cigarettes and lighter on his/her person. Review of Resident #138's medical record revealed a signed Tobacco Free Policy Acknowledgement form signed by Resident #138 on 3/3/17. Review of the facility's smoking policy revealed that the facility prohibits the use of tobacco and tobacco products on the facility's property and the facility is posted with no smoking signs at the entrances of the facility. Interview with Staff B (LNA) on 2/28/18 at approximately 1:45 p.m. revealed that this is a non-smoking facility and the facility is posted as such.Staff B confirmed that Resident #138 does smoke on the property and there are several other residents in the facility that smoke on the property. Interview with Staff C (RN/DON) on 2/28/18 at approximately 2:15 p.m. revealed there was a smoking assessment done for Resident #138 that only assessed Resident #138's cognitive ability/vision/and physical functioning. 2020-09-01