cms_SD: 13

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

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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
13	AVANTARA MILBANK	435009	1103 SOUTH SECOND STREET	MILBANK	SD	57252	2019-11-06	684	D	0	1	O5MT11	NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, record review, and policy review, the provider failed to follow professional standards to ensure physician notification, ongoing skin assessments, and treatments had occurred for one of one sampled resident (45) who had a change in the condition of her skin. Findings include: 1. Observation on 11/4/19 at 2:11 p.m. of resident 45 revealed: The resident's door to her room had been partially shut. Upon knocking on the door there was no answer. The room was darkened with her window curtains partially opened and the television on. She: -Was laying in her bed resting on her left side and facing the wall. -Had an air mattress on her bed to ensure pressure relief occurred -Was dressed in a bedtime hospital type gown. -She opened her eyes and made eye contact when spoken to but made no attempt to respond. -Was not observed making any spontaneous body movements. Interview on 11/4/19 at 2:29 p.m. with licensed practical nurse (LPN) G regarding resident 45 revealed: The resident was recently placed on bedrest. She stated: -It hurts her too much to transfer her with the lift. -She's comfort care. Observation on 11/4/19 at 4:30 p.m. of resident 45 revealed the same as observed above at 2:11 p.m. Observation and interview on 11/4/19 at 4:34 p.m. with certified nursing assistants (CNA) C and D with resident 45 revealed: They had prepared to assist the resident with repositioning and personal care. The resident had: -Been incontinent of both urine and bowel movement (BM). -Been in the same position as observed above at 2:11 p.m. -Required the CNAs to assist her with positioning, incontinence care, and dressing. When she had been turned onto her right side there was a large circular reddened area on her left buttock. -That area was approximately 12 centimeters (cm) by (x) 7 cm in size and was the color of a red apple. -The entire edge of the wound was a deeper red and approximately 0.25 cm in width. -The entire surface of the wound had been smooth, intact, gave no appearance of being dry, and peeling was noted. -Was located on an area of the skin where a pressure injury could have occurred. CNA C stated: -She always gets red areas like that. -We use a barrier cream or zinc on them. Interview on 11/5/19 at 8:10 a.m. with the director of nursing (DON) regarding resident 45 revealed: She confirmed the interview with LPN [NAME] She stated: -She's been in bed ever since her fall. -She was sitting on the edge of the bed while the CNA was dressing her and started to slide to the floor. The CNA lowered her to the floor. -The x-ray didn't show a fracture, but sometimes they don't show-up until later or when another x-ray is done. -Her right leg is swollen though. -Her family just recently decided not to have another x-ray done and put her on comfort care. -She's not a surgical candidate. Random observations on 11/5/19 from 7:35 a.m. through 10:28 a.m. of resident 45 revealed: She: -Had been laying in her bed sleeping. -Was laying on her back with her heels directly on the air mattress. There was no other pressure relieving measure in place for her heels. The head of her bed was elevated, and she had scooted down in the bed. -That position had caused the bottom of her feet to be flat up against the footboard of the bed. That morning the surveyor had requested multiple times from the staff to observe them while assisting the resident with any and all personal care. -The staff had not approached the surveyor during those three hours to observe them while assisting the resident. Observation and interview on 11/5/19 at 12:41 p.m. of CNA D with resident 45 revealed: The resident had: -Been assisted with her lunch and was positioned on her left side. -No pressure relieving devices between her knees or underneath of her legs/feet. She assisted the resident with incontinence care and repositioning to her right side. The resident continued to have the large reddened area on her left buttock. CNA D stated: -She gets that every now and then; we just put a barrier cream on it or zinc. -She had it last week when I worked. -No no one ever said anything about it in report. -I don't know, I guess maybe they should have said something. -I don't know for sure if the nurse knows about it or not. -We are supposed to position her every two hours. -I move her more than that though, cause I put her on her back to eat then turn her afterwards. -So no, she was moved, I know she was. Review of resident 45's paper and electronic medical record revealed: She was admitted on [DATE]. [DIAGNOSES REDACTED]. Her Braden Scale for Predicting Pressure ulcers score as of 9/30/19 was a twelve indicating she was at moderate risk for skin breakdown. She had: -Periods of confusion and problems with both short and long term memory recall. -Required the CNAs to assist her with positioning, incontinence care, transfers, and dressing. On 10/4/19 she: -Had a fall with an injury while being assisted by the CNA with dressing. -Had been sitting on the side of her bed while the CNA was assisting her. -Was leaning forward, started to slide down off of the bed, and the CNA lowered her to the floor. -Had been sent to the emergency room to rule out a fracture of her right leg/hip. The x-ray did not support an injury to that leg, but it had been quite swollen and painful. -The physician had ordered medication for pain control. She had a history of [REDACTED]. -Those areas had been to her elbows, under her abdominal folds, and breasts. Staff were to have applied various types of creams and ointments to those areas until healed. There was no documentation to support: -She had a skin concern to her left buttock that required the staff to monitor and treat until healed. -The physician was notified of that area on her left buttock to ensure the appropriate treatment was in place to promote proper healing of it. Review of resident 45's 8/1/19 through 11/4/19 treatment assessment record (TAR) revealed: She: -Was to have her skin assessed by the professional staff every week on Thursday evenings. -Had skin concerns on her elbows, abdominal folds, and under her breasts that required various types of treatment for [REDACTED]. There was no documentation to support: -The staff were to monitor an area of concern on her left buttock to ensure healing had occurred. -An order from her physician for a treatment was received and put in place to promote healing for a skin concern on her left buttock. Review of resident 45's 8/1/19 through 10/31/19 weekly skin evaluations revealed: On 10/10/19 the nurse had documented: -Site: Left buttock. -Description: Approximately 6 (inches) circular reddened area that is blanchable, zinc applied with each brief change. Review of resident 45's 8/12/19 through 11/3/19 nursing progress notes revealed no documentation to support: The professional staff had assessed and treated a skin concern on her left buttock. The physician was notified to ensure they had provided the proper treatment to promote healing of that skin concern. Observation and interview on 11/5/19 at 3:32 p.m. of registered nurses (RN) F and H and CNA I with resident 45 revealed: CNA I stated: She's had that spot in the past before. It's part of her psoriasis issue. RNs F and H: -Had not been aware of the skin concern located on the resident's left buttock. -Assessed the area and a majority of the area was blanchable. RN H confirmed the resident had a history of [REDACTED]. RN H agreed the nurse who had initially assessed that area should have: -Notified the physician to ensure the appropriate treatment and monitoring was put in place to promote proper healing of it. -Notified the direct care givers and other professional staff of that area to further support the proper monitoring and treatment of [REDACTED]. -Identified the area on her left buttock on the TAR to ensure the staff had monitored it for healing. They agreed she: -Was at high risk for skin breakdown and required staff support for proper positioning. -Should have been repositioned at a minimum of every two hours. RN H was not sure she had required extra pressure relieving measures for her feet and heels with the use of an air mattress. Interview on 11/5/19 at 4:56 p.m. with the DON regarding resident 45 revealed she: Confirmed the resident was: -At risk for skin breakdown and should have been repositioned at a minimum of every two hours. -Dependent upon the staff to ensure all of her activities of daily living (ADL) had occurred. Those ADLs had included repositioning, incontinence, and skin care. Agreed the air mattress would not have guaranteed no skin breakdown would not have occurred without the support of positioning and pressure relieving devices. Would have expected there to have been pressure relieving devices between her knees and underneath her heels. Confirmed the resident had a history of [REDACTED]. Was not aware of the skin concern on the resident's left buttock. Was undecided if the nurse who had initially assessed that area should have: -Contacted the physician to ensure the resident received the appropriate treatment to promote the healing of it. -Ensured the TAR was updated for the other staff to monitor that area to ensure healing of it had occurred. -Ensured the direct care givers and other nursing staff had been aware of the area on her left buttock. Review of the provider's 5/1/15 Weekly Skin Review UDA (user defined assessments) policy revealed: A weekly skin review UDA (user defined assessments) will be completed weekly on all residents and patients to check for any new skin issues not previously identified. MD/NP (medical doctor and/or nurse practitioner) are to be notified of any skin alterations, as well as the resident/patient, and his/her responsible party. Review of the provider's 11/12/14 Notification of Change in Resident Health Status policy revealed: Guideline Statement: To ensure that proper notifications are made when a resident has a change in health status. *Such as: A need to alter treatment significantly (i.e. a need to discontinue an existing form of treatment due to adverse consequences, or to commence a new form of treatment.)	2020-09-01