cms_SD: 14

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
14	AVANTARA MILBANK	435009	1103 SOUTH SECOND STREET	MILBANK	SD	57252	2019-11-06	880	E	0	1	O5MT11	Based on observation, interview, and policy review, the provider failed to ensure sanitary conditions had been maintained during personal care for three of five sampled residents (15, 20, and 45) by three of three observed certified nursing assistants (CNA) C, D, and E. Findings include: 1a. Observation on 11/4/19 at 3:36 p.m. with CNAs C and D with resident 20 revealed: The resident had been sitting on the edge of her bed sorting her mail. She had been incontinent of bowel movement (BM). -Her BM was so large it had run out of the incontinent brief and down her right thigh. She had required the use of a mechanical stand-aide for transfers. The CNAs prepared to assist the resident with personal care and a transfer from her bed onto a bedside commode. Without washing or sanitizing their hands upon entering the room they put on a clean pair of gloves. With those gloves on CNA D: -Moved the stand-aide closer to the resident. -Removed the blanket off the resident's lap. -Touched the handle on the water faucet and turned the water on. -Got a package full of dry wipes, opened that package, and wet the dry wipes. -Touched the handle on the water faucet and turned the water off. -Took the wet wipes and started to clean the BM off of her thigh. -Removed her gloves and without sanitizing or washing her hands put on another pair of gloves. With those gloves on CNA D: -Assisted CNA C with using the stand-aide to stand the resident up. -Removed the resident's incontinent brief and took several of the wet wipes and cleaned BM off her bottom. With those soiled gloves on she took more wet wipes and cleaned the resident's front perineal area. --The CNA cleaned her front area by wiping from the back towards the front of her perineal area. --There had been BM on several of those wet wipes. Both of the CNAs removed their gloves and assisted the resident to sit down on the bedside commode. They washed their hands prior to leaving the room to offer the resident privacy and wait for the bath-aide to assist them further. -That had been the only time they were observed washing or sanitizing their hands during the above observation. CNA D had not attempted to: -Use a barrier between her gloves and the water faucet handle when turning the water faucet on and off. -Open the package of dry wipes prior to putting on gloves that were used to clean the resident with. -Clean the resident's front perineal area prior to cleaning her bottom of BM. -Change her gloves and wash or sanitize her hands after cleaning the resident's bottom that had BM on it prior to cleaning her front perineal area. -Ensure she cleaned the resident's perineal area from front to back. b. Observation on 11/4/19 at 4:34 p.m. of CNAs C and D with resident 45 revealed: The resident had been laying on her bed and was ready to be repositioned. They prepared to assist her with personal care and to position her on her right side. Without washing or sanitizing their hands upon entering the room they put on a clean pair of gloves. With those gloves on they: -Raised the resident's bed up to a workable level by using the hand remote. -Pulled the resident's blanket off her and removed her incontinent brief. Both CNAs C and D had touched the water faucet handle and turned the water on and off to wet some dry wipes. CNA C cleaned the resident's front perineal area first, and then CNA D cleaned the resident's bottom. -She had been incontinent of BM. Without removing their soiled gloves they: -Put a clean incontinent brief on the resident. -Positioned her in bed on her right side. -Placed a pillow behind her back and covered her with the blanket. Both of the CNAs removed their gloves and washed their hands prior to leaving the resident's room. -That had been the only time they were observed washing or sanitizing their hands during the above observation. They had not: -Changed their gloves and washed and/or sanitized their hands after positioning the bed, removing the blanket, and taking off her incontinent brief. -Used a barrier between their gloves and the water faucet handle when turning the water faucet on and off. -Changed their gloves and washed and/or sanitized their hands after providing personal care for the resident. c. Observation on 11/5/19 at 10:36 a.m. with CNA [NAME] with resident 15 revealed: The resident had been laying on her bed and was ready to be assisted with a bed bath. The CNA prepared to assist the resident with that bed bath. After gathering all her supplies CNA [NAME] washed her hands and put on a clean pair of gloves. With those clean gloves on she washed her hair, face, and upper torso. CNA E: -Changed the water in the basin and removed her gloves. -Washed her hands and put on a clean pair of gloves. With those clean gloves on CNA E: -Took a washcloth, wet it with the water in the basin, and applied some soap to it. -Took the washcloth and cleaned both of her legs and feet with it. CNA [NAME] used those soiled gloves and that soiled washcloth to: -Rinse the washcloth in the same water used to wash her legs. -Apply soap to that washcloth and clean the resident's front perineal area with it. CNA [NAME] removed her gloves and washed her hands. d. Interview on 11/5/19 at 1:05 p.m. with CNA D regarding the above observations of personal care for residents 20 and 45 revealed: That had been her usual process for providing personal care for the residents. She had not recognized the process as unsanitary until after the observations were reviewed with her. She agreed: -The personal care provided above had not been provided in a sanitary manner and placed the residents at risk for acquiring an infection. -They should have removed their gloves and washed or sanitized their hands after they were soiled with BM. -They should have washed and/or sanitized their hands prior to entering the resident's room. She could not remember the last time she had been observed by the professional staff while providing personal and/or perineal for the residents. Interview on 11/5/19 at 3:20 p.m. with registered nurse F and the director of nursing regarding the above observations revealed: They agreed the personal care above had not been completed in a sanitary manner. The staff were required to provide personal care for the resident's bottom area prior to cleaning their front perineal area. The CNAs should have: -Washed and/or sanitized their hands upon entering the resident's room to assist them with care. -Removed their gloves and/or sanitized their hands anytime they had been soiled. They agreed the processes above had created the potential for the residents to have acquired an infection. Review of the provider's (MONTH) 2014 Handwashing/Hand Hygiene policy revealed: This facility considers hand hygiene the primary means to prevent the spread of infections. All personnel shall be trained and regularly in-serviced on the importance of hand hygiene in preventing the transmission of healthcare-associated infections. *The use of gloves does not replace handwashing/hand hygiene. Integration of glove use along with routine hand hygiene is recognized as the best practice for preventing healthcare-associated infections.	2020-09-01