cms_SD: 28

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
28	AVANTARA HURON	435020	1345 MICHIGAN AVENUE SW	HURON	SD	57350	2016-12-07	441	D	0	1	EGJW11	NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and policy review, the provider failed to follow appropriate infection control technique: Upon entering and before exiting on of one randomly observed resident's (2) room by staff development coordinator B and dietary aide C. During one of four sampled resident's (2) observed dressing change. Findings include: 1. Observation on 12/5/16 at 4:20 p.m. on B-wing during initial tour revealed: Resident 2's room had an isolation cart that sat directly outside the door. There was a note on that door to check with nursing staff prior to entering. Staff development coordinator B and dietary aide C were observed entering the resident's room without washing their hands. Staff development coordinator B answered a question for the resident and washed her hands upon exiting the room. Dietary aide C had been delivering fresh water to all the residents on B-wing. He removed the resident's water mug that had been sitting on her bedside table, walked out of her room, and placed it on a cart. Dietary aide C had not performed hand hygiene before he left the resident's room. He then proceeded to enter the next resident's room without sanitizing or washing his hands. He removed that resident's water mug and placed it on the cart. He then grabbed a fresh water mug, entered that resident's room again, and replenished the resident with a new water mug. Interview immediately following the above observation with registered nurse (RN) D regarding the above isolation room in the B-wing revealed: Resident 2 was on contact isolation precautions for [MEDICATION NAME] resistant [MEDICATION NAME] (VRE). It was isolated to the resident's urine. 2. Observation on 12/6/16 at 10:10 a.m. with RN A while she performed a dressing change on resident 2 revealed: She retrieved a bag of dressing supplies from the medication cart outside the resident's room. She then put on a gown. There was a hand sanitizer dispenser mounted on the wall adjacent to the door. There were gloves available on the isolation cart located outside the resident's room. She had not used the hand sanitizer that was readily available. She picked the gloves up from the box on the cart and carried them inside the room. She set the clean gloves down next to the sink. She then washed her hands in the sink and put on gloves that she carried from the cart in her unwashed hand. The resident was seated in her recliner. She placed a paper towel down on the far side of the resident's bedside table and placed the plastic bag of dressing supplies on it. She instructed the resident use her forward wheeled walker to pull herself up to a standing position. RN A then pulled the resident's pants and brief down. There was visible bowel movement (BM) and urine stains on her brief. RN A proceeded to remove the dressing on her coccyx. She had the resident sit again, went to the sink, washed her hands, and put on new gloves. She gathered wet washcloths and wound wash. Once more the resident stood. RN A proceeded to wash the resident's buttocks of the BM and urine. She placed the soiled washcloths on the bedside table, turned back to the resident, pulled her brief forward, and had the resident sit back down on the mattress protector that was on her chair. RN A removed her gloves, washed her hands, put on new gloves, and gathered a brief. Once more she had the resident stand. She then applied a barrier cream with her gloved hand to the resident's buttocks and replaced the brief. She pulled up the resident's brief with her soiled gloves and helped the resident walk to her bed from the chair. The resident complained of shortness of breath, so she grabbed the resident's oxygen tubing with her soiled gloves. She applied the residents oxygen tubing to her face via nasal cannula and turned the machine on with her soiled gloves. She told the resident to lie down and grabbed her legs, helping her put them on the bed. She moved the resident's walker out of her way using her soiled gloves. The resident had a decorative oven mitt on her walker that fell when RN A moved it. She retrieved it from the floor and placed it back on the resident's walker wearing the soiled gloves. She walked to the garbage, removed her gloves, and washed her hands. She then put on a clean pair of gloves and retrieved a clean garbage bag, and placed the soiled washcloths in it. There was a visibly wet spot on the bedside table where the soiled linen had laid. Further observation and interview with RN A immediately following the above dressing change revealed: She proceeded to walk out of the resident's room still wearing the isolation gown. She opened the soiled utility room door with her soiled gloves. She emptied soiled linen from the garbage bag into the hamper with the other resident's clothing and linen. She walked back into the resident's room. She removed her gown and gloves and washed her hands. She then grabbed the dressing supply bag and moved them to the area on the bedside table where the soiled washcloths had laid. She then grabbed the isolation garbage the gowns and gloves were in, tied the bag, and carried it down the hallway. She came back to the resident's room and placed a new garbage can liner in the garbage can. She grabbed the resident's dressing supplies and left the room. She returned the resident's dressing supplies to the medication cart. Those supplies were then co-mingled with other residents' dressing supplies. RN A stated she frequently did dressing changes with residents in standing positions, as it was easier. She agreed she should have followed appropriate infection control technique to avoid cross-contamination during dressing changes or when coming in contact with infectious material. Interview on 12/6/16 at 10:40 with the director of nursing regarding the above observation and interview revealed: She was not aware hand hygiene was to have been performed when entering and upon exiting an isolation room per their policy. She thought it had been dependent upon the type of isolation precautions needed. It was her expectation: -All isolation linen should have been in a red biohazard bag. -Soiled washcloths should not have been placed directly on the bedside table. -All environmental surfaces should have been appropriately cleaned and disinfected after potential contamination. -Personal protective equipment (PPE) such as gowns and gloves should have been put on before entering an isolation room and removed before exiting. -The mattress protector on the chair should have been changed after contamination from the resident's bare skin. -Cross-contamination had occurred during the above observations involving RN [NAME] Review of the provider's current undated Handwashing/Hand hygiene policy revealed employees must wash their hands or perform hand hygiene before entering and after exiting isolation precaution settings. Review of the provider's current undated Isolation Precautions policy regarding: Gloves and handwashing revealed: -Gloves were to have been worn when entering the room. -Change gloves after having had contact with infective material such as BM. -Staff were to have removed gloves before leaving the room and washed hands immediately or used a hand sanitizer. -Staff were not to have touched potentially contaminated environmental surfaces or items inside the resident's room. Gowns were to have removed and hand hygiene performed prior to leaving the resident's room. Review of the provider's current undated Multi-Drug resistant Organisms policy revealed: Non-critical care items (such as a water mug) was to have been been dedicated for individual use. The infection control coordinator (staff development coordinator B) was to have monitored environmental services for compliance with cleaning and disinfecting procedures. Review of the porvider's current undated Laundry and Linen policy revealed linen from VRE infected residents should have been placed in an appropriate bag before having been placed in a hamper.	2020-09-01