cms_SD: 44

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
44	MONUMENT HEALTH CUSTER CARE CENTER	435032	1065 MONTGOMERY ST	CUSTER	SD	57730	2018-03-28	688	D	0	1	CZRE11	NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, record review, and policy review, the provider failed to ensure one of one sampled resident (21) who had limited mobility had been screened and/or placed on a restorative program (RC) to maintain her range of motion (ROM) and physical abilities. Findings include: 1. Review of resident 21's medical record revealed: An admission date of [DATE]. Her [DIAGNOSES REDACTED]. She was dependent upon the staff to assist her with all activities of daily living (ADL). She had a Brief Interview Mental Status (BIMS) score of fourteen indicating she had good memory recall. What activities and meals she had participated in outside of her room was her choice. She had: -Therapy services for strengthening upon admission to the facility. --Those services had been discontinued d/t (due to) the resident's refusal to participate. No documentation to support the therapy services had referred her for a RC program to ensure her current mobility status was maintained. Observation and interview on 3/12/18 at 5:22 p.m. of resident 21 revealed: She had appeared: -Very thin, weak, frail, and her hair was unkempt. -To be able to move her arms without difficulty, but no spontaneous movement of her legs was observed. She had been: -Laying in her bed resting. -Awake and talked very little when spoken to. The head of her bed had been elevated to approximately thirty-five degrees. She had scooted down in the bed so her chin rested on her chest. Her feet had been hanging over the foot board that was attached to the bed. Continued observation and interview on 3/12/18 at 5:34 p.m. with resident 21 revealed: An unidentified staff member brought a tray in containing her supper. The unidentified staff member: -Placed the supper tray on the bedside table and positioned it in front of the resident. -Rolled the head of her bed up further. -Had not: --Attempted to reposition the resident or asked the resident if she would like to be moved up higher in the bed. The unidentified staff member left the room. The resident made no response when the surveyor inquired if she was comfortable in that position. Observation and interview on 3/13/18 from 8:11 a.m. through 8:57 a.m. with resident 21 revealed: She had: -Been laying in bed. -The same shirt on as the day before and her hair remained unkempt. -Been positioned higher up in the bed so her feet were not hanging over the foot board. -Been drinking a cup of coffee. Her facial affect and appearance remained unchanged when spoken to. She had not eaten breakfast yet and decided to remain in her bed for breakfast. Certified nursing assistants (CNA) F and W assisted her with personal cares, changed her clothes, and positioned her up higher in the bed. -She refused to get out of her bed. Random observations on 3/13/18 from 9:10 a.m. through 5:15 p.m. of resident 21 revealed: Her appearance and interactions with roommate and others remained minimal. She was: -Out of her bed for approximately an hour the entire day. --That had been during dinner time. Review of resident 21's 1/15/18 quarterly Minimum Data Set (MDS) assessment regarding functional status and her range of motion revealed: She had required extensive assistance from staff with bed mobility, transfers, moving around, dressing, toileting, and personal hygiene. She used a wheelchair and had not been walking. Her balance had been unsteady. She had no limitation in her ROM at that time. Interview on 03/14/18 at 1:50 p.m. with physical therapy assistant (PTA) C regarding resident 21 revealed:She used to receive skilled therapy services, but had frequently refused to work with them. They had to discontinue those skilled services due to her lack of participation and not meeting the requirements for her to remain a part of skilled therapy services. PTA C was not aware of the resident having been started or currently on a restorative program. -PTA C was unsure how those programs were set-up. She thought the restorative program was overseen by certified nursing assistant (CNA) supervisor I. Interview on 03/14/18 at 1:55 p.m. with CNA supervisor I regarding resident 21 revealed: She had agreed with her understanding of the restorative criteria the resident would have benefited and was appropriate for the RC program. -Passive and active range of motion would have benefited her. --It could have been done on a one-to-one basis for her. She reviewed the residents who were currently on restorative programs and could not locate one for the resident. She had not set-up the restorative programs since it was not in her scope of practice. -She was a CN[NAME] The MDS coordinator nurse would have set-up the residents' RC programs. She again agreed with her understanding the resident should have been on a program to ensure she maintained her current ROM status and abilities. Interview on 03/14/18 at 2:00 p.m. with the MDS coordinator regarding resident 21 revealed: She confirmed the resident was not on a RC program and would have benefited from one. She had the capability of setting up RC programs after she received a referral from the therapy department. She was not able to find a referral from the therapy department to set-up a RC program for the resident. The resident had been on skilled therapy services but frequently declined and so their services had been discontinued. Interview on 03/27/18 at 5:00 p.m. with the director of nursing regarding resident 21 and RC programs revealed: She agreed the resident was appropriate for a RC program to ensure she had no decline in her current ROM or abilities. The therapy department initiated the resident's RC programs for the nursing staff to start. -They could have changed the RC program after it was initiated from the therapists. There had been no assessment or referral completed by the therapy department to start a RC program for the resident. -A referral from the therapy department was not written until 3/17/18 after the surveyor had requested a copy of the restorative screening form. Review of the provider's 7/20/06 Restorative Nursing Program policy revealed: Policy statement: -Restorative nursing programs are utilized to promote residents ability to adapt and adjust to living as independently and safely as possible. -This concept actively focuses on achieving and maintaining physical, mental, and psychosocial functioning. Guidelines: -Licensed therapist will assess the resident and determine the resident's restorative needs from a therapist perspective on admission, at the ned (need) of a formalized rehabilitation program, quarterly or with a change in resident's status or abilities. -The licensed therapist will then collaborate with the facility's Restorative Nurse for the development an appropriate restorative nursing program. Review of the provider's RAI Manual, MDS 3.0, Version 1.15, related to ADLs, pages G-2 through G-3 and G-36, revealed: Health-related quality of life included: -Almost all nursing home residents need some physical assistance. In addition, most are at risk for further physical decline . -A wide range of physical, neurological, and psychological conditions and cognitive factors can adversely affect physical function. -As inactivity increases, complications such as pressure ulcers, falls, contractures, depression, and muscle wasting may occur. Planning for care included: -For some residents, cognitive deficits can limit ability or willingness to initiate or participate in self-care or restrict understanding of the tasks required to complete ADLs. -Most residents are candidates for nursing-based rehabilitative care that focuses on maintaining and expanding self-involvement in ADLs. *The definition of functional limitation in range of motion was Limited ability to move a joint that interferes with daily functioning (particularly with activities of daily living) or places the resident at risk for injury.	2020-09-01