cms_SD: 62

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
62	AVERA MARYHOUSE LONG TERM CARE	435034	717 EAST DAKOTA	PIERRE	SD	57501	2018-05-16	697	D	0	1	4XMM11	NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Surveyor: Based on observation, interview, and record review, the provider failed to ensure adequate pain control was monitored, reviewed, and appropriate interventions were implemented for one of one sampled resident (33) who had complaints of increased pain after a facility acquired injury occurred. Findings include: 1. Observation and interview on 5/15/18 at 9:27 a.m. of resident 33 revealed: She repeated I'm hurting terrible. It was heard by this surveyor all the way down the hallway. Certified nursing assisted (CNA) G was applying an ice pack on her left lower leg on an oval shaped bruise approximately five inches by four inches. CNA G hesitated to apply the ice pack because of her yelling. CNA G and H elevated her legs in the recliner. She continued to yell and grimace in pain. CNA G and H stated she had started yelling out more with movement this weekend after her leg had been bumped into the door. Interview on 5/15/18 at 9:47 a.m. with resident 33 revealed when the surveyor asked what happened to her leg she stated: I'm afraid that its broke. Some girls did it when they were getting me up. Hurts all over. Interview on 5/16/18 at 4:45 p.m. with the director of nursing (DON) revealed: Resident 33's injury had been reported immediately by CNA I to registered nurse (RN) F on 5/12/18. CNA I reported she had brushed resident 33's leg against the wall in the hallway. The DON stated she had not examined the injury. Interview on 5/16/18 at 6:30 p.m. with RN/MDS assessment coordinator and RN/MDS assistant revealed: There was no incident report and investigation completed after the injury had been reported by CNA I. The physician had not been notified of the incident and injury to the resident's left leg. Review of resident 33's complete medical record revealed: An admission date of [DATE]. Her [DIAGNOSES REDACTED]. She: -Had a Brief Interview Mental Status (BIMS) score of twelve indicating her memory recall was slightly impaired. -Had been capable of making her needs known. There was no documentation to support: -An incident report was completed after the injury had been reported by CNA I on 5/12/18. -A formal investigation was completed to rule out abuse and ensure no major injury had occurred to the resident's left leg. -Systems, protocols, and education were provided and implemented to ensure this type of incident and injury would not have occurred again. The physician had not been notified of: -The incident and injury that had occurred to the resident's left leg. -The resident's complaints of increased pain and discomfort -The ineffectiveness of the pain medications the staff had given her for those complaints of discomfort. Review of resident 33's 5/14/18 hospice nurse's notes revealed: The resident had been complaining of her legs hurting earlier that day. The staff had reported to the hospice nurse that the resident's leg was twisted during a transfer yesterday (5/13/18). The resident had not required extra pain medication for discomfort. The resident's pain control had been assessed with [REDACTED]. A trace amount of [MEDICAL CONDITION] was observed to both of her lower legs, ankles, and feet. No documentation to support a bruise was observed on her lower left leg. Review of resident 33's 5/14/18 hospice social services note revealed: The resident had said she was having a lot of pain in her hip, and she had stated she Thinks it is broke. An unidentified nurse had reported to her that the resident's Knee got bumped on the door frame over the weekend. She had pain medication for it, and it should have taken effect shortly. Staff feel it is not broke, more of a muscle pull. Review of resident 33's 5/15/18 registered nurse (RN) F's nursing documentation revealed: She had completed a late entry for her interview and assessment of the resident that had occurred on 5/12/18 at 4:45 p.m. On 5/12/18: -CNA I reported she had bumped the resident's left foot on the wall while taking her to the dining room in her Broda chair. -Resident 33 had complained of pain in her right foot, and then she had said it was her left foot. -There was swelling, but that had been usual for her. -Will monitor and report to (physician's name), any changes or signs of fracture. Her late entry for the resident's incident with CNA I had occurred three days later and had occurred during the facilities recertification survey. No documentation to support: -Where the swelling had been observed. -An incident report had been completed. Review of resident 33's 5/15/18 RN D's nursing documentation revealed: She had completed a late entry for her assessment of the resident that had occurred on 5/12/18. On 5/12/18 at 4:45 p.m.: -Resident was in so much pain when she was sit (sat) up from bed and place in the recliner. -The resident had complained her foot hurt, and RN D had checked her left leg from the knee down to her foot. She had noted: -A fading bruise on the lower part of her shin. -Very tender to touch, the resident was yelling and grimacing when her legs had been elevated. -[MEDICATION NAME] had been given for discomfort. -She was still agitated and grimacing an hour after the pain medication had been given. -The resident stated I don't get relief and Put me up. The nurse noted that was excruciating pain. Her late entry of that assessment was three days later after the incident and had occurred during the facilities recertification survey. No documentation to support: -An incident report had been completed. -The physician had been notified: --Of her assessment of the resident's leg and increased pain. --The pain medication was ineffective. Review of resident 33's 5/16/18 RN E's nursing documentation revealed: She had completed a late entry for her assessment of the resident that had occurred on 5/14/18. On 5/14/18 at 1:08 p.m.: -The resident had pain when the staff were assisting her with getting up. -The resident had stated It hurts, its hurts. -She had been medicated with Tylenol, [MEDICATION NAME], and [MEDICATION NAME]. --The [MEDICATION NAME] had been given again after an hour. -A warm pack had been applied to her left lower leg. Her late entry of that assessment was two days later and occurred during the facilities recertification survey. No documentation to support: -The nurse had assessed what the resident's left leg looked like. -The physician was notified of her increased pain with no relief after several pain medications had been given. Review of the provider's undated RN/Charge Nurse job description revealed: Responsiveness: -Follow through and follow up. -Anticipate and respond to individual's needs. Task 1 - Performs Nursing Task: -Contacts physician, establishes working relationship and initiates ongoing information exchange. -Provides professional nursing care to residents. -Administer professional services. -Monitor seriously ill residents as necessary. -Notify physician and next-of-kin when there are any changes in resident's condition. Task 2 - Care Planning and Record Keeping: -Consistently & thoroughly completes documentation in a timely manner, including initiating medication & treatment administration records. -Completes/supervises medical record. Task 3 - Supervisory Duties/Roles Knowledgeable status and needs of residents and communicates effectively with team members. Review of Potter/Perry's 2013 ninth edition; Fundamentals of Nursing; Chapter 44 page 1,022 on Pain Management revealed: Knowledge of pain physiology and the many factors that influence pain help you manage a patient's pain. Critical thinking attitudes and intellectual standards ensure the aggressive assessment, creative planning, and thorough evaluation needed to obtain an acceptable level of patient pain relief while balancing treatment benefits with treatment-associated risks. Successful pain management does not necessarily mean pain elimination but rather attainment of mutually agreed-on-pain-relief goal that allows patients to control their pain instead of the pain controlling them. Nurses approach pain management systemically to understand and treat a patients pain. The American Nurses Association (ANA, 2005) upholds that pain assessment and is within the scope of every nurse's practice. Review of Potter/Perry's 2013 ninth edition; Fundamentals of Nursing; Chapter 44 page 1,023 on Pain Management revealed: Routine Clinical Approach to Pain Assessment and Management: ABCDE: -A: Ask about pain regularly. Assess pain systematically. -B: Believe patient and family in their report of pain and what relieves it. -C: Choose pain control options appropriate for the patient, family, and setting. -D: Deliver interventions in a timely, logical, and coordinated fashion. -E: Empower patients and their families. Enable them to control their course to the greatest extent possible.	2020-09-01