cms_SD: 64

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
64	AVERA MARYHOUSE LONG TERM CARE	435034	717 EAST DAKOTA	PIERRE	SD	57501	2018-05-16	880	E	0	1	4XMM11	Based on observation, interview, and policy review, the provider failed to ensure infection control practices and protocols were followed when providing: Personal care for two of seven sampled residents (44 and 52) by two of two certified nursing assistants (CNA) (A and B). Foley catheter care for one of one sampled resident (4) by one of one CNA (A). Findings include: 1. Observation on 5/15/18 at 11:48 a.m. of CNAs A and B during personal care for resident 52 revealed: He had been laying in his bed and was ready to get up for dinner. They had sanitized their hands and put on a clean pair of gloves. With those gloves on they had: -Pushed a mechanical transfer lift over to his bed. -Adjusted his covers and clothes to expose his upper and lower body. -Removed his soiled incontinent brief. CNA B had: -Assisted the resident to lay on his right side. -Retrieved and opened a package of wet wipes. -Taken several wet wipes out of the package and cleansed his bottom with them. --He had been incontinent with a small amount of bowel movement. -Not removed her soiled gloves and washed/sanitized her hands after performing perineal care for the resident. CNA A had: -Opened the top drawer of his bedside stand and removed a tube of barrier cream and bottle of powder. -Taken a small amount of barrier cream from the tube and applied it to his bottom. -Opened the bottle of powder and sprinkled some on his bottom over the barrier cream. -Removed her gloves and without washing/sanitizing her hands put on a clean pair of gloves. With those gloves on they had: -Put a clean incontinent brief on the resident. -Placed a sling underneath of him, pulled the mechanical lift closer to the bed, and attached it to the sling. They both had assisted the resident out of his bed and into his wheelchair with use of the mechanical lift. At that time they both removed their soiled gloves and washed their hands. 2. Observation on 5/15/18 at 1:30 p.m. of CNAs A and B during personal care for resident 44 revealed: The resident had been sitting in a Broda w/c and was ready to lay down on her bed. They had washed their hands and put on a clean pair of gloves. With those gloves on they had: -Used a mechanical lift to transfer her from the w/c onto the bed. -Pulled down her pants and removed her soiled incontinent brief. With those same gloves CNA A had: -Opened the top drawer on the bedside table. -Retrieved a package of wet wipes, a tube of barrier cream, and a package of skin prep swabs. CNA B had: -Retrieved several wet wipes from the package and cleaned the resident's bottom. -Opened the tube of barrier cream and applied some to her bottom. CNA A had: -Retrieved several wet wipes from the package and cleaned her perineal area. -Changed her gloves without sanitizing/washing her hands. They had removed a pressure relieving boot and sock from the resident's left foot. -That pressure relieving boot had been sitting on a soiled footrest attached to the w/c. -There had been a black colored area on the resident's left heel. With the same gloves that CNA B had used to: -Handle/move a mechanical lift and w/c. -Transfer a resident into her bed. -Remove clothes and an incontinent brief. -Clean the bottom of a resident. -Remove a pressure relieving boot and sock from a foot. CNA B had proceeded to: -Open the package containing skin prep swabs. -Get a skin prep swab from that package. -Wipe the skin prep over the wound on the resident's left foot. -Put the resident's sock and pressure relieving boot back on. They finished positioning the resident in her bed. At that time they both removed their soiled gloves and washed their hands. 3. Observation on 5/16/18 at 8:00 a.m. of CNA A during Foley catheter care for resident 4 revealed: The resident had: -Been laying in his bed. -A Foley catheter in place with a collection bag attached to it, and it was hanging from the bedframe. The CNA washed her hands and put on a clean pair of gloves. With those gloves on CNA A had touched multiple unclean surfaces prior to the catheter care. Those surfaces had been: -A plastic basin containing a Foley catheter leg bag. -A package of wet wipes, a bottle of perineal cleansing spray, and several packages of alcohol wipes. -A clothes hanger with a shirt on it. --She showed it to the resident to ensure it was the shirt he had picked out to wear for the day. -The bed covers to expose the catheter and perineal area. With those soiled gloves on CNA A: -Detached the Foley collection bag from the catheter tubing and attached the Foley catheter leg bag to it. -Retrieved several wet wipes and cleaned the front perineal area and Foley catheter insertion site. -Cleaned the catheter tubing in an upward and downward motion. The CNA removed her gloves, washed her hands, and assisted the resident to get dressed for the day. Interview on 5/16/18 at 8:29 a.m. with CNA A regarding the above observations revealed she: Had not recognized the processes above as unsanitary until being reviewed with the surveyor. Agreed the processes above could have created the potential for cross-contamination of germs to the resident. Had not recognized the outside surfaces of all the items touched above would have been considered unclean. Confirmed her hands should have have been washed/sanitized between glove change. Could not remember the last time the staff had been trained on proper protocols and processes for personal and Foley catheter care. 4. Interview on 5/16/18 at 3:40 p.m. with the director of nursing and administrator confirmed: The above observations had not been completed in a sanitary manner. There was the potential for cross-contamination of germs to have been transmitted to those residents. Hands should have been washed/sanitized between glove change. With those processes used above the residents had been at risk for facility acquired infections. Review of the provider's (MONTH) (YEAR) Hand Hygiene policy revealed: Hand hygiene was the single most important procedure for the control of infection. It was a critical component of patient and employee safety. Policy: -Wash hands with system approved soap and water when hands are visibly soiled with blood or other body fluid. -Hand hygiene with Alcohol Hand Rub (antisepsis) after contact with inanimate objects in the immediate vicinity of the patient (resident) and after glove removal. Review of the provider's 2007 Catheter Care policy revealed: Purpose: To prevent infections. Procedure: Wash the catheter from the meatus down the tube about three inches.	2020-09-01