cms_SD: 89

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
89	ROLLING HILLS HEALTHCARE	435035	2200 13TH AVE	BELLE FOURCHE	SD	57717	2018-03-01	658	D	0	1	2S8V11	NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, record review, interview, job description review, and policy review, the provider failed to ensure: Medications were initialed after being administered by one of one registered nurse (RN) (I) who administered medication to resident 61. Unlicensed assistive personnel (UAP) (A) had supervision of a registered nurse (RN) to calculate medication doses for two of two sampled residents (14 and 27) who required dosage calculation. physician's orders [REDACTED]. -One of one sampled resident (10) with a new physician's orders [REDACTED]. -One of one sampled resident (40) who used oxygen and a bilevel positive airway pressure ([MEDICAL CONDITION]) device had been followed. Findings include: 1. Observation on 2/28/18 at 7:50 a.m. of RN I while she prepared medications for resident 61 revealed she signed the resident's medication as having been given as soon as she had finished preparing it. Interview with RN I at that time revealed she had done that because she was only going to administer medication to resident 61. She stated she did not want to have to come back to the medication cart to sign the medication administration record. 2a. Observation and interview on 2/27/18 at 9:00 a.m. of UAP A while she administered medication to resident 27 revealed: An order on the resident's (MONTH) (YEAR) medication administration record (MAR) stated ranitadine 150 milligrams (mg) (for stomach) in the morning. There ha There had not been verification on the MAR that had indicated the correct doage was two tablet of ranitadine. She gave the resident two 75 mg tablets of ranitadine and stated:-She gave two tablets of ranitadine 75 mg to the resident, because there had not been any 150 mg tablets. -There used to be 150 mg tablets. -Now the tablets were 75 mg. -She just knew two 75 mg tablets would equal 150 mg of medication for the resident. -She had not asked a licensed nurse for verification of the correct dose of medication when the tablets had changed from 150 mg to 75 mg. b. Observation and interview on 2/28/18 at 9:00 a.m. of UAP A while she administered medication to resident 14 revealed: An order on the resident's (MONTH) (YEAR) MAR [MEDICATION NAME] 1000 mg, give two tablets in the a.m. UAP A gave the resident two 500 mg tablets of [MEDICATION NAME]. UAP A stated: -She just knew two 500 mg tablets would equal 1000 mg of medication for the resident. -She had not asked a licensed nurse for verification of the correct dose of medication. 3a. Review of resident 25's physician's orders [REDACTED]. Observation on 2/28/18 at 2:30 p.m. of resident 25 while he was laying in bed on his left side revealed: He had on soft foam covered ankle boots. His right heel laid directly on the inside of the boot approximately half way up from the heel area. His right heel had not been exposed in the opened area of the boot meant for off loading. That ankle boot laid directly on the resident's bed. b. Review of resident 40's medical record revealed: Her Brief Interview for Mental Status score was fifteen indicating no cognitive impairment. She had an above the knee amputation of the left leg. Her [DIAGNOSES REDACTED].>-Type 2 diabetes mellitus. -Sleep apnea. -Heart failure. -Major [MEDICAL CONDITION]. -[MEDICAL CONDITION]. -[MEDICAL CONDITION]. -Gastro-[MEDICAL CONDITION] reflux. -Abnormal posture. -Muscle weakness. physician's orders [REDACTED]. -Oxygen at 4 liters per minute (lpm) continuous when [MEDICAL CONDITION] not in use. -Oxygen at 10 lpm via [MEDICAL CONDITION] at night and during naps. -[MEDICAL CONDITION] at 16/8 with a backup rate of 12. physician's orders [REDACTED]. -Oxygen at 2 lpm continuous. -Continue [MEDICAL CONDITION] when sleeping. Observation on 2/27/18 at 3:00 p.m. of resident 40 revealed she had: Been sitting up in her lift chair taking a nap. Been using oxygen at 2 lpm. A [MEDICAL CONDITION] machine on her bedside table. Interview on 2/27/18 at 3:00 p.m. with CNA R regarding resident 40 revealed she used: Oxygen at 2 lpm during the day. [MEDICAL CONDITION] at night. Interview on 2/27/18 at 3:15 p.m. with CNA S regarding resident 40 revealed: She stated I have never seen her wear her [MEDICAL CONDITION] when she takes a nap during the day. She used oxygen at 2 lpm during the day. Interview and observation on 2/27/18 at 3:30 p.m. with resident 40 revealed: She had been sitting up in her lift chair and using her oxygen per a nasal cannula. Oxygen concentrator had been set at 2 lpm. She stated I only use my oxygen at 2 lpm during the day and 6 lpm with my [MEDICAL CONDITION]. -I have lost weight and my breathing is getting much better. -I only use my [MEDICAL CONDITION] at night. She no longer took naps in her bed, since she was getting stronger. Used a stand aid for transfers. She took her naps in her lift chair. Review of resident 40's (MONTH) (YEAR) and (MONTH) (YEAR) treatment administration record (TAR) revealed: 02 at 10 lpm via [MEDICAL CONDITION] at night and during naps. -Start date 4/27/17. 02 at 4 lpm per nasal cannula continuous when [MEDICAL CONDITION] not in use. -Start date 4/27/17. Documentation of 02 and [MEDICAL CONDITION] checks from 6 a.m. to 2 a.m., 2 a.m. to 1 p.m., and 10 p.m. Review of resident 40's 2/21/18 revised care plan revealed: I USE OXYGEN AT 10 lpm AT N[NAME] (night) with a Bi-Pap. 02 4 lpm DURING THE DAY. Interview on 2/28/18 at 2:55 p.m. with registered nurse (RN) I regarding resident 40 revealed she: Used a [MEDICAL CONDITION] device at night with oxygen at 6 lpm bled-in. Used oxygen at 2 lpm continuous during the day. Took naps during the day. -Did not use her [MEDICAL CONDITION] for naps. 4. Interview on 3/1/18 at 9:15 a.m. with the director of nurses confirmed: Resident 25's right heel had not been off-loaded per physician's orders [REDACTED]. RN I should not have pre-signed for medications. Medications were to have been signed by the RN after they had been given. UAP A should not have calculated medication doses. -The MAR had not indicated giving two tablets of ranitadine or [MEDICATION NAME] had equaled the croccert dosage. -Medication doses should only have been calculated by a licensed nurse. -UAP A required the supervision of an RN to pass medications. -UAP A should have verified the doses of the above mentioned medications with a RN. Interview on 3/1/18 at 12:27 p.m. with the director of nursing regarding resident 40 revealed: Her oxygen order had been changed on 2/2/18 to: -Oxygen at 2 lpm continuous. -Continue [MEDICAL CONDITION] when sleeping. The new order was not changed on the TAR or care plan. -She agreed that should have been changed to reflect the resident's current oxygen orders. She had been unable to provide an order for [REDACTED]. -Unsure when or why that had been changed. She planned on calling the [MEDICAL CONDITION] physician for clarification of the following: -Oxygen liter flow for daytime and nighttime. -Oxygen usage for daytime and nighttime. -[MEDICAL CONDITION] usage with or without naps. Review of the provider's last revised 1/2/18 medication aide job description revealed they were to have: Asked questions, so he/she could understand and support decisions having been made. Kept direct supervisor informed on necessary information. Strived to master the skills needed to do the best for the people they cared for. Consulted with the staff nurse as needed. Passed routine and as needed medications under the direction of a nurse. Review of provider's revised (MONTH) (YEAR) Physician order [REDACTED]. To correctly and safely receive and transcribe physician's orders [REDACTED]. A notation needs to be made in the resident's medical record as to the reason for the new order and a brief summary of what it was. All transcription of orders should have been signed off by a nurse and double-checked by a second nurse to assure that all steps have been carried out to avoid errors. The second nurse will run the Administration Record Report for the MAR/Tar to view for accuracy of the transcription. Review of the provider's 2014 Medication Administration policy revealed medication should have been signed after it had been given. Review of provider's revised (MONTH) 2014 Physician Services policy revealed: Physician orders [REDACTED]. Review of provider's revised (MONTH) (YEAR) Care Planning policy revealed: The physician's orders [REDACTED]. The DON was responsible for updating the care plan. Surveyor: . Review of [NAME] [NAME] Potter et al., Fundamentals of Nursing, 9th Ed., Elsevier, St. Louis, Mo., (YEAR), page 311, revealed: The physician is responsible for directing medical treatment (311). Nurses follow care provider's orders unless they believe that the orders are in error, violate agency policy, or are harmful to the patient (resident) (311).	2020-09-01