cms_SD: 91

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

This data as json, copyable

rowid	facility_name	facility_id	address	city	state	zip	inspection_date	deficiency_tag	scope_severity	complaint	standard	eventid	inspection_text	filedate
91	ROLLING HILLS HEALTHCARE	435035	2200 13TH AVE	BELLE FOURCHE	SD	57717	2018-03-01	686	D	0	1	2S8V11	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 two sampled residents (320) who had a diabetic/pressure ulcer received appropriate dietary interventions and services per the physician's orders [REDACTED]. 1. Interview on 2/27/18 at 8:10 a.m. with licensed practical nurse (LPN) C regarding resident 320 revealed: He: -Had been admitted on [DATE] from an acute care setting. -Was diabetic and had been admitted with two wounds. She stated He has a black wound to the tip of his right second toe and a small scrape behind his left ankle. -He had a daily dressing change for the wound to his right second toe. -The dressing on his left ankle was changed every three days. She was unsure how he had gotten the wounds. Observation and interview on 2/27/18 at 8:40 a.m. of resident 320 revealed: He had: -Been in his room sitting on the edge of the bed. -Been wearing a nasal canula that was hooked up to an oxygen concentrator and running at 2 liters per minutes (LPM). -Gripper socks on his feet. He stated: -I was in really poor condition when I went to the hospital. -I'm a diabetic and my sugars were very high. -My goal is to go home here really soon. He had a wound on the tip of his right toe and left ankle. He stated: -I've been told my toe is a diabetic ulcer. -I fell at the hospital and scraped my left ankle. Observation on 2/27/18 at 12:46 p.m. with LPN C during a dressing change with resident 320 revealed: She had: -Prepared to change the dressing on his right second toe. -Removed the old dressing and exposed the wound on his toe. The tip of the resident's toe had been: -Contracted at the first joint, so the tip was in the downward position. -Covered with a brown colored scab. --That scab measured approximately 0.5 centimeters (cm) by 0.5 cm in diameter. She assessed, cleaned, and applied a new dressing to that wound. The resident stated: I think it came from a shoe, but I'm not sure. Review of resident 320's medical record with the Minimum Data Set (MDS) assessment coordinator revealed: On 2/21/18: -He had been readmitted to the facility from an acute care setting. -The staff had completed an admission physical assessment of his skin and documented Small black scab to tip R (right) foot 2nd toes, black ulcer intact and dry, observing for any changes. [DIAGNOSES REDACTED]. He was: -Alert, oriented, and had good memory recall. -Working with the therapy department to improve his strength, safety, and independence with the goal to return home. On 2/22/18 the physician had: -Been in the facility to assess the resident and review his orders from the hospital. -Written orders for [MEDICATION NAME] to be applied to his toe daily. -Referred the resident to the dietary department for education and nutritional support. -Not provided a [DIAGNOSES REDACTED]. No documentation to support the dietary department had been notified of the wound to his right toe per physician's orders [REDACTED]. Review of resident 320's 2/21/18 through 2/28/18 daily skilled progress notes with the MDS assessment coordinator revealed: There was no consistent charting to identity the type of wound the resident had on his right second toe. The nursing staff had randomly charted the wound as a: -Small, shallow, black scab. -Black ulcer. -Pressure ulcer. -Dark/black area/pressure sore on second toe right foot. -Diabetic sore 2nd toe on the right. No documentation: -To support the dietary department had been notified of his wound. -By the dietary manager or the dietician to support nutritional involvement or knowledge of that wound. Review of resident 320's 2/28/18 skilled status assessment with the MDS assessment coordinator revealed the wound to his right second toe was assessed and documented as a diabetic ulcer by the director of nursing (DON). Review of resident 320's 2/23/18 admission care plan with the MDS assessment coordinator revealed: A focus area: I am at nutritional risk. -Goal was: --I wish to have my nutritional and hydration needs met so that I do not suffer from dehydration, significant weight changes, and/or skin breakdown. --No goal identifying a wound or ulcer to his right second toe. There had been no nutritional interventions in place to support and promote healing of an ulcer or wound to his right toe. Interview on 2/28/18 at 4:01 p.m. with the dietician and MDS assessment coordinator revealed: He had not been aware the resident had an ulcer to his right toe until 2/27/18. -The director of nursing (DON) had emailed him their weekly wound report. --That report supported a diabetic ulcer on the resident's toe. -He would not have expected to be notified of a diabetic ulcer. -He stated: --There is really nothing I can do for a vascular wound, but a stage two or greater pressure ulcer absolutely. --I talked to the resident and looked at his toe, it is deformed, and the resident said it is a diabetic ulcer. He would have expected the staff to notify him of a pressure ulcer. He was available to the staff and dietary manager via email or phone on the days he was not in the facility. Interview on 2/28/18 from 3:37 p.m. through 4:13 p.m. with the MDS assessment coordinator after review of resident 320's medical record revealed she: Agreed the nursing staff: -Could not [DIAGNOSES REDACTED]. -Had the capability to assess, document, and stage a pressure ulcer. -Should have clarified with the physician what type of ulcer the resident had on his right toe on 2/22/18. Agreed the physician should have documented what type of ulcer the resident had on his toe. She confirmed there was no documentation to support the dietary department had been aware of an ulcer to his right toe. She confirmed: -There was no physician progress notes [REDACTED]. -She stated: --The doctor does not have progress notes in any of the resident's charts. --There are some notes hand written on the physician's orders [REDACTED]. --The progress notes are dictated, but we have printing issues and we can't print them. --I believe we don't have access to their new system at the clinic. Interview on 3/1/18 at 11:15 a.m. with the dietary manager regarding resident 320 revealed: She had not been aware he had an ulcer to his right toe. The department managers had stand-up meetings every week day morning. -Wounds would have been discussed at that meeting. She: -Would have handwritten any pertinent notes for the dietary department during those meetings. -Had no documentation on any of her handwritten notes from the past week to support knowledge of a wound to the resident's right toe. -Confirmed the dietician was available via email or phone when he was not in the facility to address any nutritional concerns. -Would not confirm whether the dietary department should have been notified of all types of wounds and ulcers to ensure adequate nutritional support. Interview on 3/1/18 at 1:20 p.m. with the DON and physician regarding resident 320 revealed: The physician confirmed her visit and assessment with the resident on 2/22/18. She had been aware of the wound to his right second toe. She agreed: -Her assessment and documentation on the physician's orders [REDACTED]. -The nursing staff could not [DIAGNOSES REDACTED]. She stated: -But I don't care what type of ulcer it is the dietary department should be involved with any and all types of ulcers. -His toe is both a diabetic and pressure ulcer due to the deformity of it, his [MEDICAL CONDITION] problems, and possible pressure from his shoes. -He specifically requested dietary education and support, because he is diabetic, has [MEDICAL CONDITION], and will be going home soon. -Its crucial to have that nutritional support and involvement because of his [MEDICAL CONDITION] and the potential of that wound to worsen when he goes home. -I expected the dietary department to have been notified per my orders. She confirmed: -She wrote a brief and shorthand note on all the resident's physician's orders [REDACTED]. -She had dictated her progress notes, and they could not be found in the residents' charts. She stated: -In (MONTH) we went to a different system and the nursing home cannot access them and print them now. -The clinic can print them, we will have to start printing them, and getting them to the facility. The DON: -Confirmed: --The department heads had a daily stand-up meeting on the weekdays, and wounds were discussed at that time. --The dietary manager would have attended all of those meetings. -She stated: -We reviewed that resident in stand-up after he was admitted , and the dietary manager was there. -I personally myself told the dietician about it. -Had a form dated 2/23/18 from that morning stand-up meeting. --The resident's name had been written down on that form to review for skin concerns that day. -Confirmed the dietician had been emailed the weekly wound form on 2/27/18. -Was unable to locate any documentation to support her conversation with the dietician regarding the resident's ulcer prior to 2/27/18. Review of resident 320's 2/22/18 physician's visit progress note revealed: He had: -Type 2 diabetes with multiple complications including [MEDICAL CONDITION]. -A right second toe shallow diabetic ulcer. -Been referred to dietary for nutritional education and support. It was not available for review by the staff, and a part of his medical record until 3/1/18 after the surveyor requested to review it. Review of the provider's (MONTH) (YEAR) Skin Program policy revealed: Policy: To provide care and services to promote the healing of pressure ulcers/wounds that are present. Procedure: -Nursing personnel will utilize the results of the physical exam and the Pressure Ulcer Assessment tools to determine an individualized pressure ulcer prevention program for each at-risk resident. -This will include interventions to encourage optimal nutrition and fluid intake. When a skin ulcer is identified. This assessment will include: Type of skin ulcer (MD (medical doctor) is asked to identify type of ulcer, e.g., pressure, stasis (venous, ischemic (arterial), or neuropathic, and provide skin treatment orders. Nursing personnel will develop a P[NAME] (plan of care) with interventions consistent with resident and family preferences, goals, and abilities. -P[NAME] to include nutritional status and interventions.	2020-09-01