cms_SD: 92

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
92	ROLLING HILLS HEALTHCARE	435035	2200 13TH AVE	BELLE FOURCHE	SD	57717	2018-03-01	688	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 a functional restorative therapy program was in place for one of three sampled residents (61) residents who had contractures. Findings include: 1. Observation and interview on 2/27/18 at 8:05 a.m. with resident 61 revealed: Both hands had observable contractures. -Her left hand side fingers were touching the palms of her hand, and her wrist had contracted toward her forearm. -Her right hand and wrist were slightly less contracted than her left side. The left arm had been tight against her chest. -A contracture in her left elbow made it impossible for her arm to be straightened. Her head angled toward the right due to contracture. -She could stretch it toward the left with much effort. Both legs were unable to lay completely straight due to contracture. She stated she was unhappy with therapy services. -She would like to walk again but understood she was a long way from that. -She stated her contractures were getting worse. --Her hands, neck, and legs felt tight. --Stretching made it feel better. She stated she would enjoy more restorative therapy if it were offered. Review of the 3/1/18 physician's orders [REDACTED].>[DIAGNOSES REDACTED]. Pain medications included: a [MEDICATION NAME] every seventy-two hours, and as needed [MEDICATION NAME] suppository, [MEDICATION NAME] tablet, and [MEDICATION NAME]-[MEDICATION NAME] tablets. Review of her 2/13/18 care plan revealed: A focus area of: I am at risk for contractures. A goal of: I will participate with Restorative Therapy through next review to maintain ROM (range of motion) to UE's (upper extremities), LE's (lower extremities), and neck 2-3x/wk (times per week). 5-10 reps. (repetitions) to prevent further contractures for ADL (activities of daily living) functioning. Interventions of: Passive ROM to both UE's and LE's 5-10 reps. while in supine or w/c (wheelchair). Passive stretch to neck right side bending, 1-5 mins. 2-3x/wk. A second focus area of: I am at risk for a decline in function. The goals were: I will participate in my restorative program for PROM (passive range of motion) stretching 10-15 minutes 2-3 x a week. The interventions were: Nursing Rehab: PROM to both upper and lower extremities, passive neck stretch to right neutral 10-15 minutes 2-3 x a week. Review of 1/30/18 through 2/27/18 task documentation titled nursing rehab revealed: Instructions had been to perform passive range of motion to both upper and lower extremities, passive neck stretch to right neutral with five to ten repetitions; two to three times a week revealed: -Resident had completed care/training as directed. Review of the (YEAR) quarterly physical therapy (PT) screen forms revealed: A 2/13/17 order for PT to improve head position during meals. A 6/26/17 screen stated no change, and that PT evaluation had not been indicated. A 9/13/17 screen stated no new complaints of positioning. An 11/7/17 PT evaluation stated to re-establish the restorative program after return to long term care from hospital. Review of the 11/7/17 occupational therapy (OT) evaluation revealed a recommendation of placing a washcloth roll in her left hand. And to resume the range of motion program for the restorative nursing program. Interview on 2/28/18 at 9:41 a.m. with the director of nursing (DON) revealed: The current process for placing a resident on a restorative nursing program consisted of the OT and the PT completing an initial evaluation. Each therapist would then create recommendations for a restorative nursing program. Those recommendations would be discussed with the restorative supervisor who was a certified nursing assistant (CNA). The restorative supervisor would discuss the recommendations with the DON to determine a realistic individualized restorative nursing program. She would review the restorative supervisor's monthly program review for each resident and decide if the resident's restorative program should be changed or stay the same. -Review of resident 61's program revealed no changes had been made. She had not been told that resident felt her contractures had gotten worse. -She felt the resident's contractures had remained the same and had not worsened. There was only one restorative aide, so they had to consider that when creating each restorative program. She did not feel CNA's could provide passive range of motion stretches due to time constraints. Interview on 2/28/18 at 2:10 p.m. with resident 61 revealed: She had been lying down in bed with a rolled washcloth partially in her hand. According to her: -That was to prevent her fingernails from pushing into the palm of her hand. -It was also to prevent her contracture from getting worse. She said she used to wear a brace. She stated she did not always get therapy two to three times a week. -It was usually in the mornings. -If there were not enough staff she might not get therapy. She sometimes tried to do her own stretches. - Using her right hand she demonstrated by pushing her left hand and arm to stretch it herself. --Her ability to do that had been very limited. Interview on 2/28/18 at 2:15 p.m. with restorative supervisor/CNA O revealed: She did passive range of motion exercises with resident 61 three to four times per week. Her day started at 4:00 a.m. to get everyone done per their preferences. Resident 61 had not complained to her about pain or contractures worsening. -If she had known that she would have reported it to her supervisor for an evaluation. She was the only restorative aide. -Her schedule was four days per week. -There were forty residents on her caseload. She did not feel resident 61's contractures had worsened. -Her supervisor, the DON, had completed monthly reviews of all residents on her caseload for apprporiateness on the restorative therapy program. If a resident needed more days of restorative therapy she would have needed to work longer days to get everything done. Interview on 2/28/18 at 2:20 p.m. with PT revealed: He completed a screen with each quarterly MDS. He would get information from residents when possible and from staff. If a resident was worsening or had a change of condition they could screen any time, they did not need to wait until the quarterly screen. -He would then decide if he could work with her on the physical therapy program, or if he would recommend her for the restorative therapy program. He worked closely with the restorative aide and nursing to set recommendations. He agreed that current restorative aide had a large caseload. He had not heard that resident 61 had a concern. -He would talk to her. He had seen her twice during the past year. -He had completed an evaluation after her last hospitalization that had been from 10/20/17 to 11/6/17. Interview on 3/01/18 at 3:21 p.m. with the DON and the medical consultant revealed: They had been unaware of resident 61's wish to receive more restorative therapy. They were unaware that she had any concerns regarding her restorative therapy program or her contractures. The DON completed monthly reviews of all residents on the restoative therapy program caseload for apprporiateness. Both acknowledged that if the resident were to request more services they would need to review her current services for appropriateness. Review of (MONTH) (YEAR) Restorative Nursing Program policy revealed: The concept actively focuses on achieving and maintaining optimal physical, mental, and psychosocial functioning.	2020-09-01