cms_SD: 99

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
99	ROLLING HILLS HEALTHCARE	435035	2200 13TH AVE	BELLE FOURCHE	SD	57717	2019-05-23	550	G	0	1	LF7K11	NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review, the provider failed to ensure three of six residents (52, 73, and 125) who required a full body sling with lift transfers were given an option to use a commode or toilet. Findings include: 1. Review of resident 52's medical record revealed:An admission date of [DATE].She had a Brief Interview for Mental Status (BIMS) score of two indicating she was severely cognitively impaired.Her 4/16/19 quarterly Minimum Data Set assessment (MDS) revealed:-She was an extensive assist with a two plus person physical assist for:--Bed mobility.--Transfers.--Dressing.--Toilet use.--Personal hygiene.--Bathing.Interview on 5/21/19 at 8:06 a.m. after resident 52's brief change with certified nurse aides (CNAs) O and P revealed:She was a Hoyer lift resident.Residents that are a Hoyer lift and wear a brief are not brought into the bathroom.-It is to hard to get the Hoyer sling off of the resident so they could use the toilet or commode.They stated residents urinate and have bowel movements (BM) in their brief.-Residents are then changed.Residents can have a bedpan if they choose.They are not given the choice to use the toilet.Interview on 5/22/19 at 1:18 p.m. with CNA M concerning resident 52 revealed:If a resident is a Hoyer lift, their choice is to use a bedpan or urinate or have a BM in their brief.We check her brief when we lay her down.She won't use a bedpan.She uses a Hoyer lift.We do not toilet her.I don't know what else we're suppose to do if she will not use a bedpan. She is a Hoyer lift. Interview on 5/22/19 at 1:34 p.m. during resident 52's brief change with CNAs H and N revealed:They both state they check on her every two hours.She urinates and has BM's in her brief.She is a Hoyer lift.There is no way to toilet her or put her on the commode.-They do not have the correct Hoyer sling to do that. 2. Review of resident 73's 3/29/19 MDS assessment revealed: She had been admitted on [DATE]. Her BIMS score had been thirteen indicating her cognition was intact. She required the extensive assistance of one staff member for personal hygiene. She was totally dependent on two or more staff members for: -Dressing. -Transfers. -Toilet use. -Bed mobility. She had an indwelling catheter and had been frequently incontinent of bowel. Interview on 5/21/19 at 7:40 a.m. with resident 73 revealed: She could not walk or stand and required a total lift for transfer. She could not use the toilet for bowel elimination due to needing the total body lift. She stated it would be too hard for the staff to get her into the bathroom and onto a toilet. She did not know what a commode was and had never been offered one for bowel elimination. Interview on 5/21/19 at 8:00 a.m. with CNA Q revealed, residents who use a total body lift must use the bed pan. Interview on 5/21/19 at 9:23 a.m. with CNA A revealed, residents using a total lift had to use the bed pan due to not being able to access the toilet with the lifts. Interview on 5/21/19 at 9:26 a.m. with physical therapy assistant (PTA) B revealed: He did the nursing assistant training for lift use. Residents cannot be toileted with a total lift due the full body slings. Interview on 5/22/19 at 11:01 a.m. with unlicensed assistive personnel (UAP) C revealed, residents who required a total lift had to use the bed pan. Interview on 5/22/19 at 11:02 a.m. with UAP D revealed: The provider did have mesh slings that would allow for toileting with a total lift. She was not aware of this until a few days prior. -She was informed of these slings due to another resident who currently used the toilet being evaluated for a total lift. There were no bathrooms big enough to get into with a resident in a total lift. Interview on 5/22/19 at 11:04 a.m. with CNA [NAME] revealed, she did not believe residents who required a total lift could use a toilet or commode. Interview of 5/22/19 at 2:10 p.m. with resident 73 revealed: She was unable to get onto a bed pan and had to eliminate her bowels in her incontinent products. When asked if she felt embarrassed about having to use her incontinent product for bowel elimination she stated, I have to go in my diaper and that is it. She then changed the topic to her upcoming birthday party and the weather. 3. Review of resident 125's medical record revealed: An admission date of [DATE]. A BIMs of thirteen that indicated she had been cognitively intact. Her admission MDS assessment revealed: -She required extensive assistance with two person physical assistance for: --Bed mobility. --Transfers. --Dressing. --Personal hygiene. --Bathing. -She had an indwelling urinary catheter. -She had been frequently incontinent of bowel. Interview on 5/22/19 at 11:02 a.m. with resident 125 revealed she: Had to use the bedpan for bowel elimination. Stated she: -Did not like using the bedpan. -It had been embarrassing for her to ask to use the bedpan. -Had been told by staff she had to use the bedpan for bowel elimination. Interview on 5/22/19 at 8:30 a.m. with CNA U revealed she stated: Resident 125 used the bedpan for bowel movements. That was how she had been told to assist her by the nurses and therapy. She thought the resident could probably use a commode but could not do that unless therapy told them they could. Observation on 5/22/19 at 2:00 p.m. of resident 125 while she had been in the therapy room revealed: She was sitting in a chair with her right leg extended and elevated on a therapy ball. The certified occupation therapy assistant W and CNA U were looking for a commode. -It took fifteen minutes to find a commode. That commode was to have been used to do a dry run transfer for the resident to use a commode for bowel elimination. Observation on 5/22/19 at 2:35 p.m. of resident 125 in her room revealed a stand aid transfer done by CNA U and PTA B. They assisted the resident onto the commode. The resident had a continent bowel movement. Interview on 5/23/19 at 9:45 a.m. with resident 125 in the therapy room revealed she stated It is a good thing I don't have to use that bedpan anymore. I could do it but really did not like it. It is much better now when I can use a commode. Easier too. Interview 5/23/19 at 10:45 a.m. with the DON confirmed resident 125 should not have had to use the bedpan for bowel elimination. She stated There are alternate ways. Review of providers Qtr 3, (YEAR) Quality of Life-Dignity policy revealed: Each resident shall be cared for in a manner that promotes and enhances quality of life, dignity, respect and individuality. Treated with dignity meant the residents will be assisted in maintaining and enhancing his or her self-esteem and and self-worth. *Demeaning practices and standards of care that compromise dignity are prohibited. Staff shall promote dignity and assist residents as needed by: promptly responding to resident's request for toileting.	2020-09-01