Nursing Investigation Results -

Pennsylvania Department of Health
BRADFORD COUNTY MANOR
Patient Care Inspection Results

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BRADFORD COUNTY MANOR
Inspection Results For:

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BRADFORD COUNTY MANOR - Inspection Results Scope of Citation
Number of Residents Affected
By Deficient Practice
Initial comments:

Based on an Abbreviated Survey in response to a Complaint Investigation completed on February 6, 2019, it was determined that Bradford County Manor was not in compliance with the following requirements of 42 CFR Part 483, Subpart B, Requirements for Long Term Care and the 28 PA Code, Commonwealth of Pennsylvania Long Term Care Licensure Regulations.



 Plan of Correction:


483.24(a)(2) REQUIREMENT ADL Care Provided for Dependent Residents:This is a less serious (but not lowest level) deficiency and affects more than a limited number of residents, staff, or occurrences. This deficiency is one that results in minimal discomfort to the resident or has the potential (not yet realized) to negatively affect the resident's ability to achieve his/her highest functional status. This deficiency was not found to be throughout this facility.
483.24(a)(2) A resident who is unable to carry out activities of daily living receives the necessary services to maintain good nutrition, grooming, and personal and oral hygiene;
Observations:

Based on review of select facility policies and procedures, clinical record review, and staff and resident interview, it was determined that the facility failed to ensure dependent residents received necessary assistance with bathing for four of nine residents reviewed (Residents 124, 96, 100, and 116).

Findings include:

The facility policy entitled, "Bath or Shower," last reviewed without changes on April 30, 2018, revealed that all residents are to be offered a bath or shower (their preference) at least weekly.

The facility policy did not address how resident preferences are obtained and documented in the resident's clinical record and/or plan of care to ensure all staff are aware of resident preferences and needs.

Interview with Resident 124 on February 6, 2019, at 12:14 PM revealed that she is to receive two showers per week; however, she was "skipped" Sunday (February 3, 2019) because there was not enough staff help.

Review of Resident 124's plan of care for potential skin impairment confirmed that staff are to provide showers twice a week at Resident 124's request. The plan of care did not indicate what days of the week Resident 124 receives shower assistance.

Review of electronic documentation of bathing provided to Resident 124 revealed that staff provided bathing assistance twice weekly on a schedule that included Sundays and Wednesdays. The documentation confirmed that Resident 124 did not receive a shower on Sunday, February 3, 2019, as indicated in the interview with Resident 124.

Interview with Resident 96 on February 6, 2019, 12:27 PM revealed that she is to receive a bubble bath twice weekly; however, there are occasions when she only received one a week because of insufficient staffing.

Review of Resident 96's plan of care revealed no indication of the frequency, or what days of the week Resident 96 requires assistance with her bubble bath.

Review of electronic documentation of bathing provided to Resident 96 dated December 1, 2018, to February 6, 2019, appeared to indicate that staff provided bathing assistance on an intended schedule of Tuesday and Friday. The documentation indicated that staff provided bathing assistance on Tuesday, December 11, 2018; however, failed to provide bathing assistance again until Wednesday, December 19, 2018 (eight days later). Staff provided bathing assistance on Thursday, December 20, 2018; however, failed to provide bathing assistance again until Friday, December 28, 2018 (eight days later). Staff provided bathing assistance on Friday, January 4, 2019; however, failed to provide bathing assistance again until Wednesday, January 9, 2019 (five days later). Staff provided bathing assistance on Wednesday, January 9, 2019; however, failed to provide bathing assistance again until Tuesday, January 15, 2019 (six days later). Staff provided bathing assistance on Friday, February 1, 2019; however, failed to provide bathing assistance as per the routine schedule on Tuesday, February 5, 2019.

Interview with Resident 100 on February 6, 2019, at 11:28 AM revealed that she receives a shower on Thursdays only. Resident 100 stated that she did not know why she did not receive showers more frequently than once a week; however, was not opposed to doing so.

Review of Resident 100's plan of care developed by the facility to address her activities of daily living revealed that the facility initiated an intervention on November 14, 2016, that Resident 100 prefers two baths per week.

Review of electronic documentation of bathing provided to Resident 100 dated December 1, 2018, to February 6, 2019, confirmed Resident 100's interview that the facility provided only weekly bathing assistance (on Thursdays) from December 13, 2018, through February 6, 2019, despite her care planned preference for bathing assistance twice a week.

Interview with Resident 116 on February 6, 2019, at 11:36 AM revealed that she is supposed to receive shower assistance twice a week, Monday and Friday; however, is guaranteed only once a week because staff are not able to assist her timely in the morning (e.g. not until 11:00 AM) because staff is busy with other things.

Review of Resident 116's plan of care did not indicate bathing preferences or scheduled days when staff provide bathing assistance.

Review of electronic documentation of bathing assistance provided to Resident 116 dated December 1, 2018, to February 6, 2019, revealed that staff provided bathing assistance twice weekly (on Monday and Friday) from December 3, 2018, through January 18, 2019. Staff did not provide bathing assistance again until Monday, January 28, 2019 (10 days later). Staff did not provide bathing assistance again until Monday, February 4, 2019 (seven days later).

Interview with the Nursing Home Administrator and Director of Nursing on February 6, 2019, at 2:10 PM confirmed the above findings. The interview confirmed that staff are to document resident bathing preferences on the plan of care; however, did not consistently do so for the residents noted above.

28 Pa. Code 211.10(a)(c) Resident care policies
Previously cited 6/15/18

28 Pa. Code 211.11(d) Resident care plan
Previously cited 6/15/18

28 Pa. Code 211.12(d)(1)(5) Nursing services
Previously cited 6/15/18


 Plan of Correction - To be completed: 03/12/2019

F0677
1) Residents 96, 100, 116, and 124 are being bathed per their individual preferences and documented.
2) Current residents are surveyed for bathing preferences and are bathed accordingly.
3) A. The facility policy entitled "Bath or Shower" will be amended to address how preferences are obtained and documented in the resident's clinical record. B. Nursing staff will be re- inserviced on bathing policy and documentation by Staff Development Coordinator or designee.
4) Bathing tasks will be audited three times a week for three months and weekly thereafter by Director of Nursing or designee. The results of the audit will be presented to the Quality Assurance/ Performance Improvement Committee monthly for review and recommendation.

483.25(e)(1)-(3) REQUIREMENT Bowel/Bladder Incontinence, Catheter, UTI:This is a less serious (but not lowest level) deficiency and affects more than a limited number of residents, staff, or occurrences. This deficiency is one that results in minimal discomfort to the resident or has the potential (not yet realized) to negatively affect the resident's ability to achieve his/her highest functional status. This deficiency was not found to be throughout this facility.
483.25(e) Incontinence.
483.25(e)(1) The facility must ensure that resident who is continent of bladder and bowel on admission receives services and assistance to maintain continence unless his or her clinical condition is or becomes such that continence is not possible to maintain.

483.25(e)(2)For a resident with urinary incontinence, based on the resident's comprehensive assessment, the facility must ensure that-
(i) A resident who enters the facility without an indwelling catheter is not catheterized unless the resident's clinical condition demonstrates that catheterization was necessary;
(ii) A resident who enters the facility with an indwelling catheter or subsequently receives one is assessed for removal of the catheter as soon as possible unless the resident's clinical condition demonstrates that catheterization is necessary; and
(iii) A resident who is incontinent of bladder receives appropriate treatment and services to prevent urinary tract infections and to restore continence to the extent possible.

483.25(e)(3) For a resident with fecal incontinence, based on the resident's comprehensive assessment, the facility must ensure that a resident who is incontinent of bowel receives appropriate treatment and services to restore as much normal bowel function as possible.
Observations:

Based on clinical record review and staff and resident interview, it was determined that the facility failed to provide toileting assistance for incontinent residents for four of nine residents reviewed (Residents 124, 127, 96, and 106).

Findings include:

Interview with Resident 124 on February 6, 2019, at 12:14 PM revealed that she requires total assistance via lift equipment for staff to transfer her from her wheelchair to her bed for toileting. Resident 124 stated that to receive care, she alerts staff when she believes that she requires incontinence care; however, she may wait for approximately one hour before staff assist her.

Clinical record review for Resident 124 revealed a quarterly MDS assessment (Minimum Data Set, an assessment tool completed at specific intervals to determine resident care needs) dated January 11, 2019, that assessed her as frequently incontinent of both bowel and bladder.

Review of electronic task documentation for Resident 124 regarding toilet use revealed that Resident 124's plan of care includes a program for staff to check and change Resident 124 every two hours and as needed every shift. The documentation revealed 19 shifts in December 2018 when staff failed to complete the check and change program for Resident 124. The documentation revealed 33 shifts in January 2019 when staff failed to complete the check and change program for Resident 124. The documentation revealed 5 of the 16 completed shifts in February 2019 when staff failed to complete the check and change program for Resident 124.

Clinical record review for Resident 127 revealed an admission MDS dated November 12, 2018, indicating that he was frequently incontinent of bladder.

Review of electronic task documentation for Resident 127 dated December 1, 2018, through February 6, 2019, revealed his plan of care included a bladder program to toilet/offer bedpan four times during the night shift (between the hours of 12:00 AM and 7:00 AM), two times during the day shift (between the hours of 7:00 AM and 3:30 PM), and three times during the evening shift (between the hours of 3:00 PM and 11:30 PM). The electronic documentation dated December 2018 revealed 12 shifts when staff failed to implement Resident 127's bladder program. The electronic documentation dated January 2019 revealed six shifts when staff failed to implement Resident 127's bladder program. The electronic documentation dated February 2019 revealed staff failed to implement Resident 127's bladder program on three of 16 completed shifts.

Interview with Resident 96 on February 6, 2019, at 12:27 PM revealed that she requires staff assistance to transfer from her wheelchair for toileting needs. Resident 96 stated that there was an occasion when she waited for an hour for toileting assistance.

Clinical record review for Resident 96 revealed an annual MDS dated December 13, 2018, that assessed her as frequently incontinent of bladder and occasionally incontinent of bowel.

Review of electronic task documentation for Resident 96 dated December 1, 2018, through February 5, 2019, revealed her plan of care included a toileting program for staff to check and change her every two hours and as needed on each shift. The documentation revealed 10 shifts in December 2018 when staff failed to complete the check and change program for Resident 96. The documentation revealed six shifts in January 2019 when staff failed to complete the check and change program for Resident 96. The documentation revealed staff failed to implement the check and change program on two of the 15 completed shifts in February 2019.

Clinical record review for Resident 106 revealed the facility readmitted her from the hospital on December 28, 2018. A quarterly MDS assessment dated January 4, 2019, assessed her as frequently incontinent of both bowel and bladder.

Review of electronic task documentation for Resident 106 dated January and February 2019 revealed that the facility implemented a bladder program on January 7, 2019, to toilet/offer the bedpan to Resident 106 three times during night shift, two times during day shift, and three times during evening shift. The electronic documentation dated January 2019 revealed that staff failed to implement the program on six shifts from January 7 through 31, 2019. The electronic documentation dated February 2019 revealed that staff failed to implement the program on two of the 16 completed shifts.

Interview with the Nursing Home Administrator and Director of Nursing on February 6, 2019, at 2:10 PM, confirmed the above findings.

28 Pa. Code 211.12(d)(1)(5) Nursing services
Previously cited 6/15/18


 Plan of Correction - To be completed: 03/12/2019

F0690
1) Residents 96, 106, 124, and 127 toileting programs are followed and documented.
2) Current residents' toileting programs are followed.
3) A. Current residents' toileting programs will be reviewed to assure accuracy in care planning and documentation by Director of Nursing or designee. B. Nursing staff will be re-inserviced on toileting programming and documentation by Staff Development Coordinator or designee.
4) Toileting task documentation will be audited three times a week for three months and weekly thereafter by Director of Nursing or designee. The results of the audit will be presented to the Quality Assurance/ Performance Improvement Committee monthly for review and recommendation.


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