Nursing Investigation Results -

Pennsylvania Department of Health
LAWSON NURSING HOME, INC.
Patient Care Inspection Results

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Minimal Citation - No Harm Minimal Harm Actual Harm Serious Harm
LAWSON NURSING HOME, INC.
Inspection Results For:

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LAWSON NURSING HOME, INC. - Inspection Results Scope of Citation
Number of Residents Affected
By Deficient Practice
Initial comments:
Based on a Medicare/Medicaid Recertification, State Licensure and Civil Rights Compliance Survey completed on March 4, 2019, it was determined that Lawson Nursing Home, Inc. 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:


483.25(n)(1)-(4) REQUIREMENT Bedrails: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(n) Bed Rails.
The facility must attempt to use appropriate alternatives prior to installing a side or bed rail. If a bed or side rail is used, the facility must ensure correct installation, use, and maintenance of bed rails, including but not limited to the following elements.

483.25(n)(1) Assess the resident for risk of entrapment from bed rails prior to installation.

483.25(n)(2) Review the risks and benefits of bed rails with the resident or resident representative and obtain informed consent prior to installation.

483.25(n)(3) Ensure that the bed's dimensions are appropriate for the resident's size and weight.

483.25(n)(4) Follow the manufacturers' recommendations and specifications for installing and maintaining bed rails.
Observations:

Based on review of clinical records, observations, and staff interview it was determined that the facility failed to assess seven of 12 residents for the use of a bed rails (Residents R12, R18, R22, R31, R33, R35, and R36).

Findings Include:

Review of the Minimum Data Set assessment (MDS-assessment of care needs) dated 10/17/18, indicated Resident R12 was admitted to the facility on 3/29/17, with current diagnoses that include alzheimer's disease, anemia, and heart failure.

Review of physician orders dated 2/1/19, indicated Resident R12 was to have two-1/2 bed rails to assist resident with turning and repositioning.

Review of Resident R12's clinical record did not include an assessment pertaining to the use of bed rails.

Review of the annual MDS assessment dated 4/24/18, indicated Resident R18 was admitted to the facility on 4/18/18, with current diagnoses that include thyroid disorder, heart failure, and stroke.

Review of physician orders dated 3/1/19, indicated Resident R18 was to have two-1/2 bed rails to assist with turning and repositioning.

Review of Resident R18's clinical record did not include an assessment pertaining to the use of bed rails.

Review of the significant change MDS assessment dated 11/1/18, indicated Resident R22 was admitted to the facilty on 8/4/16, with diagnoses that include pneumonia, peripheral vascular disease, and chest pain.

Review of physician orders dated 2/12/19, indicated Resident R22 is to have two-1/2 bed rails to assist with turning and repositioning.

Review of Resident R22's clinical record did not include an assessment pertaining to the use of bed rails.

Review of the admission MDS assessment dated 2/19/19, indicated Resident R31 was admitted to the facility on 2/12/19, with diagnoses that include enterocolitis, anxiety disorder, and heart failure.

Review of physician orders dated 2/12/19, indicated Resident R31 is to have two-1/2 bed rails to assist with turning and repositioning.

Review of Resident R31's clinical record did not include an assessment pertaining to the use of bed rails.

Review of the admission MDS assessment dated 10/14/18, indicated Resident R33 was admitted to the facility on 10/7/18, with current diagnoses that include depression, neurogenic bladder, and hypertension.

Review of physician orders dated 2/1/19, indicated Resident R33 is to have two-1/2 bed rails to assist with turning and repositioning.

Review of Resident R33's clinical record did not include an assessment pertaining to the use of bed rails.

Review of the significant change MDS assessment dated 2/21/19, indicated Resident R35 was admitted to the facility on 10/10/18, with current diagnoses that include diabetes, right femur fracture, and anxiety disorder.

Review of physician orders dated 2/1/19, indicated Resident R35 is to have two-1/2 bed rails to assist with turning and repositioning.

Review of Resident R35's, clinical record did not include an assessment pertaining to the use of bed rails.

Review of the admission MDS assessment dated 2/26/19, indicated Resident R36 was admitted to the facility on 2/19/19, with diagnoses that include sepsis, diabetes, and hypertension.

Review of physician orders indicated Resident R36 is to have two-1/2 bed rails up to assist resident in bed.

Review of Resident R36's clinical record did not include an assessment pertaining to the use of bed rails.

During a tour of the North Hall on 3/1/19, at 2:15 p.m. Residents R12, R18, R22, R31, R33, R35, and R36's beds were observed to have adjustable partial bed rails.

During an interview on 3/1/19, at 2:20 p.m. Registered Nurse Employee E2 stated he was not aware residents needed assessments for bed rails.

During an interview on 3/1/19, at 2:27 p.m. Physical Therapist Employee E3 stated that the bed rails orders are generated automatically upon admission.

During an interview on 3/1/19, at 3:05 p.m. the Director of Rehabilitation Employee E4 stated that the use for the use of bed rails is not on the assessments for any resident completed by the Occupational Therapist Employee E5.

During an interview on 3/4/19, at 11:39 a.m. the Occupational Therapist Employee E5 confirmed the facility failed to assess residents for the use of bed rails as required.


28 PA Code: 211.8 (a ) (b)(c)(d)(e)(f) Use of Restraints.



 Plan of Correction - To be completed: 04/18/2019

The standing order for (2) 1/2 rails will be removed from all orders.

All current resident will be assessed by Occupational Therapy for bed rails.

All new residents will be evaluated by Occupational Therapy for bed rails upon admission.

The IDT will evaluate all new residents and exisitng residents for alternatives to bed rails, as well as ways to reduce the use of bed rails on residents currently using.

If rails are indicated on any existing or new resident, resident/responsible party will be informed of all pro's and con's to bed rails. Consent for or against bed rails will be obtained from the resident or responsible party depend on resident's cognitive level.

An order for bed rails will be obtained from residents physician and placed into their medical record.

Care planing of bed rails will be initiated by the MDS coordinator.

Maintenance and Director of Nursing will monitor the bed rails montlhy to ensure proper, safe function and for possible alternatives.
Therapy will screen residents quarterly for the continued necessity of bed rails.

All staff will be inservices on the new bed rail policy and procedure. New staff will be inserviced upon hire. Yearly inservice's will be conducted regarding bed rails.

All results of resident evaluations, monitoring, etc will be reviewed by the QA committee at the next quarterly meeting.


483.10(i)(1)-(7) REQUIREMENT Safe/Clean/Comfortable/Homelike Environment:Least serious deficiency but affects more than a limited number of residents, staff, or occurrences. This deficiency has the potential for causing no more than a minor negative impact on the resident but is not found to be throughout this facility.
483.10(i) Safe Environment.
The resident has a right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.

The facility must provide-
483.10(i)(1) A safe, clean, comfortable, and homelike environment, allowing the resident to use his or her personal belongings to the extent possible.
(i) This includes ensuring that the resident can receive care and services safely and that the physical layout of the facility maximizes resident independence and does not pose a safety risk.
(ii) The facility shall exercise reasonable care for the protection of the resident's property from loss or theft.

483.10(i)(2) Housekeeping and maintenance services necessary to maintain a sanitary, orderly, and comfortable interior;

483.10(i)(3) Clean bed and bath linens that are in good condition;

483.10(i)(4) Private closet space in each resident room, as specified in 483.90 (e)(2)(iv);

483.10(i)(5) Adequate and comfortable lighting levels in all areas;

483.10(i)(6) Comfortable and safe temperature levels. Facilities initially certified after October 1, 1990 must maintain a temperature range of 71 to 81F; and

483.10(i)(7) For the maintenance of comfortable sound levels.
Observations:
Based on observation, and staff interview, it was determined that the facility failed to maintain a safe and homelike environment for the residents in three of four resident areas (South Unit, South Lounge and Dining Room).

Findings Include:

During an observation of the South Lounge on 2/28/19, at 9:45 a.m. one chair with a blue vinyl seat was wobbly and had a large tear in the seat with foam padding exposed.

During an interview on 2/28/19, at 9:50 a.m. Housekeeper Employee E10 confirmed the observation.

During an observation of the South hallway on 2/28/19, at 9:53 a.m. one wheelchair had both arm rests wrapped with duct tape and another wheelchair had one arm rest wrapped with duct tape and a quarter sized hole was in the other armrest.

During an interview on 2/28/19, at 9:55 a.m. Nurse Aide Employee E11 confirmed the observations.

During an observation of the Dining Room on 2/18/19, at 10:00 a.m. four chairs with blue vinyl seats had large tears in the seats with foam padding exposed.

During an interview on 2/28/19, at 10:05 a.m. the Rehabilitation Director confirmed the observation.

During an observation of the South Nurse's station on 2/28/19, at 1:10 p.m. one chair with blue vinyl seat had large tear in the seat with foam padding exposed and the wall across from nurse's station had multiple large areas of missing paint.

During an interview on 2/28/19, at 1:20 p.m. with Licensed Practical Nurse, Employee E9 confirmed the above and that the facility failed to maintain a safe and homelike environment.

28 Pa Code: 207.2(a) Administrator's responsibility.










 Plan of Correction - To be completed: 04/15/2019

This plan of correction is being submitted pursuant to the applicable Federal and State regulations. Nothing contained herein shall be construed as an admission that the facility violated any Federal or State regulations or failed to follow any applicable standard of care.

All blue vinyl chairs that were identified as damaged were removed from the building during state survey and placed into the dumpster for immediate disposal.

Facility chairs will be monitored once monthly by the maintenace director to ensure that they are free of any signs of damage. Maintennace Director will keep a log of all chair inspections conducted. If any furniture is identified as damaged it will be disposed of immediately.

The wall across from the south nurses station will be repainted by the maintenance director. Maintenance Director will monitor all painted areas monthly to ensure that there are no painted areas that are missing paint.

Staff will be inserviced by the maintenance director on how to notify maintenance when any items need repaired or removed. Maintenance repair sheets will then be placed at both nursing stations and the main office

Staff inservice and monitoring will be presented and reviewed at the next scheduled QA meeting.
201.19 LICENSURE Personnel policies and procedures.:State only Deficiency.
Personnel records shall be kept current and available for each employe and contain sufficient information to support placement in the position to which assigned.
Observations:
Based on policy review, review of facility newly hired employees records, and staff interview, it was determined that the facility failed to obtain criminal background checks for 4 of 5 newly hired employees (Employee E1, E6, E7 and E8).

Findings Include:

The facility policy "Criminal Background Check" dated 2/20/19, stated all facility applicants must submit with their employment application a criminal history report from the PA State Police. If a report is not available, the facility submits a request to the PA State Police for a criminal check. The employee is able to work for 30 days until receipt of results from the criminal check.

Review of personnel files revealed the following:

Maintenance Director Employee E1's hire date was 1/7/19.
Physical Therapy Assistant Employee E6's hire date was 1/4/19.
Licensed Practical Nurse Employee E7's hire date was 10/30/18.
Certified Nurse Aide, Employee E8's hire date was 11/8/18.

The PA State Police Criminal Background Checks were not obtained until 2/28/19, for Employee E1, E6, E7 and E8.

During an interview on 3/1/19, at 1:55 p.m. the Nursing Home Administrator confirmed that the facility failed to obtain criminal background checks within the 30 days of employment as required for Employee E1, E6, E7 and E8.



 Plan of Correction - To be completed: 04/15/2019

All employees identified during survey as not having their criminal background checks done, were completed during survey and are current at this time.

All new hires will have a criminal back ground completed on or before their start date. Administrator will monitor and sign off on all completed background checks to remain in compliance with this regulation.

An new hire with a pending background check can work for up to 30 days while the facility awaits the final results of the background check. Anyone that has any prohibitive offenses contained under Act 169 will then be terminated from their employment.

All background check monitoring will be reported to QA during the next regularly scheduled meeting.
209.8(b) LICENSURE Fire Drills.:State only Deficiency.
(b) A written report shall be maintained of each fire drill which includes date, time required for evacuation or relocation, number of residents evacuated or moved to another location and number of personnel participating in a fire drill.
Observations:
Based on review of facility fire drill records, and staff interview, it was determined that the facility failed to relocate and document the number for residents moved during fire drills for 12 of 12 fire drills (February 2018 to February 2019).

Findings Include:

Review of fire drill reports dated 2/19/18, to 2/13/19, were observed blank or had a "0" indicating that no residents were moved/relocated during fire drills.

During an interview on 2/28/19, at 2:31 p.m. the Director of Facility Services Employee E1 confirmed that the facility failed to relocate and document the number of residents moved during fire drills from February 2018, to February 2019, as required.






 Plan of Correction - To be completed: 04/15/2019

Maintenance Director will conduct fire drills monthly with varying shifts to be covered. There will be a clear indication on all fire drill sheets of how many residents were moved during each fire drill. Locations of the fire drill will vary throughout the year, avoiding being conducted in the same location.

Maintenace Director will keep accurate records of fire drills conducted with the above information. Administrator will monitor and sign off on monthly fire drills.

Administrator has inserviced Maintenance director on the proper procedure for conducting fire drills.

Maintenance Director will inservice all employees on the proper protocol of fire drills and evacuating residents during the drill.

All inservices and fire drills will be presented and reviewed at the QA at the next scheduled meeting.

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