Nursing Investigation Results -

Pennsylvania Department of Health
NORTHAMPTON COUNTY HOME- GRACEDALE
Patient Care Inspection Results

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NORTHAMPTON COUNTY HOME- GRACEDALE
Inspection Results For:

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NORTHAMPTON COUNTY HOME- GRACEDALE - Inspection Results Scope of Citation
Number of Residents Affected
By Deficient Practice
Initial comments:
Based on an Abbreviated Survey in response to a complaint completed on April 25, 2019, it was determined that Gracedale-Northampton County was not in compliance with the following Requirements of 42 CFR Part 483, Subpart B, Requirements for Long Term Care Facilities and the 28 PA Code, Commonwealth of Pennsylvania Long Term Care Licensure Regulations.









 Plan of Correction:


483.21(b)(1) REQUIREMENT Develop/Implement Comprehensive Care Plan:This is a less serious (but not lowest level) deficiency and is isolated to the fewest 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.
483.21(b) Comprehensive Care Plans
483.21(b)(1) The facility must develop and implement a comprehensive person-centered care plan for each resident, consistent with the resident rights set forth at 483.10(c)(2) and 483.10(c)(3), that includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment. The comprehensive care plan must describe the following -
(i) The services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being as required under 483.24, 483.25 or 483.40; and
(ii) Any services that would otherwise be required under 483.24, 483.25 or 483.40 but are not provided due to the resident's exercise of rights under 483.10, including the right to refuse treatment under 483.10(c)(6).
(iii) Any specialized services or specialized rehabilitative services the nursing facility will provide as a result of PASARR recommendations. If a facility disagrees with the findings of the PASARR, it must indicate its rationale in the resident's medical record.
(iv)In consultation with the resident and the resident's representative(s)-
(A) The resident's goals for admission and desired outcomes.
(B) The resident's preference and potential for future discharge. Facilities must document whether the resident's desire to return to the community was assessed and any referrals to local contact agencies and/or other appropriate entities, for this purpose.
(C) Discharge plans in the comprehensive care plan, as appropriate, in accordance with the requirements set forth in paragraph (c) of this section.
Observations:

Based on clinical record review, and observation, it was determined that the facility failed to implement care planned interventions for one of five sampled residents. (Resident R1)

Findings include:

Clinical record review revealed that Resident R1 had diagnoses that included dementia, pulmonary embolism (obstruction of blood clot) and repeated falls. The Minimum Data Set assessment dated April 3, 2019, indicated that the resident had memory impairment and required extensive assistance from staff for most activities of daily living including dressing, transfers and bed mobility. Review of a physician's order since December 9, 2016, revealed that the staff were to apply compression stockings (TEDS) in the morning and remove at night. Review of the current care plan revealed that the resident was at risk for complications related to a diagnosis of bilateral pulmonary embolism and an intervention was for staff to apply the TEDS in the morning and remove at night. Observation on April 25, 2019, at 11:30 a.m., and 12:30 p.m., revealed that the resident was dressed but did not have the TEDS stockings in place. In addition, the resident had a physician's order since December 2016 to have a high/low bed with bilateral fall mats. Review of the current care plan revealed that the resident was at risk for falls due to a history of falls and an intervention was for staff to place bilateral floor mats on the floor when the resident was in bed. Observation on April 25, 2019, at 11:30 a.m., revealed that the resident was in bed without the bilateral floor mats in place.

28 Pa. Code 211.11(d) Resident care plan

28 Pa. Code 211.12(d)(5) Nursing services.




 Plan of Correction - To be completed: 06/23/2019

Regarding Resident R1, TED hose were immediately applied and floor mats put in place.
Unit Staff for Resident R1 was immediately re-educated by nursing supervisor and ADON regarding following care cards.
Re-training will be provided as stated below.
Results will be discussed at the QAPI meeting to ensure compliance and further audits will be added if necessary.
483.24(a)(2) REQUIREMENT ADL Care Provided for Dependent Residents:This is a less serious (but not lowest level) deficiency and is isolated to the fewest 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.
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 clinical record review and observation, it was determined that the facility failed to ensure that personal hygiene was provided to one of five sampled residents. (Resident R3)

Findings include:

Clinical record review revealed that Resident R3 had diagnoses that included Parkinson's disease and arthritis. The Minimum Data Set assessment dated March 6, 2019, indicated that the resident had some memory impairment and required extensive assistance from staff for dressing and personal hygiene. Review of the current care plan revealed a restorative nursing problem related to upper and lower body bathing with an intervention for the resident to participate in upper body bathing with set-up and supervision. Observation on April 25, 2019, at 12:45 p.m., revealed that the resident was dressed and seated in his wheelchair in the dining room area. The resident stated " I like to be shaved but I don't have a razor". The resident had facial hair and his fingernails were dirty.

28 Pa. Code 211.12(d)(5) Nursing services.



 Plan of Correction - To be completed: 06/23/2019

Resident R3 was shaved and nails were cleaned/cut immediately.
All nursing assistants will be required to successfully perform a skills lab scenario. This lab will include reviewing care card, making sure environment is safe, performing ADL's, i.e. nail care, applying TED hose, shaving etc.
Staff will prove competent by performing a return-demonstration.
Audits: Upon completion of skills lab, supervisors will conduct 10 random audits per month, per shift. Audits will begin on June 23 and be done for a 6 month period.
Results will be discussed at the QAPI meeting to ensure compliance and further audits will be added if necessary.

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