§483.10(c)(6) The right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.
§483.10(c)(8) Nothing in this paragraph should be construed as the right of the resident to receive the provision of medical treatment or medical services deemed medically unnecessary or inappropriate.
§483.10(g)(12) The facility must comply with the requirements specified in 42 CFR part 489, subpart I (Advance Directives).
(i) These requirements include provisions to inform and provide written information to all adult residents concerning the right to accept or refuse medical or surgical treatment and, at the resident's option, formulate an advance directive.
(ii) This includes a written description of the facility's policies to implement advance directives and applicable State law.
(iii) Facilities are permitted to contract with other entities to furnish this information but are still legally responsible for ensuring that the requirements of this section are met.
(iv) If an adult individual is incapacitated at the time of admission and is unable to receive information or articulate whether or not he or she has executed an advance directive, the facility may give advance directive information to the individual's resident representative in accordance with State law.
(v) The facility is not relieved of its obligation to provide this information to the individual once he or she is able to receive such information. Follow-up procedures must be in place to provide the information to the individual directly at the appropriate time.
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Observations:
Based on review of the facility policy, clinical records, and staff interviews it was determined that the facility failed to provide the opportunity to formulate an advance directive (written instructions such as a living will or durable power of attorney for health care for when the individual is incapacitated) for eighteen of twenty residents reviewed (Resident R1, R10, R38, R39, R57, R68, R70, R76, R77, R78, R79, R87, R94, R95, R96, R206, R207, R208).
Findings include:
A review of the facility policy "Advanced Directives" reviewed 1/13/23 and 1/2/2024, indicated the facility will comply with the requirements related to maintaining written policies and procedures regarding advance directives, including provisions to inform and provide written information to all adult residents concerning the right to accept or refuse medical or surgical treatment and formulate an advance directive.
A review of the medical record indicated Resident R1 was admitted to the facility on 6/23/2020, with diagnoses that included cerebral palsy (group of disorders that affect movement, muscle tone, balance, and posture), dysphagia (difficulty swallowing) and tracheostomy (a hole made in throat to place a tube into the person ' s trachea or windpipe).
A review of the clinical record failed to reveal an advance directive or documentation that Resident R1 was given the opportunity to formulate an Advanced Directive.
A review of the clinical record indicated Resident R10 was re-admitted to the facility on 10/29/2023, with diagnoses that include diabetes, high blood pressure, and chronic obstructive pulmonary disease (COPD - constriction of the airways making it difficult to breath).
A review of the clinical record failed to reveal an advance directive or documentation that Resident R10 was given the opportunity to formulate an Advanced Directive.
A review of the clinical record indicated Resident R38 was re-admitted to the facility on 7/27/2022, with diagnoses that include paralysis (no movement of lower body or legs), dysphagia, respiratory failure (disease or injury that causes interference with the lungs to deliver oxygen), and tracheostomy.
Review of the clinical record failed to reveal an advance directive or documentation that Resident R38 was given the opportunity to formulate an Advanced Directive.
A review of the clinical record indicated Resident R39 was admitted to the facility on 5/21/2021, with diagnoses that include tracheostomy, muscular dystrophy (genetic condition that causes progressive weakness and loss of muscle mass), diabetes and high blood pressure.
A review of the clinical record failed to reveal an advance directive or documentation that Resident R39 was given the opportunity to formulate an Advanced Directive.
A review of the clinical record indicated Resident R57 was admitted to the facility on 2/8/2024, with diagnoses that include high blood pressure, chronic pain, and depression.
A review of the clinical record failed to reveal an advance directive or documentation that Resident R57 was given the opportunity to formulate an Advanced Directive.
A review of the clinical record indicated Resident R68 was re-admitted to the facility on 7/19/2022, with diagnoses of high blood pressure, respiratory failure, and tracheostomy.
A review of the clinical record failed to reveal an advance directive or documentation that Resident R68 was given the opportunity to formulate an Advanced Directive.
A review of the clinical record indicated Resident R70 was re-admitted to the facility on 1/31/2024, with diagnoses that include diabetes, high blood pressure, and amputation below left knee.
A review of the clinical record failed to reveal an advance directive or documentation that Resident R70 was given the opportunity to formulate an Advanced Directive.
A review of the clinical record indicated Resident R76 was admitted to the facility on 1/30/2024, with diagnoses that include high blood pressure, COPD, and muscle weakness.
A review of the clinical record failed to reveal an advance directive or documentation that Resident R76 was given the opportunity to formulate an Advanced Directive.
A review of the clinical record indicated Resident R77 was admitted to the facility on 10/8/2022, with diagnoses that include a stroke (an interruption of the blood flow within your brain that causes the death of brain cells), with paralysis on right side, high blood pressure, and dysphagia.
A review of the clinical record failed to reveal an advance directive or documentation that Resident R77 was given the opportunity to formulate an Advanced Directive.
A review of the clinical record indicated Resident R78 was admitted to the facility on 2/18/2022, with diagnoses that include stroke, high blood pressure and end-stage renal disease (ESRD - when the kidneys permanently fail to work).
A review of the clinical record failed to reveal an advance directive or documentation that Resident R78 was given the opportunity to formulate an Advanced Directive.
A review of the clinical record indicated Resident R79 was readmitted to the facility on 8/31/2021, with diagnoses that include amyotrophic lateral sclerosis (ALS - weakens all muscles and impacts physical function), tracheostomy, and depression.
A review of the clinical record failed to reveal an advance directive or documentation that Resident R79 was given the opportunity to formulate an Advanced Directive.
A review of the clinical record indicated Resident R87 was admitted to the facility on 3/7/2023, with diagnoses that include high blood pressure, ALS, tracheostomy.
A review of the clinical record failed to reveal an advance directive or documentation that Resident R87 was given the opportunity to formulate an Advanced Directive.
A review of the clinical record indicated Resident R94 was admitted to the facility on 2/20/2023, with diagnoses that includes respiratory failure, tracheostomy, and high blood pressure.
A review of the clinical record failed to reveal an advance directive or documentation that Resident R94 was given the opportunity to formulate an Advanced Directive.
A review of the clinical record indicated Resident R95 was re-admitted to the facility on 10/3/2023, with diagnoses that includes ALS, tracheostomy, and depression.
A review of the clinical record failed to reveal an advance directive or documentation that Resident R95 was given the opportunity to formulate an Advanced Directive.
A review of the clinical record indicated Resident R96 was admitted to the facility on 4/29/2023, with diagnoses that include diabetes, and muscle weakness.
review of the clinical record failed to reveal an advance directive or documentation that Resident R96 was given the opportunity to formulate an Advanced Directive.
A review of the clinical record indicated Resident R206 was admitted to the facility on 2/15/2024, with diagnoses that include dementia (loss of thinking, remembering, and reasoning to such an extent that it interferes with a person's daily life and activities), diabetes, and high blood pressure.
A review of the clinical record failed to reveal an advance directive or documentation that Resident R206 was given the opportunity to formulate an Advanced Directive.
A review of the clinical record indicated Resident R207 was admitted to the facility on 2/14/2024, with diagnoses that include Parkinson ' s disease (affects movement of muscles often seen with tremors, shaking), dysphagia, and abdominal hernia (weakening of abdominal muscle causing a bulge).
A review of the clinical record failed to reveal an advance directive or documentation that Resident R207 was given the opportunity to formulate an Advanced Directive.
A review of the clinical record indicated Resident R208 was admitted to the facility on 2/15/2024, with diagnoses that include diabetes, atrial fibrillation (abnormal heartbeat) and nicotine dependence.
A review of the clinical record failed to reveal an advance directive or documentation that Resident R208 was given the opportunity to formulate an Advanced Directive.
During an interview on 2/22/2024, at 1:44 p.m. the Social Services Assistant E2 stated she confused the POLST with Advance Directives, confirming Residents (Resident R1, R10, R38, R39, R57, R68, R70, R76, R77, R78, R79, R87, R94, R95, R96, R206, R207, R208), were not afforded the opportunity to formulate Advance Directives upon admissions and periodically during their stay in the facility.
During an interview on 2/22/24, at 2:00 p.m. the Nursing Home Administrator confirmed the facility failed to afford the residents the opportunity to formulate Advance Directives upon admissions and periodically during their stay in the facility.
28 Pa. Code: 201.29(b)(d)(j) Resident rights.
| | Plan of Correction - To be completed: 04/03/2024
Preparation and or evaluation of the following plan of correction set forth in this document does not constitute admission or agreement by the provider of the truth of the facts alleged or conclusions set forth in the statement of deficiencies. The plan of correction is prepared and or executed solely because it is required by the provisions of federal and state law.
No adverse outcome for residents R1, R10, R38, R39, R57, R68, R70, R76, R77, R78, R79, R87, R94, R95, R96, R206, R207, R208. Two advanced Directives were obtained (R87 & R78). The remaining listed residents still at the facility were given information and education on how to formulate and advanced directive should the choose to do so.
Social Service Director will complete a whole house audit for advanced directives. Any resident who does not have one will be provided the opportunity to formulate an advanced directive(living will/power attorney). A cliniconex message will also go to responsible parties and it will provide information regarding forumulation of advanced directives.
Advanced Directives will be reviewed and information regarding formulations of advanced directives will be discussed/reviewed quarterly during care plan meetings and documented in the medical record.
NHA will provide education to the Social Service department and IDT team regarding the differene between Advanced Directives and the POLST.
NHA/designee will complete audits of 5 new admissions weekly x 4 weeks.
Audits will be taken to QAPI for review of findings.
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