Nursing Investigation Results -

Pennsylvania Department of Health
REHABILITATION & NURSING CENTER AT GREATER PITTSBURGH, THE
Patient Care Inspection Results

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REHABILITATION & NURSING CENTER AT GREATER PITTSBURGH, THE
Inspection Results For:

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REHABILITATION & NURSING CENTER AT GREATER PITTSBURGH, THE - Inspection Results Scope of Citation
Number of Residents Affected
By Deficient Practice
Initial comments:
Based on a complaint survey completed on February 28, 2019, it was determined that The Rehabilitatiuon and Nursing Center at Greater Pittsburgh 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:


483.24(a)(1)(b)(1)-(5)(i)-(iii) REQUIREMENT Activities Daily Living (ADLs)/Mntn Abilities: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) Based on the comprehensive assessment of a resident and consistent with the resident's needs and choices, the facility must provide the necessary care and services to ensure that a resident's abilities in activities of daily living do not diminish unless circumstances of the individual's clinical condition demonstrate that such diminution was unavoidable. This includes the facility ensuring that:

483.24(a)(1) A resident is given the appropriate treatment and services to maintain or improve his or her ability to carry out the activities of daily living, including those specified in paragraph (b) of this section ...

483.24(b) Activities of daily living.
The facility must provide care and services in accordance with paragraph (a) for the following activities of daily living:

483.24(b)(1) Hygiene -bathing, dressing, grooming, and oral care,

483.24(b)(2) Mobility-transfer and ambulation, including walking,

483.24(b)(3) Elimination-toileting,

483.24(b)(4) Dining-eating, including meals and snacks,

483.24(b)(5) Communication, including
(i) Speech,
(ii) Language,
(iii) Other functional communication systems.
Observations:


Based on review of policies and clinical records, as well as staff interviews, it was determined that the facility failed to ensure that residents received restorative ambulation programs to maintain or improve their abilities to walk in accordance with their physician's orders for three of nine residents reviewed (Residents 3, 5, 6).

Findings include:

The facility's policy regarding restorative nursing programs, dated February 20, 2019, indicated that a resident would receive restorative nursing care as needed to help promote optimal safety and independence.

A diagnosis record for Resident 3, dated December 1, 2018, revealed that the resident had diagnoses that included syncope (dizziness), seizures and a history of falls. Physician's orders, dated February 21, 2019, revealed that the resident's physical therapy was discontinued, that she was to be provided with restorative ambulation (walking), and was to ambulate up to 25 feet with a regular walker with the moderate assistance of two staff, with a wheelchair to follow.

As of February 28, 2019, there was no documented evidence that Resident 3 received restorative ambulation as ordered by the physician.


A diagnosis record for Resident 5, dated December 30, 2018, revealed that the resident had diagnoses that included dementia (brain disease that causes declines in the abilities to think and remember), stroke, muscle weakness and a history of falls. Physician's orders, dated February 8, 2019, revealed that the resident's physical therapy was discontinued, that he was to be provided with restorative ambulation, and was to ambulate 150 feet with a wheeled walker and minimal assistance.

As of February 28, 2019, there was no documented evidence that Resident 5 received restorative ambulation as ordered by the physician.


A diagnosis record for Resident 6, dated September 26, 2017, revealed that the resident had diagnoses that included a history of falls, joint disorder and dementia. Physician's orders, dated February 20, 2019, revealed that the resident's physical therapy was discontinued, that she was to be started on a restorative ambulation program, and was to ambulate 150 feet with stand-by assistance with a regular walker.

As of February 28, 2019, there was no documented evidence that Resident 6 received restorative ambulation as ordered by the physician.

Interview with the Director of Nursing on February 28, 2019, at 4:20 p.m. confirmed that there was no documented evidence that Residents 3, 5 and 6's restorative ambulation programs were provided as ordered by the physician.

28 Pa. Code 211.12(d)(3) Nursing services.
Previously cited 11/27/18, 11/7/18.

28 Pa. Code 211.12(d)(5) Nursing services.
Previously cited 11/27/18, 11/7/18.


 Plan of Correction - To be completed: 03/29/2019

The filing of this plan of correction does not constitute an admission that the alleged deficiencies did, in fact, exist. This plan of corrections is filed as evidence to comply with requirements of participation and continue to provide high quality resident centered care.

1) Corrective Action for those residents found to be affected by the alleged deficient practice.
Resident #3, #5, #6 are currently receiving restorative services. Immediate education with nursing, nursing leadership, and the restorative nursing assistants regarding ensuring that the residents with restorative orders are receiving restorative services.

2) Corrective Actions taken for residents with potential to be affected by alleged deficient practice.
Residents admitted into the facility have the potential to be affected. Audit completed on residents with restorative orders to ensure resident is participating in restorative therapy and the documentation reflects the physician order or selected therapies.

3) Systemic Changes put into place to ensure the alleged deficient practice does not recur.
Restorative nursing modalities are being moved to the Point of Care nursing assistant charting system under the resident task list/Kardex for ease of charting, this will prevent residents from not receiving restorative services should the primary restorative assistant be pulled to the floor for call outs. The Director of Nursing has weekly meetings with the restorative nursing team and the rehabilitation team to address and evaluate current residents receiving restorative services as well as any potential restorative candidates and to check documentation.

4) Monitoring of corrective action to ensure the alleged deficient practice does not recur.
Director of nursing will audit the restorative nursing program weekly x 4 weeks and monthly x 2 months to ensure proper charting and documentation.

Plan of correction information and audits will be reviewed in the quality assurance and performance improvement process for tracking/trending and any necessary additional interventions.

Date of compliance-3/29/19

483.45(f)(2) REQUIREMENT Residents are Free of Significant Med Errors: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.
The facility must ensure that its-
483.45(f)(2) Residents are free of any significant medication errors.
Observations:


Based on clinical record reviews and staff interviews, it was determined that the facility failed to provide medication as ordered by the physician resulting in a significant medication error for one of nine residents reviewed (Resident 3).

Findings include:

A diagnosis record for Resident 3, dated December 1, 2018, revealed that the resident had diagnoses that included Alzheimer's disease (brain disease that causes gradual declines in the abilities to think and remember), altered mental status, seizures and convulsions. Physician's orders, dated December 3, 2018, included an order for the resident to receive 150 milligrams (mg) of Vimpat (anticonvulsant) two times a day for seizures.

Resident 3's Medication Administration Record (MAR) for February 2019 contained no documented evidence that six doses of Vimpat were administered to the resident on February 25 at 9:00 p.m. through February 28 at 9:00 a.m. Nursing notes for these dates indicated that the medication was not available for administration to the resident.

Interview with the Director of Nursing on February 28, 2019, at 3:10 p.m. confirmed that Resident 3 did not receive Vimpat on the above dates. She indicated that the medication required a monthly physician's prescription and the licensed nurse should have notified the physician timely for a refill, however, did not do so.

42 CFR 483.45(f)(2) Residents are Free of Significant Medication Errors.
Previously cited 11/7/18.

28 Pa. Code 211.12(d)(3) Nursing services.
Previously cited 11/27/18, 11/7/18.

28 Pa. Code 211.12(d)(5) Nursing services.
Previously cited 11/27/18, 11/7/18.


 Plan of Correction - To be completed: 03/29/2019

1) Corrective Action for those residents found to be affected by the alleged deficient practice.
Medical error forms were completed and the physician notified with orders as applicable. Immediate education with licensed nurses on medication availability procedures.

2) Corrective Actions taken for residents with potential to be affected by alleged deficient practice.
Residents admitted into the facility have the potential to be affected. Audit completed on current residents to ensure all medications are available and given as ordered and addressed as necessary.

3) Systemic Changes put into place to ensure the alleged deficient practice does not recur.
Electronic medication and treatment administration record charting system is in place which communicates directly with the pharmacy for medication refill alerts, substitutions, or scripts needed and the pharmacy communicates directly with the RN supervisor by phone to alert licensed nursing staff of any medication needs or issues. Education to licensed nurses on proper medication administration, medication error procedure charting, and the electronic medication passport dispensing system to ensure that the dispensing system is checked for the medication before calling for substitution.

4) Monitoring of corrective action to ensure the alleged deficient practice does not recur.
Director of nursing will audit Point of Care electronic medical record administration alert system for missed medication administration daily x 2 weeks and monthly x 2 months.

Plan of correction information and audits will be reviewed in the quality assurance and performance improvement process for tracking/trending and any necessary additional interventions.

Date of compliance-3/29/19


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