Pennsylvania Department of Health
JULIA RIBAUDO EXTENDED CARE CENTER
Patient Care Inspection Results

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Severity Designations

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JULIA RIBAUDO EXTENDED CARE CENTER
Inspection Results For:

There are  105 surveys for this facility. Please select a date to view the survey results.

Surveys don't appear on this website until at least 41 days have elapsed since the exit date of the survey.
JULIA RIBAUDO EXTENDED CARE CENTER - Inspection Results Scope of Citation
Number of Residents Affected
By Deficient Practice
Initial comments:

Based on a revisit and abbreviated complaint survey completed on January 18, 2024, it was determined that Julia Ribaudo Extended Care Center corrected the federal deficiencies cited during the survey of December 20, 2023, but continued to be out of 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:


483.10(g)(6)-(9) REQUIREMENT Right to Forms of Communication w/ Privacy: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.
§483.10(g)(6) The resident has the right to have reasonable access to the use of a telephone, including TTY and TDD services, and a place in the facility where calls can be made without being overheard. This includes the right to retain and use a cellular phone at the resident's own expense.

§483.10(g)(7) The facility must protect and facilitate that resident's right to communicate with individuals and entities within and external to the facility, including reasonable access to:
(i) A telephone, including TTY and TDD services;
(ii) The internet, to the extent available to the facility; and
(iii) Stationery, postage, writing implements and the ability to send mail.

§483.10(g)(8) The resident has the right to send and receive mail, and to receive letters, packages and other materials delivered to the facility for the resident through a means other than a postal service, including the right to:
(i) Privacy of such communications consistent with this section; and
(ii) Access to stationery, postage, and writing implements at the resident's own expense.

§483.10(g)(9) The resident has the right to have reasonable access to and privacy in their use of electronic communications such as email and video communications and for internet research.
(i) If the access is available to the facility
(ii) At the resident's expense, if any additional expense is incurred by the facility to provide such access to the resident.
(iii) Such use must comply with State and Federal law.
Observations:

Based on observation and staff interviews, it was determined that the facility failed to ensure residents had access to a telephone that afforded privacy for residents during telephone calls on two out of two resident units.

Findings include:

Observation of the Countryside nursing station on January 18, 2024, at approximately 10:50 AM revealed no telephones intended for resident use that afforded the residents privacy during telephone calls.

Interview with Employee 1 (nurse aide) on January 18, 2024, at approximately 10:52 AM revealed that the residents may use the corded telephone located behind the nursing station. The resident may sit behind the nurses station or staff place the phone on the counter for the resident to reach. Employee 1 confirmed there is no area for the residents to have a private conversation while at the nurses station. Employee 1 explained that the facility previously had cordless phones for the residents use however the phones stopped working and they were never replaced.

Observation of the Grandview nursing station on January 18, 2024, at approximately 11:05 AM revealed no telephone for resident use that afforded privacy during resident phone calls. Observation revealed a corded telephone located in the Activities Room across from the Grandview nursing station.

Interview with Employee 2 (Activities Director) on January 18, 2024, at 11:10 AM revealed that if the Activities room is empty, staff can close the door and the resident may have a private conversation, but that may not always be the situation when a resident wishes to use the phone. Employee 2 stated employees allow residents to use their personal employee cell phones for private telephone calls if they are in bed or unable to get to the nurses station or activities room.

Interview with Employee 3 (licensed practical nurse) on January 18, 2024, at 11:12 AM revealed that the facility previously had cordless phones for resident use, but the connection was poor and calls were unable to be maintained. The facility disconnected the cordless phones for resident use and did not obtain replacements.

Resident access to telephones was limited to nurses' stations alone and failed to meet the provisions of the regulatory requirement. The facility failed to provide reasonable access to the use of a telephone without being overheard such as providing cordless telephones or phones with telephone jacks in residents' rooms.

Interview with the Nursing Home Administrator on January 18, 2024, at approximately 3:05 PM confirmed that the facility stopped providing the residents' cordless phones for their use and no longer maintained telephone access that afforded residents privacy during telephone conversations.



28 Pa. Code 201.18(b)(2)(e)(1) Management

28 Pa. Code 201.29(a) Resident rights







 Plan of Correction - To be completed: 02/02/2024

Preparation, submission and implementation of the Plan of Correction does not constitute an admission of or agreement with the facts and conclusions set forth on the survey report. Our Plan of Correction is prepared and executed as a means to continuously improve the quality of care and to comply with state and federal regulatory requirements.

Residents in the community now have a functional mobile phone and I pad for private conversations.

The community has a functional mobile phone system and iPad available for resident use.

To prevent this from reoccurring the Director of Nursing (DON)/designee educated the staff on the resident's right to have access to communication devices for private conversations, and on the availability of the mobile phone system and iPad for resident use.
To prevent this from recurring the DON/designee educated nursing staff on notifying maintenance and supervisor if phones or iPad are not working correctly.

To monitor and maintain ongoing compliance the Maintenance Director/designee will audit the mobile phones and iPAD weekly x4 then monthly x2 to ensure devices are functional and available for resident use. Negative findings will be corrected as needed.

To monitor and maintain ongoing compliance the Nursing Home Administrator (NHA)/designee will interview 5 staff and 5 residents (able to be interviewed) weekly x4 then monthly x2 to ensure phone system is functioning and available for use. Ad Hoc education will be completed as needed.

The results of the audits will be forwarded to the facility QAPI committee for further review and recommendations.


483.10(g)(14)(i)-(iv)(15) REQUIREMENT Notify of Changes (Injury/Decline/Room, etc.):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.
§483.10(g)(14) Notification of Changes.
(i) A facility must immediately inform the resident; consult with the resident's physician; and notify, consistent with his or her authority, the resident representative(s) when there is-
(A) An accident involving the resident which results in injury and has the potential for requiring physician intervention;
(B) A significant change in the resident's physical, mental, or psychosocial status (that is, a deterioration in health, mental, or psychosocial status in either life-threatening conditions or clinical complications);
(C) A need to alter treatment significantly (that is, a need to discontinue an existing form of treatment due to adverse consequences, or to commence a new form of treatment); or
(D) A decision to transfer or discharge the resident from the facility as specified in §483.15(c)(1)(ii).
(ii) When making notification under paragraph (g)(14)(i) of this section, the facility must ensure that all pertinent information specified in §483.15(c)(2) is available and provided upon request to the physician.
(iii) The facility must also promptly notify the resident and the resident representative, if any, when there is-
(A) A change in room or roommate assignment as specified in §483.10(e)(6); or
(B) A change in resident rights under Federal or State law or regulations as specified in paragraph (e)(10) of this section.
(iv) The facility must record and periodically update the address (mailing and email) and phone number of the resident
representative(s).

§483.10(g)(15)
Admission to a composite distinct part. A facility that is a composite distinct part (as defined in §483.5) must disclose in its admission agreement its physical configuration, including the various locations that comprise the composite distinct part, and must specify the policies that apply to room changes between its different locations under §483.15(c)(9).
Observations:

Based on review of clinical records and staff interview, it was determined that the facility failed to timely notify the resident's interested representative of a change in condition for one resident out of 12 sampled (Resident A1).

Findings include:

A review of the clinical record revealed that Resident A1 was admitted to the facility on May 18, 2023, with diagnoses which included schizoaffective disorder ( is a mental health disorder that is marked by a combination of schizophrenia symptoms, such as hallucinations or delusions, and mood disorder symptoms, such as depression or mania), diabetes and anxiety.

A review of the resident's recorded monthly weights revealed that on November 7, 2023, the resident's weight was noted as 195 lbs. The resident's next recorded monthly weight was dated December 6, 2023, revealed that the resident's weight decreased to 171 lbs. The resident lost 24 lbs, a significant weight loss of 12% loss of body weight, in one month.

A dietary note dated December 6, 2023, indicated that the resident's weight had decreased to 171 lbs and the plan was to add a house nutritional supplement, 120 ml, four times a day. The resident's attending physician was notified.

According to nursing documentation the resident's interested representative representative, a daughter, was not notified of the resident's significant weight loss until December 13, 2023, at 1:39 PM at which time she expressed concerns regarding the resident's mental health.

The resident's significant weight loss was identified on December 6, 2023, but the resident's representative was not informed until a week later on December 13, 2023.

An interview with the Nursing Home Administrator on January 18, 2024, at approximately 2:00 PM confirmed the facility failed to timely notify the resident's representative of the resident's significant weight loss.


28 Pa Code 211.12 (d)(3) Nursing services








 Plan of Correction - To be completed: 02/02/2024

Resident #A1 no longer resides at the community.

To identify those residents that have the potential to be affected the Registered Dietician (RD)/designee completed a review of current resident's monthly weights (December to January) for weight loss to ensure residents with a significant weight loss have timely RP notification and MD notification.

To prevent this from recurring the DON/designee educated licensed nursing staff on timely notification of RP and MD for residents with significant weight loss.

To monitor and maintain ongoing compliance the RD/designee will audit residents with weight losses weekly x4 then monthly x2 to ensure timely notification of RP and MD. Notification and Ad hoc education will be completed as needed.

The results of the audits will be forwarded to the facility QAPI committee for further review and recommendations.
483.25(b)(2)(i)(ii) REQUIREMENT Foot Care: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.
§483.25(b)(2) Foot care.
To ensure that residents receive proper treatment and care to maintain mobility and good foot health, the facility must:
(i) Provide foot care and treatment, in accordance with professional standards of practice, including to prevent complications from the resident's medical condition(s) and
(ii) If necessary, assist the resident in making appointments with a qualified person, and arranging for transportation to and from such appointments.
Observations:

Based on review of clinical records and staff interview, it was determined that the facility failed to consistently provide timely and necessary foot care for one of eight residents sampled (Resident A1).

Findings include:

Review of Resident A1's clinical record revealed that the resident was admitted to the facility on May 18, 2023, with diagnoses to include diabetes and deep vein thrombosis (blood clot in a deep vein).

Review of clinical records revealed Resident A1 was admitted to the hospital on December 19, 2023. A review of the hospital podiatry (foot doctor) consultation report dated December 22, 2023, at 12:00 PM, revealed that the reason for the consult was "Nails in disarray." The report stated that the "Patient has elongated nails with what looks like a traumatic avulsion of the right 4th nail. Elongated nails that appear painful for the patient. Elongated nails x 9 b/l LE (bilateral lower extremities) that are thickened and with subungual debris noted (debris under to toenails)."

Further review of the resident's clinical record revealed no evidence that during the resident's stay at the facility from May 18, 2023, through hospitalization on December 19, 2023, that that Resident A1 received podiatry care in the facility and the necessary foot care.

Interview with the Nursing Home Administrator on January 18, 2024, at approximately 3:00 PM confirmed that the facility was unable to provide documented evidence that Resident A1 had been provided routine podiatry and foot care as a resident in the facility.


28 Pa. Code 211.12 (d)(3)(5) Nursing Services



 Plan of Correction - To be completed: 02/02/2024

Resident #A1 no longer resides in the community.

To identify those residents that have the potential to be affected the SSD/designee reviewed current residents to determine that residents were seen by the Podiatrist in a timely manner.

To identify those residents that have the potential to be affected the DON/designee assessed current resident's feet to determine need for podiatry services. The Social Services Director (SSD)/designee will notify podiatry services of those residents needing and wanting podiatry care.

To prevent this from recurring the RDCS educated the SSD on routine podiatry care and tracking.

To prevent this from happening again the RDCS educated the DON and ADON on ensuring accurate assessments of residents feet with weekly skin evaluations.

To monitor and maintain ongoing compliance the NHA/designee will audit 10 current residents weekly x4 then monthly x2 to ensure residents have been seen yearly by podiatry services. The Social Services Director (SSD)/designee will notify podiatry services of those residents needing and wanting podiatry care.

To monitor and maintain ongoing compliance the DON/designee will assess 10 resident's feet weekly x4 then monthly x2 to determine need for podiatry services and compare it to the weekly skin evaluation to ensure all issues needing podiatry care are addressed.

The results of the audits will be forwarded to the facility QAPI committee for further review and recommendations.


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