§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).
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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.
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