Nursing Investigation Results -

Pennsylvania Department of Health
ABRAMSON SENIOR CARE AT LANKENAU MEDICAL CENTER
Patient Care Inspection Results

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ABRAMSON SENIOR CARE AT LANKENAU MEDICAL CENTER
Inspection Results For:

There are  23 surveys for this facility. Please select a date to view the survey results.

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ABRAMSON SENIOR CARE AT LANKENAU MEDICAL CENTER - Inspection Results Scope of Citation
Number of Residents Affected
By Deficient Practice
Initial comments:

Based on a Medicare Recertification, State Licensure, and Civil Rights Compliance Survey completed on June 3, 2019, it was determined that Abramson Senior Care at Lankenau Medical Center was not in compliance with the 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)(2)(i)-(iii) REQUIREMENT Care Plan Timing and Revision: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.
483.21(b) Comprehensive Care Plans
483.21(b)(2) A comprehensive care plan must be-
(i) Developed within 7 days after completion of the comprehensive assessment.
(ii) Prepared by an interdisciplinary team, that includes but is not limited to--
(A) The attending physician.
(B) A registered nurse with responsibility for the resident.
(C) A nurse aide with responsibility for the resident.
(D) A member of food and nutrition services staff.
(E) To the extent practicable, the participation of the resident and the resident's representative(s). An explanation must be included in a resident's medical record if the participation of the resident and their resident representative is determined not practicable for the development of the resident's care plan.
(F) Other appropriate staff or professionals in disciplines as determined by the resident's needs or as requested by the resident.
(iii)Reviewed and revised by the interdisciplinary team after each assessment, including both the comprehensive and quarterly review assessments.
Observations:

Based on review of clinical records and interviews with staff, it was determined that the facility failed to review and revise the comprehensive person centered plan of care in a timely manner, for seven of 11 resident records reviewed (Residents R1, R5, R6, R7, R8, R63 and R109).

Findings include:

Clinical record review for Resident R1 revealed an admission physician order dated, May 21, 2019, which indicated a diagnosis of Methicillin Susceptible Staphylococcus Aureus, (MRSA - an infection caused by a type of staph bacteria that's become resistant to many of the antibiotics used to treat ordinary staph infections). Continued review of Resident R1's clinical record revealed admission was related to receiving therapy services, related to being a high risk for falls, increased need for assistance with activities of daily living (adl's) and plan was for R1 to be discharged to home after therapy services. Further review of the R1's clinical record, on May 31, 2019, revealed no documentation that Resident R1's plan of care included areas related to R1 having an infection, being a fall risk, an increased need for assistance with adl's and discharge planning.

An individual interview with Resident R5 and observations of R5 and an interview with facility staff revealed that R5 was receiving dialysis services, oxygen therapy, used a CPAP (a machine that delivers constant and steady air pressure, while sleeping, which requires pressure settings for inhalation and exhalation) and had an implanted CardioMEMS (Heart Failure System is a safe, reliable way to help one manage their heart failure and to promote ease of use for patients, while providing essential data and insight to clinicians). Review of Resident R5's clinical record revealed no plan's of care were developed related to R5 receiving dialysis services, treatment related to oxygen therapy and an implanted CardioMEMS.

Clinical record review for Resident R109 revealed an admission physician order dated, May 17, 2019, for an advance directive which indicated, DNR (do not resuscitate - no advance wishes of wanting CPR performed should breathing cease and/or heart stop). Further review of Resident R109's clinical record revealed no documentation that R109's plan of care included the resident's wishes related to DNR.

An interview with the Nursing Home Adminstrator and Director of Nursing on June 3, 2019, at 2:50 p.m. confirmed that plan's of care were not developed for Resident's R1, R5, R6 and R109, for identified areas such as an infection, discharge planning, fall risk, dialysis, activities of daily living, code status and oxygen therapy.

Clinical record review for Resident R6 revealed the resident was discharged from the facility on May 26, 2019. Review of the clinical record on June 3, 2019, revealed no documentation that Resident R6's plan of care was updated to include discharge planning as a goal for the resident. Interview with the Director of Nursing on June 3, 2019, at approximately 2:30 p.m. confirmed that there was no documentation that Resident R6's plan of care included discharge planning.

Review of the clinical record for Resident R7 revealed the resident was admitted to the facility on May 14, 2019, with diagnoses including, but not limited to, atrial fibrillation (Afib-irregular and rapid heart beat). Review of an admission nursing note, dated May 14, 2019, at 8:39 p.m. indicated that Resident R7 had a pacemaker (surgically implanted electronic device to stimulate the heartbeat) and implantable cardioverter defibrillator (ICD-surgically implanted electronic medical device used to deliver an electric shock to the heart to treat irregular or life-threatening heartbeat dysfunction) that was located in the resident's left chest wall. Further review of the clinical record on May 30, 2019, revealed no documentation that Resident R7's plan of care was updated to include the presence of a pacemaker, and what interventions were necessary by staff if the resident received an internal electric shock from the ICD.

Further review of the clinical record for Resident R7 revealed the resident was discharged from the facility on May 31, 2019. Review of the clinical record on June 3, 2019, revealed no documentation that Resident R7's plan of care was updated to include discharge planning as a goal for the resident. Interview with the Director of Nursing on June 3, 2019, at approximately 2:18 p.m. confirmed that there was no documentation that Resident R7's plan of care was reviewed and revised to include the presence of a pacemaker, assessment interventions for the ICD, and discharge planning.

Review of the clinical record for Resident R8 revealed the resident was admitted to the facility on May 14, 2019, with diagnoses including, but not limited to, physical rehabilitation after surgical repair of a right hip fracture (broken right hip). Review of a nursing discharge clinical note dated June 2, 2019, at 2:26 p.m. revealed Resident R8 was discharged from the facility. Review of the clinical record on June 3, 2019, revealed no documentation that Resident R8's plan of care was updated to include discharge planning as a goal for the resident. Interview with the Director of Nursing on June 3, 2019, at approximately 2:21 p.m. confirmed that there was no documentation that Resident R8's plan of care was reviewed and revised to include discharge planning.

Review of the clinical record for Resident R63 revealed the resident was admitted to the facility on May 22, 2019, with diagnoses including, but not limited to, congestive heart failure (CHF-excessive body/lung fluid caused by a weakened heart muscle). Review of a nursing admission clinical note dated May 22, 2019, at 8:01 p.m. revealed Resident R63 was admitted to the facility from an acute care hospital for treatment of CHF secondary to alcohol abuse, with the note indicating the resident currently drinks one pint of bourbon daily at home. Review of the clinical record on June 3, 2019, revealed no documentation that Resident R63's plan of care was updated to include alcohol abuse and assessment for alcohol withdrawal symptoms (nausea, vomiting, shakiness, insomnia, seizures) for the resident. Interview with the Director of Nursing on June 3, 2019, at approximately 2:17 p.m. confirmed that there was no documentation that Resident R63's plan of care was reviewed and revised to include alcohol abuse and potential for alcohol withdrawal.

The facility failed to review and revise the comprehensive person centered plans of care in a timely manner,

CFR(s): 483.32(b)(2)(i)-(iii) Care Plan Timing and Revision
Previously cited 04/20/17

28 Pa. Code 201.25 Discharge policy

28 Pa. Code 211.5(f) Clinical records
Previously cited 04/20/17

28 Pa. Code 211.11(a)(b)(c) Resident care plan

28 Pa. Code 211.12(d)(1)(5) Nursing services
Previously cited 04/20/17










 Plan of Correction - To be completed: 07/15/2019

1. The Plan of Care specified for resident's: R1, R5, R6, and R109, if not already developed, were developed by 6/3/2019. R7, was discharged therefore DNR could not be care planned. However, it was documented throughout the electronic medical record.
2. Facility educated clinical team to comprehensive person centered care plan.
3. The night RN will add person centered care plans as appropriate. Care plans will be reviewed by the interdisciplinary team and expanded upon as necessary.
4. DON/ Designee will audit Comprehensive person centered care plan process weekly times 4, then monthly times 3 and periodically thereafter; results will be tracked in facilities QAPI meeting.

483.25 REQUIREMENT Quality of 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 Quality of care
Quality of care is a fundamental principle that applies to all treatment and care provided to facility residents. Based on the comprehensive assessment of a resident, the facility must ensure that residents receive treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the residents' choices.
Observations:

Based on resident interview, clinical record review and interview with facility staff, it was determined that the facility failed to obtain physician orders for administration of oxygen and settings related to a CPAP machine (a machine that delivers constant and steady air pressure, while sleeping, which requires pressure settings for inhalation and exhalation), for one of 11 resident records reviewed (Resident R5).

Findings include:

During an interview with Resident R5 on May 31, 2019, at 11:15 a.m. the resident was observed having oxygen in place and a CPAP machine on the bedside table. While interviewing R5, it was revealed that she had COPD, (Chronic Obstructive Pulmonary Disease - disease process that caused decreased ability of the lungs to perform) and sleep apnea, (loud snoring and breathing sensations).

Clinical record review for Resident R5, revealed a physician order dated May 10, 2019, which indicated the following diagnoses, COPD, sleep apnea and CHF (congestive heart failure - excessive body/lung fluid caused by a weakened heart muscle).

After a second observation of Resident R5, on May 31st at 1:30 p.m. with Employee E4, Licensed nurse, Employee E4 was asked by the surveyor about R5's oxygen and CPAP settings. Employee E4 indicated the oxygen setting was to be between 3L/minute and 4L/minute and indicated that the CPAP machine was R5's and she was not familiar with the settings.

An interview with the Director of Nursing on June 3, 2019, at 1:30 p.m. confirmed that the facility failed to obtain physician order's related to the settings for oxygen and the CPAP machine for Resident R5.

The facility failed to obtain physician order's related to administration of oxygen and settings for a CPAP machine.

CFR(s): 483.25 Quality of Care
Previously cited 04/20/17

28 Pa. Code 211.3(b) Oral and telephone orders

28 Pa. Code 211.5(f) Clinical records
Previously cited 04/20/17

28 Pa. Code 211.10(a)(b)(c) Resident care policies

28 Pa. Code 211.12(c)(d)(1)(2)(5) Nursing services
Previously cited 04/20/17









 Plan of Correction - To be completed: 06/30/2019

1. CPAP settings were added to Resident R5 clinical record May 31, 2019.
2. Clinical staff were educated to documentation of settings for CPAP
3. DON/ Designee will audit CPAP records weekly times 4, then monthly times 3.
4. Audit results will be tracked in facility QAPI meeting.

483.15(c)(3)-(6)(8) REQUIREMENT Notice Requirements Before Transfer/Discharge:Least serious deficiency and is isolated to the fewest number of residents, staff, or occurrences. This deficiency has the potential for causing no more than a minor negative impact on the resident.
483.15(c)(3) Notice before transfer.
Before a facility transfers or discharges a resident, the facility must-
(i) Notify the resident and the resident's representative(s) of the transfer or discharge and the reasons for the move in writing and in a language and manner they understand. The facility must send a copy of the notice to a representative of the Office of the State Long-Term Care Ombudsman.
(ii) Record the reasons for the transfer or discharge in the resident's medical record in accordance with paragraph (c)(2) of this section; and
(iii) Include in the notice the items described in paragraph (c)(5) of this section.

483.15(c)(4) Timing of the notice.
(i) Except as specified in paragraphs (c)(4)(ii) and (c)(8) of this section, the notice of transfer or discharge required under this section must be made by the facility at least 30 days before the resident is transferred or discharged.
(ii) Notice must be made as soon as practicable before transfer or discharge when-
(A) The safety of individuals in the facility would be endangered under paragraph (c)(1)(i)(C) of this section;
(B) The health of individuals in the facility would be endangered, under paragraph (c)(1)(i)(D) of this section;
(C) The resident's health improves sufficiently to allow a more immediate transfer or discharge, under paragraph (c)(1)(i)(B) of this section;
(D) An immediate transfer or discharge is required by the resident's urgent medical needs, under paragraph (c)(1)(i)(A) of this section; or
(E) A resident has not resided in the facility for 30 days.

483.15(c)(5) Contents of the notice. The written notice specified in paragraph (c)(3) of this section must include the following:
(i) The reason for transfer or discharge;
(ii) The effective date of transfer or discharge;
(iii) The location to which the resident is transferred or discharged;
(iv) A statement of the resident's appeal rights, including the name, address (mailing and email), and telephone number of the entity which receives such requests; and information on how to obtain an appeal form and assistance in completing the form and submitting the appeal hearing request;
(v) The name, address (mailing and email) and telephone number of the Office of the State Long-Term Care Ombudsman;
(vi) For nursing facility residents with intellectual and developmental disabilities or related disabilities, the mailing and email address and telephone number of the agency responsible for the protection and advocacy of individuals with developmental disabilities established under Part C of the Developmental Disabilities Assistance and Bill of Rights Act of 2000 (Pub. L. 106-402, codified at 42 U.S.C. 15001 et seq.); and
(vii) For nursing facility residents with a mental disorder or related disabilities, the mailing and email address and telephone number of the agency responsible for the protection and advocacy of individuals with a mental disorder established under the Protection and Advocacy for Mentally Ill Individuals Act.

483.15(c)(6) Changes to the notice.
If the information in the notice changes prior to effecting the transfer or discharge, the facility must update the recipients of the notice as soon as practicable once the updated information becomes available.

483.15(c)(8) Notice in advance of facility closure
In the case of facility closure, the individual who is the administrator of the facility must provide written notification prior to the impending closure to the State Survey Agency, the Office of the State Long-Term Care Ombudsman, residents of the facility, and the resident representatives, as well as the plan for the transfer and adequate relocation of the residents, as required at 483.70(l).
Observations:

Based on resident interview, clinical record review and interview with facility staff, it was determined that the facility failed to provide documentation that the required notification to the office of the State Long-Term Care, (LTC) Ombudsman had been performed after a facility - initiated transfer to an acute care hospital had occurred for one of one resident reviewed that was transferred to the hospital (Resident R5).

Findings include:

During a resident interview on May 31, 2019, at 10:15 a.m. Resident R5 indicated since her stay at the facility she was transferred to the hospital once, for a lengthy stay.

Clinical record review for Resident R5, revealed that the resident was transferred to the hospital on April 30, 2019, for evaluation and treatment related to abnormal lab values. Continued review of the clinical record revealed that Resident R5 was readmitted to the facility from the hospital on May 10, 2019.

An interview with Employee E3, Social Worker, on June 3, 2019, confirmed that the State Long- Care, (LTC) Ombudsman was not notified of Resident R5's transfer to the hospital.

The facility failed to notify the Office of the State Long - Term Care Ombudsman of a facility initiated hospital transfer.

28 Pa. Code 201.14(a) Responsibility of licensee
Previously cited 04/20/17






 Plan of Correction - To be completed: 06/30/2019

This Plan of Correction constitutes our written allegation of compliance for the deficiencies cited. However, submission of this Plan of Correction is not an admission that a deficiency exists or that one was cited correctly. This Plan of Correction is submitted to meet requirements established by state and federal law.


1. Facility Furnished notice to the PA State Ombudsman regarding R5 transfer on May 30, 2019.

2. Facility follows the, Involuntary Discharge and Transfer Notices
Guidance tool released by PA Long-Term Care Ombudsman Office (State Office), to determine notification requirements.

3. Facility Social Service/ Designee will send written communication to the State Ombudsman following the,
Involuntary Discharge and Transfer Notices Guidance tool before the end of each month.

4. NHA/ designee will audit facility notification to State Ombudsman times 3 months then periodically thereafter; results will be tracked in facilities QAPI meeting.


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