|§483.10(a) Resident Rights.|
The resident has a right to a dignified existence, self-determination, and communication with and access to persons and services inside and outside the facility, including those specified in this section.
§483.10(a)(1) A facility must treat each resident with respect and dignity and care for each resident in a manner and in an environment that promotes maintenance or enhancement of his or her quality of life, recognizing each resident's individuality. The facility must protect and promote the rights of the resident.
§483.10(a)(2) The facility must provide equal access to quality care regardless of diagnosis, severity of condition, or payment source. A facility must establish and maintain identical policies and practices regarding transfer, discharge, and the provision of services under the State plan for all residents regardless of payment source.
§483.10(b) Exercise of Rights.
The resident has the right to exercise his or her rights as a resident of the facility and as a citizen or resident of the United States.
§483.10(b)(1) The facility must ensure that the resident can exercise his or her rights without interference, coercion, discrimination, or reprisal from the facility.
§483.10(b)(2) The resident has the right to be free of interference, coercion, discrimination, and reprisal from the facility in exercising his or her rights and to be supported by the facility in the exercise of his or her rights as required under this subpart.
Based on observations, a review of facility documentation and policies, and interviews with staff and residents, it was determined that the facility did not ensure voting rights for three of 34 residents reviewed (Residents R17, R22 and R28), did not ensure dignity for residents related to feeding and dining for one of two dining rooms (first-floor dining room) and did not ensure that residents had the right to self-determination related to the use of Wanderguards for one of 34 resident reviewed (Resident R80).
Review of a facility policy titled, "Voting," dated January 2019, revealed that "The center strongly respects the voting rights of each resident and supports the residents in the effort to vote in local and national elections. The center provides the opportunity for residents to vote in their polling station or by completing an absentee or provisional ballot." Further, the policy revealed, "The resident will be asked to if they wanted to vote."
Review of the census report provided by the Director of Recreation revealed that all residents as of April 29, 2019, had either a handwritten "NA", "Refused", a check mark or "Not Registered" next to their name. The report showed Resident R17 as "NA", Resident R22 as "Not Registered" and Resident R28 as "Refused".
Interview with the Director of Recreation on May 28, 2019, at 11:30 a.m. revealed as stated that "NA" meant either not available to vote or not able to vote based on his determination of the Brief Interview for Mental Status (BIMS - a brief screening tool that aids in detecting cognitive impairment) score of the resident and his impression of their cognitive level and ability to understand the voting process.
Interviews with Residents R17, R22 and R28 on May 28, 2019, at 10:00 a.m. revealed that Resident R17 wanted to vote but was not asked if he wanted an absentee ballot, Resident R22 was not asked if he wanted an absentee ballot and Resident R28 wanted to vote and did not refuse the absentee ballot.
The facility failed to ensure voting rights for residents.
Dining observations in the first-floor dining room on May 23, 2019, at 12:30 p.m. revealed that Employee E8, Restorative Nursing Assistant, was feeding two residents at the same time, one resident on each side of her. Further observation revealed that Employee E8 placed the plate for the resident to her left in front of her while she fed the male resident. When the DON asked her why she had the plate in front of herself, she said that the resident would "dig" into the food on the plate.
Further dining observations in the first-floor dining room on May 23, 2019, at 12:30 p.m. revealed that residents were served cold beverages and water in disposable plastic cups and the dessert, lemon bars, were served on disposable Styrofoam plates.
Dining observations on May 24, 2019, at 8:30 a.m. in the first-floor dining room revealed that residents were served hot cereal in disposable Styrofoam bowls and cold beverages in disposable plastic cups.
Interview with the DON on May 28, 2019, at 2:15 p.m. confirmed the dining observations.
The facility failed to ensure dignity for residents related to feeding and dining.
Review of facility policy, "Wanderguard/Watchmate (a device that triggers an alarm to prevent a resident from leaving an area) Policy," dated January 2019, revealed that "Once a resident has been identified at risk for elopement (the act leaving a safe area or safe premises, done by a person with a mental disorder or cognitive impairment), as per Elopement Assessment form, a Wanderguard/Watchmate will be obtained and placed on the resident ... The responsible representative and the resident physician will be notified a Wanderguard/Watchmate is in use."
Interview with a group of alert and oriented residents as selected by the Director of Recreation on May 24, 2019, at 10:30 a.m. revealed that Resident R80 had received a Wanderguard (device designed to trigger an alarm if the person wearing the device moves outside a defined area) device after he expressed interest in going to a convenience store across the street to buy snacks. Further interview with Resident R80 revealed that he expressed concern that he had to wear the wanderguard device.
Review of medical records for Resident R80 revealed a BIMS score of 15 which indicated that the resident was cognitively intact and able to make his own decisions.
Observation of Resident R80 on May 24, 2019, at 10:30 a.m. and 12:45 p.m. and May 29, 2019, at 9:39 a.m. revealed the resident was wearing a Wanderguard bracelet.
A request for elopement and/or wander risk assessments for Resident R80 to the Nursing Home Administrator and Director of Nursing on May 24, 2019, at 12:50 p.m. was not fulfilled. In the paper and electronic medical record that was accessible for review, there was no observable elopement and/or wander risk assessment for Resident R80.
Review of physician orders for Resident R80 revealed an order for Wanderguard that was discontinued on May 24, 2019, at 12:00 p.m. Further review of physician orders revealed a new order for Wanderguard starting May 27, 2019, at 10:00 p.m.
Interview with Resident R80 on May 29, 2019, at 9:39 a.m. revealed the resident had continued to wear the Wanderguard bracelet over the weekend, even when there was no physician order to wear it and he did not know why he had to wear it.
The facility failed to ensure that residents had the right to a dignified existence and self-determination related to the use of Wanderguards.
42 CFR 483.10(a)(1) Resident Rights/Exercise of Rights
Previously cited 06/14/18
28 Pa. Code 201.29(a) Resident rights
Previously cited 06/14/18
28 Pa. Code 201.29(d) Resident rights
Previously cited 06/14/18
28 Pa. Code 201.29(j) Resident rights
Previously cited 06/14/18
| ||Plan of Correction - To be completed: 07/24/2019|
The statements made on this plan of correction are not an admission to and do not constitute an agreement with the alleged deficiencies herein. To remain in compliance with all federal and state regulations, the center has taken or will take the actions set forth in the following plan of correction. The following plan of correction constitutes the
center's allegation of compliance such that all alleged deficiencies cited have been or will be corrected by the date or dates indicated.
1. Residents R17, R22 and R28 were provided information on voting.
2. The Staff Educator will rein-service the TR staff on voting rights and the voting process.
3. The Director of Recreation or Designee will complete facility wide audit to identify residents who are interested in voting.
4. Residents who are interested in voting and are not yet registered will complete a voter registration application with the assistance from TR staff. An audit of Resident's BIMS will be completed to identify Residents with a BIMS of 10-15.
5. Residents with a BIMS of 10-15, who are interested in voting and are not yet registered will complete a voter registration application with assistance from TR staff.
6. The Director of Recreation or Designee or designee will verify voter registration status for Residents who expressed interest in voting and or have a BIMS of 10-15 using the PA Department of State voter database.
7. The Director of Recreation or Designee will maintain proof of registration for current Residents with an active voter registration in a binder in the recreation office. Copy of completed applications will be kept in a binder in the recreation office.
8. The Director of Recreation or Designee will be responsible for implementing acceptable POC.
1. There were no negative outcomes to Residents regarding the food plates being placed in front of E8 or being served cold beverages and water in disposable plastic cups and the dessert, lemon bars, were served on disposable Styrofoam plates and hot cereal in disposable Styrofoam bowls.
2. The Facility Educator or Designee will in-service the staff on placing the Resident's meals in front of them, serving beverages, food and snacks with dishware.
3. The dining process will be audited weekly x 4, monthly x2, to ensure Resident's meals are being placed in front of them and beverages, food and snacks are being served with dishware.
4. The Dining Process Audits will be reviewed in QA Meeting monthly times 3.
5. The Director of Dietary Services or Designee will be responsible for implementing acceptable POC.
1. An elopement assessment was conducted on Resident R80 and he was provided a Wander Guard.
2. The Resident Representative and Physician were notified.
3. The Staff Educator will in-service the staff on the Wander Guard process.
4. The facility will audit Residents with Wander Guards to ensure an Elopement Risk Assessment was performed, The Physician and Resident Representative were notified, a Physician's order for the Wander Guard was obtained and the Wander Guard was care planned.
5. The Wander Guard Audit will be reviewed by the IDT Team weekly x4 and monthly x 2.
6. The Wander Guard Audit will be reviewed in QA meeting monthly times 3
7. The Unit Manager or Designee will be responsible for implementing acceptable POC.