Pennsylvania Department of Health
DRESHER HILL HEALTH & REHABILITATION CENTER
Patient Care Inspection Results

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DRESHER HILL HEALTH & REHABILITATION CENTER
Inspection Results For:

There are  212 surveys for this facility. Please select a date to view the survey results.

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DRESHER HILL HEALTH & REHABILITATION CENTER - Inspection Results Scope of Citation
Number of Residents Affected
By Deficient Practice
Initial comments:
Based on a Medicare/Medicaid Recertification survey, State Licensure survey, and a Civil Rights Compliance survey completed on January 5, 2024, it was determined that Dresher Hill Health and Rehabilitation Center was not in 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:


483.45(d)(1)-(6) REQUIREMENT Drug Regimen is Free from Unnecessary Drugs: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.
§483.45(d) Unnecessary Drugs-General.
Each resident's drug regimen must be free from unnecessary drugs. An unnecessary drug is any drug when used-

§483.45(d)(1) In excessive dose (including duplicate drug therapy); or

§483.45(d)(2) For excessive duration; or

§483.45(d)(3) Without adequate monitoring; or

§483.45(d)(4) Without adequate indications for its use; or

§483.45(d)(5) In the presence of adverse consequences which indicate the dose should be reduced or discontinued; or

§483.45(d)(6) Any combinations of the reasons stated in paragraphs (d)(1) through (5) of this section.
Observations:


Based on clinical record review, pharmacy literature review, and staff interview, it was determined that the facility failed to ensure a resident's drug regimen was free from drugs used in an excessive dose for one of 21 sampled residents. (Resident 33)

Findings include:

Clinical record review revealed that Resident 33 was admitted to the facility on December 9, 2023, and had diagnoses of a pressure ulcer and surgical incision site infection. A physician's order dated December 8, 2023, directed staff to administer 650 milligrams (mg) of a pain medication (acetaminophen) every four hours as needed for pain. A physician's order dated December 9, 2023, directed staff to administer 1,000 mg of the same pain medication (acetaminophen) every six hours for mild to moderate pain. A review of the medication packing information on the administration of acetaminophen revealed the maximum dose an adult should take in 24 hours should not exceed 4,000 mg. A review of the medication administration records revealed that Resident 33 received acetaminophen 1,000 mg four times and 650 mg one time, for a total of 4,650 mg within a 24-hour period on December 15 and 17, 2023.

In an interview on January 5, 2024, at 10:10 a.m., the Director of Nursing confirmed that Resident 33 received over 4,000 mg of acetaminophen on December 15 and 17, 2023.


28 Pa. Code 211.12(d)(1)(5) Nursing services.








 Plan of Correction - To be completed: 01/19/2024

Preparation and submission of this POC is required by state and federal law. This POC does not constitute an admission for purposes of general liability, professional malpractice or any other court proceeding.


1. Resident 33, Tylenol orders were clarified by the physician and an incident report was completed. No ill effects noted to resident.
2. To identify other residents, Unit Manager completed a house audit to review Tylenol orders and orders were adjusted per physician order as needed.
3. To prevent this from reoccurring, RDCS/ADON completed education for licensed nurses on reviewing Tylenol orders and pain medications to ensure no duplicate orders and not above recommended dosage.
4. Ongoing monitoring for compliance, DON/designee will review admission orders weekly during resident review to ensure pain medications due not exceed parameters. New orders will be audited 5 times a week for 4 weeks then 2 times a week for 4 weeks then weekly for 4 weeks to monitor for Tylenol dosage.
5. Results will be presented at QAPI for review and revision.


§ 211.12(f.1)(2) LICENSURE Nursing services. :State only Deficiency.
(2) Effective July 1, 2023, a minimum of 1 nurse aide per 12 residents during the day, 1 nurse aide per 12 residents during the evening, and 1 nurse aide per 20 residents overnight.

Observations:
Based on a review of nursing schedules, it was determined that the facility failed to meet the minimum nurse aide (NA) to resident ratios for 11 of 21 days reviewed.

Findings include:

Review of nursing schedules for 21 days from August 25, 2023, to August 31, 2023, October 28, 2023, to November 3, 2023, and December 28, 2023, to January 3, 2024, revealed the following:

The facility failed to meet the minimum NA to resident ratio of one NA for 12 residents on day shift (7:00 a.m. to 3:00 p.m.) on Ocotober 28, 2023.

The facility failed to meet the minimum NA to resident ratio of one NA for 12 residents on evening shift (3:00 p.m. to 11:00 p.m.) on August 28, 29, and 30, 2023, October 28 and 31, 2023, November 1, 2, and 3, 2023, December 28 and 29, 2023, and January 1, 2024.



 Plan of Correction - To be completed: 01/15/2024

1. No ill effects noted
2. To identify other residents, staffing ppd and ratios will be posted at each nursing station for reference. Facility to utilize full-time staff, part-time staff, pool staff and staffing agencies to replace staffing call outs.
3. To prevent this from reoccurring, NHA/designee will educate scheduler and nursing supervisors regarding staffing regulations to ppd and nursing ratios.
4. Ongoing monitoring for compliance, NHA/designee will audit nursing schedule for nursing ratios 3 times a week for 4 weeks and weekly for 2 months.
5. Results will be presented to QAPI committee for review and revision.


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