Nursing Investigation Results -

Pennsylvania Department of Health
JEWISH HOME OF EASTERN PA
Patient Care Inspection Results

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JEWISH HOME OF EASTERN PA
Inspection Results For:

There are  61 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.
JEWISH HOME OF EASTERN PA - Inspection Results Scope of Citation
Number of Residents Affected
By Deficient Practice
Initial comments:

Based on a Medicare/Medicaid Recertification, State Licensure, Abbreviated Complaint and Civil Rights Compliance Survey completed on Janaury 24, 2019, it was determined that the Jewish Home of Eastern PA 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:


483.10(f)(5)(i)-(iv)(6)(7) REQUIREMENT Resident/Family Group and Response: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(f)(5) The resident has a right to organize and participate in resident groups in the facility.
(i) The facility must provide a resident or family group, if one exists, with private space; and take reasonable steps, with the approval of the group, to make residents and family members aware of upcoming meetings in a timely manner.
(ii) Staff, visitors, or other guests may attend resident group or family group meetings only at the respective group's invitation.
(iii) The facility must provide a designated staff person who is approved by the resident or family group and the facility and who is responsible for providing assistance and responding to written requests that result from group meetings.
(iv) The facility must consider the views of a resident or family group and act promptly upon the grievances and recommendations of such groups concerning issues of resident care and life in the facility.
(A) The facility must be able to demonstrate their response and rationale for such response.
(B) This should not be construed to mean that the facility must implement as recommended every request of the resident or family group.

483.10(f)(6) The resident has a right to participate in family groups.

483.10(f)(7) The resident has a right to have family member(s) or other resident representative(s) meet in the facility with the families or resident representative(s) of other residents in the facility.
Observations:

Based on resident and staff interview, review of select facility policy and minutes from Resident Council Meetings it was determined that the facility failed to demonstrate timely and adequate efforts to resolve resident grievances brought forth at resident group meetings regarding cold air temperatures in the shower room.

Findings include:

A review of the facility policy "Grievance Policy" last reviewed by the facility on March 2018, revealed that all residents have the right to voice grievances without discrimination or reprisal and without fear of discrimination or reprisal. Grievances can include those with respect to care and treatment, the behavior of staff and of other residents and other concerns regarding their facility stay. Grievances will be afforded prompt investigations and resolution by facility administration. Upon receipt of a grievance, the Grievance Offical will oversee the grievance process, see it through conclusion, and track them through the quality assurance grievance process.

A review of the minutes from the Resident Council Meetings held on September 27, 2018, and December 20, 2018, revealed that the residents in attendance at these resident group meetings voiced their concerns regarding cold air temperatures in the shower room. The facility's response to the residents concerns were to inservice the staff to turn the heat up in the shower room before bringing the resident into the shower room.

A review of an in-service training dated October 11, 2018, revealed that 14 staff members were in-serviced on turning the heat up in the shower room before bringing the resident into the room.

During a group meeting held on January 23, 2019, at 10:00 AM, with nine residents, five out of the nine residents (Residents 40, 35, 41, 119 and 69) in attendance stated that cold air temperatures in the shower room continued to be a problem.

During an interview with the Chief Operations Officer and Director of Nursing on January 24, 2019, at 9:30 AM, these administrative staff members were unable to provide documented evidence that the facility had determined if the residents' felt that their complaints/grievances regarding shower room temperatures had been resolved through the efforts taken by the facility in October 2018 in response to the residents' expressed concerns.


28 Pa Code 211.12 (c) Nursing services
Previously cited 9/25/18, 2/16/18,

28 Pa. Code 201.18 (e)(1)(4) Management
Previously cited 9/25/18, 2/16/18

28 Pa. Code 201.29 (i)(j) Resident Rights
Previously cited 9/25/18, 2/16/18













 Plan of Correction - To be completed: 02/15/2019

The Jewish Home of Eastern Pennsylvania (the "Home") submits this Plan of Correction under procedures established by the Department of Health in order to comply with the Department's directive to change conditions which the Department alleges are deficient under State and Federal regulations relating to long-term care. This Plan of Correction should not be construed as either a waiver of the Home's right to appeal or an admission of past or ongoing violations of State and Federal regulatory requirements.
1. Elements detailing how the facility will correct the deficiency as it relates to the individual residents.

Grievance Official will follow-up with Resident #s 40, 35, 41, 119, 69 to ensure resolution of cold air temperatures in the shower room.

2. Indicate how the facility will act to protect residents in similar situations.

Grievance Official will follow-up with residents who have had grievances during Resident Council in the past 30 days to ensure resolution was obtained.

3. The measures the facility will take or the system it will alter to ensure that the problem does not reoccur.

Grievance form will be updated to include a space for documentation of grievance resolution. Education will be provided to staff who complete grievance forms.

4. How the facility plans to monitor its performance to make sure that solutions are sustained.

Grievance resolution will be included in the weekly Incident Meeting.

483.45(c)(3)(e)(1)-(5) REQUIREMENT Free from Unnec Psychotropic Meds/PRN Use: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.
483.45(e) Psychotropic Drugs.
483.45(c)(3) A psychotropic drug is any drug that affects brain activities associated with mental processes and behavior. These drugs include, but are not limited to, drugs in the following categories:
(i) Anti-psychotic;
(ii) Anti-depressant;
(iii) Anti-anxiety; and
(iv) Hypnotic

Based on a comprehensive assessment of a resident, the facility must ensure that---

483.45(e)(1) Residents who have not used psychotropic drugs are not given these drugs unless the medication is necessary to treat a specific condition as diagnosed and documented in the clinical record;

483.45(e)(2) Residents who use psychotropic drugs receive gradual dose reductions, and behavioral interventions, unless clinically contraindicated, in an effort to discontinue these drugs;

483.45(e)(3) Residents do not receive psychotropic drugs pursuant to a PRN order unless that medication is necessary to treat a diagnosed specific condition that is documented in the clinical record; and

483.45(e)(4) PRN orders for psychotropic drugs are limited to 14 days. Except as provided in 483.45(e)(5), if the attending physician or prescribing practitioner believes that it is appropriate for the PRN order to be extended beyond 14 days, he or she should document their rationale in the resident's medical record and indicate the duration for the PRN order.

483.45(e)(5) PRN orders for anti-psychotic drugs are limited to 14 days and cannot be renewed unless the attending physician or prescribing practitioner evaluates the resident for the appropriateness of that medication.
Observations:

Based on clinical record review and staff interviews, it was determined that the facility failed to attempt gradual dose reductions of psychoactive medications for one of 31 residents reviewed (Resident 8) and failed to clinically justify the use of a long acting, intramuscular, antipsychotic medication for one of five sampled residents (Resident 94).

Findings included:

A review of the clinical record revealed that Resident 8 was admitted to the facility on January 11, 2016, and had diagnoses that included depression with psychotic features, anxiety, insomnia and major depressive disorder, single episode, unspecified.

The resident had physician orders for Lorazepam (an antianxiety medication) 1 mg, three times a day to treat anxiety, dated January 11, 2016; Escitalopram (an antidepressant medication) 15 mg daily to treat major depression, dated March 13, 2017; Aripiprazole (an antipsychotic medication) 2 mg daily to treat major depression with psychotic features, dated March 30, 2017; Zolpidem (hypnotic medication) 5 mg used to treat insomnia, dated October 13, 2017; and Duloxetine (an antidepressant medication) 30 mg in the AM and 60 mg in the PM to treat major depressive disorder, dated February 21, 2018.

A review of pharmacy recommendations dated December 27, 2017, revealed that the pharmacist requested that the physician evaluate the current dose of Escitalopram 15 mg daily and Duloxetine 90 mg daily and consider a gradual dose reduction. The physician response was that the resident requires combination and current dose.

A review of pharmacy recommendations dated January 31, 2018, revealed that the pharmacist requested that the physician reevaluate the use for Zolpidem 5 mg daily. The physician response was to adjust the medication to 5 mg daily (no change noted).

A review of pharmacy recommendations dated February 27, 2018, revealed that the pharmacist requested that the physician evaluate the current dose of Aripiprazole 2 mg and consider a gradual dose reduction. The physician response was no change.

A review of pharmacy recommendations dated April 23, 2018, revealed that the pharmacist requested that the physician evaluate the current dose of Lorazepam 1 mg three times a day and consider a gradual dose reduction. The physician response was no change.

A review of pharmacy recommendations, dated May 23, 2018, requesting to evaluate the
current dose of Escitalopram 15 mg daily and Duloxetine 90 mg daily and consider a gradual dose reduction, the physician response was patient has good response, no change.

A review of pharmacy recommendations dated June 21, 2018, revealed that the pharmacist requested that the physician reevaluate the use for Zolpidem 5 mg daily. The physician response was patient has good response (no change noted).

A review of pharmacy recommendations dated July 26, 2018, revealed that the pharmacist requested the physician evaluate the current dose of Aripiprazole 2 mg and consider a gradual dose reduction. The physician response was the condition is not well controlled (no change noted).

A review of pharmacy recommendations dated November 29, 2018, revealed that the pharmacist requested that the physician evaluate the current dose of Lorazepam 1 mg three times a day and consider a gradual dose reduction. The physician response was lower dose ineffective (no change noted).

A review of pharmacy recommendations dated November 29, 2018, revealed that the pharmacist requested that the physician evaluate the current dose of Zolpidem 5 mg daily and consider a gradual dose reduction. The physician response was patient has good response to treatment (no change noted).

A review of pharmacy recommendations dated December 27, 2018, revealed that the pharmacist requested that the physician evaluate the current dose of Escitalopram 15 mg daily and Duloxetine 90 mg daily and consider a gradual dose reduction. The physician response was, no change.

During an interview with the Director of Nursing on January 25, 2019, at 10:30 AM, she confirmed that no attempts at gradually reducing the doses of the above psychoactive medications had been made and that the physician documentation failed to include an individualized evaluation with resident specific details in support of the GDR declinations.

A review of the clinical record revealed that Resident 94 was admitted to the facility on November 16, 2018, and had diagnoses that included dementia with behavioral disturbances.

The resident had a current physician's order initially dated November 16, 2018 for Haloperidol Decanoate (a long acting, slow release injectable antipsychotic medication ) 50 mg IM ( intramuscular) every 28 days for dementia with behavioral disturbances.

A review of December 2018 medication administration records revealed that on December 3rd and 31st, 2018, Resident 94 received the long acting Haldol deconoate medication.

There was no documented evidence at the time of the survey that the facility was monitoring targeted behaviors and the related use of this antipsychotic drug to demonstrate its clinical necessity.

During an interview with the Director of Nursing on January 24, 2019, at 11:30 a.m. she confirmed that there was no documented behavior tracking of the Haldol deconoate.



28 Pa. Code 211.2(a) Physician services

28 Pa. Code 211.5(f)(g)(h) Clinical records
previously cited 9/25/18, 2/16/18

28 Pa. Code 211.9(a)(1)(k) Pharmacy Services

28 Pa. Code 211.12(c)(d)(3)(5) Nursing Services
Previously cited 9/25/18, 2/16/18

























 Plan of Correction - To be completed: 03/15/2019

The Jewish Home of Eastern Pennsylvania (the "Home") submits this Plan of Correction under procedures established by the Department of Health in order to comply with the Department's directive to change conditions which the Department alleges are deficient under State and Federal regulations relating to long-term care. This Plan of Correction should not be construed as either a waiver of the Home's right to appeal or an admission of past or ongoing violations of State and Federal regulatory requirements.



1. Elements detailing how the facility will correct the deficiency as it relates to the individual residents.

Resident # 8's psychotropic medications were reviewed by the psychiatrist and documentation was placed in the medical record. Resident # 94 no longer resides in the facility.

2. Indicate how the facility will act to protect residents in similar situations.

Residents with active psychotropic medication orders in past 30 days will be reviewed to ensure a GDR is attempted or physician documentation includes an individualized evaluation with specific resident details in support of GDR declinations. Residents with active psychotropic medication orders will be reviewed to ensure monitoring targeted behaviors is documented in the medical record.

3. The measures the facility will take or the system it will alter to ensure that the problem does not reoccur.

Review of policy and procedure for behavior monitoring and gradual dose reductions with education to appropriate staff as needed.

4. How the facility plans to monitor its performance to make sure that solutions are sustained.

Residents with psychotropic medications will be monitored at the monthly psychotropic meetings to ensure GDRs are attempted or documentation for declination includes an individualized evaluation with specific resident details, and behaviors are monitored.


483.15(c)(3)-(6)(8) REQUIREMENT Notice Requirements Before Transfer/Discharge: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.
483.15(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 clinical record review and staff interview, it was determined that the facility failed to ensure that a written notice of transfer to the hospital was provided to the resident and the residents' responsible representative for five of 31 residents reviewed (Residents 114, 102, 103, 147 and 106).

Findings include:

A review of the clinical record revealed that Resident 114 was transferred and admitted to the hospital on November 30, 2018, and returned on November 30, 2018.

A review of the clinical record revealed that Resident 102 was transferred and admitted to the hospital on November 8, 2018, and returned on November 12, 2018.

A review of the clinical record revealed that Resident 103 was transferred and admitted to the hospital on January 5, 2019, and returned on January 7, 2019.

A review of the clinical record revealed that Resident 147 was transferred and admitted to the hospital on October 1, 2018, and returned on October 4, 2018. She was also transferred and admitted to the hospital on January 10, 2019, and returned on January 14, 2019.

A review of the clinical record revealed that Resident 106 was transferred and admitted to the hospital on November 30, 2018, and returned on December 1, 2018.

There was no evidence that written notice was provided to the above residents and their responsible parties regarding the transfer that included the required contents: reason for the transfer, contact and address information for the Office of the State Long-Term Care Ombudsman, and if applicable, information for the agency responsible for the protection and advocacy of individuals with developmental disabilities.

Interview with the Chief Operating Officer on Janaury 24, 2019, at approximately 10:23 a.m. verified that the facility did not send written notices to the resident and the residents' representatives of the facility initiated transfers of the above residents, but does send a monthly report to the State Ombudsman of facility initiated transfers.




28 Pa. Code 201.14(a) Responsibility of Licensee.
Previously cited 9/25/18

28 Pa. Code 201.29 (f)(g)(h) Resident rights.

28 Pa Code 201.18 (e)(1) Management
Previously cited 2/16/18, 9/25/18.






































 Plan of Correction - To be completed: 03/01/2019

The Jewish Home of Eastern Pennsylvania (the "Home") submits this Plan of Correction under procedures established by the Department of Health in order to comply with the Department's directive to change conditions which the Department alleges are deficient under State and Federal regulations relating to long-term care. This Plan of Correction should not be construed as either a waiver of the Home's right to appeal or an admission of past or ongoing violations of State and Federal regulatory requirements.


1. Elements detailing how the facility will correct the deficiency as it relates to the individual residents.

Resident #s 114, 102, 103, 147, and 106 letters were sent.

2. Indicate how the facility will act to protect residents in similar situations.

Audit of discharges in past 30 days to ensure notice of transfer letters were sent.


3. The measures the facility will take or the system it will alter to ensure that the problem does not reoccur.

Education regarding process for transfer letters to appropriate staff.

4. How the facility plans to monitor its performance to make sure that solutions are sustained.

Audit of transfer letters for 30 days to ensure process continues. Results will be submitted to QA.

483.12(b)(1)-(3) REQUIREMENT Develop/Implement Abuse/Neglect Policies: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.
483.12(b) The facility must develop and implement written policies and procedures that:

483.12(b)(1) Prohibit and prevent abuse, neglect, and exploitation of residents and misappropriation of resident property,

483.12(b)(2) Establish policies and procedures to investigate any such allegations, and

483.12(b)(3) Include training as required at paragraph 483.95,
Observations:

Based on review of clinical records, the facility's abuse prohibition policy and procedures and
select investigative reports and staff interviews, it was revealed that the facility failed to
implement established procedures for investigation of alleged resident abuse and the protection of residents following incidents of potential resident abuse and/or injury of unknown origin for two residents out of 31 sampled (Resident 107 and 133).

Findings Include:

A review of the facility's policy "Incident/Accident Protocols (other than falls)" dated last revised December 18, 2018, revealed that it is the facility's policy to guide nursing staff in documentation of a resident who experienced an incident/accident. An incident is defined, as any happening which is not consistent with the routine operation of the facility or the routine care of a particular resident. This includes a situation, which has potential for injury or resulted in an injury. Procedures include the immediate investigation to determine the cause of the incident and completion of an "Event of known Origin (Other Than Fall)" form or an "Event of Unknown Origin (Other Than Fall)". Based on type of incident, a statement will be obtained from the person who discovered the injury, noted the event had occurred or witnessed the event.

A review of the Resident 107's clinical record and an "Event Of Known Origin (other than Fall)" revealed that on Novemeber 12, 2018, at approximately 8:30 a.m. an allegation of resident to resident abuse was reported. The report noted that Resident 107 was fidgeting with Resident 208 when Resident 107 removed Resident 208's shoe and struck Resident 208 across the face with the shoe.

Review of a "Witness Statement" (a written statement containing a person's account of the facts relating to an observed incident/event) made by Employee 1 (NA-nurse aide) on November 11, 2018, and interview with this employee on Janaury 24, 2019, at approximately 10:25 a.m., revealed that she (Employee 1) witnessed Resident 107 remove Resident 208's shoe and hit Resident 208 across her face.

Review of a "Witness Statement" made by Employee 2 (RN-registered nurse ) on November 22, 2018, revealed that she (Employee 2) heard a commotion, looked over and saw a shoe in the air and Employee 1 attempting to stand between Residents 107 and 208.

During an interview with Employee 3 (LPN-licensed practical nurse) on Janaury 24, 2019, at approximately 10:55 a.m., she stated that she was on the unit at the time of the resident-to-resident altercation and saw Resident 107 remove Resident 208's shoe from Resident 208's roll-walker basket and proceed to hit her on her face.

Further review of the "Event Of Known Origin (other than Fall)" and a corresponding "Investigation of Alleged Abuse, Neglect" (PB 22) form dated November 22, 2019, failed to include a witness statement from Employee 3.

During an interview on Janaury 25, 2019, at approximately 10:15 a.m. with the director of nursing (DON), she was unable to explain the facility's failure to follow their abuse prohibition policy and procedures in response to the altercation between Residents 107 and 208. The DON confirmed that established procedures, including obtaining all witness statements and verifying information obtained, were not implemented in response to the instance of resident-to-resident abuse.

A review of the Resident 133's clinical record and an "Event Of Known Origin (other than Fall)" revealed that on November 5, 2018, at 9:00 PM, indicated that a nurse aide was cleaning and trimming Resident 133's beard and moustache and was having difficulty getting it cleaned. The nurse aide asked Resident 133 (severely cognitively impaired resident) if she "can shave it off."

The facility's intervention to prevent future occurances of this kind was to counsel the nurse aide to contact the resident's representative of incapable residents for their permission, as a resident has a right to have facial hair. The facility failed to educate all applicable staff regarding resident rights to have facial hair following this incident to prevent recurrence. .

Further review of documentation provided by the facility revealed no statement had been obtained from the nurse aide who had shaved the resident.

The failure to educate/train all applicable staff on resident rights following this incident was confirmed with the Director of Nursing on January 25, 2019, at 1:27 PM.

483.12(b)(1)-(3) Develop/Implement Abuse/Neglect Policies
Previously cited 9/25/18

28 Pa. Code 201.14(a)(c)(e) Responsibility of Licensee.
Previously cited 9/28/18

28 Pa. Code 201.18(e)(1) Management.
Previously cited 9/28/18, 2/26/18

28 Pa. Code: 201.29(a)(c)(d) Resident Rights.
Previously cited 9/25/18, 2/16/18

28 Pa Code 211.2(a)(c)(d) Nursing services.
Previously cite 9/25/18, 2/16/18















 Plan of Correction - To be completed: 03/01/2019

The Jewish Home of Eastern Pennsylvania (the "Home") submits this Plan of Correction under procedures established by the Department of Health in order to comply with the Department's directive to change conditions which the Department alleges are deficient under State and Federal regulations relating to long-term care. This Plan of Correction should not be construed as either a waiver of the Home's right to appeal or an admission of past or ongoing violations of State and Federal regulatory requirements.


1. Elements detailing how the facility will correct the deficiency as it relates to the individual residents.

Resident # 107 & 133 investigations will be reviewed and updated as needed. Statement was obtained from Employee #3 for Resident #107 incident. Education to nurse aides regarding shaving of facial hair was completed for Resident #133 incident. Statement from nurse aide for Resident #133 incident was obtained.

2. Indicate how the facility will act to protect residents in similar situations.

Audit of abuse investigations for past 30 days to ensure thorough and complete investigations.

3. The measures the facility will take or the system it will alter to ensure that the problem does not reoccur.

Review of abuse investigation policy and procedure and education to staff who complete abuse investigations.

4. How the facility plans to monitor its performance to make sure that solutions are sustained.

Review of abuse investigations for complete and thorough investigation will occur during weekly Incident meetings.


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 a review of clinical records and select facility policy and staff interview, it was determined that the facility failed to timely consult with the physician and notify the resident's responsible party of a significant decline in a pressure sore and the need to initiate new treatment for one resident out of 31 sampled (Resident 94).

Findings included:

A review of facility policy for physician notification dated as reviewed by the facility December 19, 2018, revealed that a resident's physician will be notified by the Nursing Unit manager or nursing supervisor in the following instances: if there is a significant change in a residents physical, medical or psychosocial status.

A review of a facility policy for notification of change in resident condition, reviewed by the facility December 19, 2018, revealed that should there be any significant changes in the resident's condition, the resident's representative will be notified by the licensed nurse.

A review of the clinical record revealed that Resident 94 was admitted to the facility on November 16, 2018, with diagnoses that included post surgery rehab and dementia with behavioral disturbances.

A review of an admission Minimum Data Set Assessment (MDS - a federally mandated standardized assessment completed at specific times to identify resident care needs) dated November 23, 2018, revealed that Resident 91 was moderately, cognitively impaired and had no skin issues noted at that time.

Further review of the Resident 94's clinical record revealed revealed that on December 5, 2018, a Stage II pressure area (partial thickness skin loss involving epidermis, dermis, or both. The lesion is superficial and presents clinically as an abrasion, blister, or shallow center. It may be warm to the touch and red) to her coccyx area measuring 0.5 cm x 0.5 cm x 0.1 cm. The physician and the resident representative were notified. New interventions were ordered and initiated that time, which included an occlusive dressing to be changed weekly.

The resident's clinical record indicated that licensed nursing staff conducted weekly skin checks with no change in the pressure area noted.

On December 20, 2018, during the 7 AM to 3 PM shift, nursing staff removed the occlusive dressing and assessed the resident's wound. This assessment indicated that the area was now an unstageable (Unstageable Pressure Injury: Obscured full-thickness skin and tissue loss Full-thickness skin and tissue loss in which the extent of tissue damage within the ulcer cannot be confirmed because it is obscured by slough or eschar), measuring 5 cm x 7 cm with 5 cm, with red skin surrounding the wound.

There was no documented evidence that the physician had been consulted and the resident's responsible party notified at the time the decline in the resident's pressure had been identified on December 20, 2018.

A review of nursing documentation dated December 21, 2018, at 5 pm revealed that nursing had spoken with the physician regarding the resident's decline in condition. It was noted that the physician had spoken with the resident's daughter about the resident's condition and recommendation for palliative care. It was also noted that the resident's daughter was in at that time.

Interview with the director of nursing on January 24, 2019, at approximately 11:15 A.M, confirmed that the physician and responsible party were not notified of the resident's worsening pressure sore, which was identified during the 7 AM to 3 PM shift on December 20, 2018, until December 21, 2018.

CFR 483.10(g)14) Notification of changes
previously cited 2/16/18

28 Pa. Code 211.12 (a)(c) Nursing services.
Previously cited 9/25/18, 2/16/18

28 Pa. Code 201.29(a) Resident rights.
Previously cited 9/25/18, 2/16/18


















 Plan of Correction - To be completed: 02/15/2019

The Jewish Home of Eastern Pennsylvania (the "Home") submits this Plan of Correction under procedures established by the Department of Health in order to comply with the Department's directive to change conditions which the Department alleges are deficient under State and Federal regulations relating to long-term care. This Plan of Correction should not be construed as either a waiver of the Home's right to appeal or an admission of past or ongoing violations of State and Federal regulatory requirements.
1. Elements detailing how the facility will correct the deficiency as it relates to the individual residents.

Resident # 94 no longer resides at the Jewish Home of Eastern PA.

2. Indicate how the facility will act to protect residents in similar situations.

Residents requiring notification of change in condition in the past 30 days will be audited to ensure timely notification of change in condition occurred.

3. The measures the facility will take or the system it will alter to ensure that the problem does not reoccur.

Licensed nursing staff will be educated regarding notification of change in condition.

4. How the facility plans to monitor its performance to make sure that solutions are sustained.

Notification of Change will be monitored in nursing morning meeting.

483.20(g) REQUIREMENT Accuracy of Assessments: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.
483.20(g) Accuracy of Assessments.
The assessment must accurately reflect the resident's status.
Observations:

Based on a review of clinical records and the Resident Assessment Instrument and staff interviews, it was determined the facility failed to ensure the Minimum Data Set Assessments (MDS - a federally mandated standardized assessment conducted at specific intervals to plan resident care) accurately reflected the status of two residents out of 31 sampled (Residents 87 and 108).

Findings include:
According to the RAI User's Manual, Section E0900 Wandering-Presence and Frequency is to be completed for all regularly scheduled assessments.
A quarterly MDS Assessment of Resident 87 dated September 7, 2018, revealed Section E0900 was coded as "0" indicating that the resident exhibited no wandering behaviors.
However, a review of Resident 87's clinical record revealed nursing documentation that the resident exhibited wandering behaviors on September 2, 2018, during the above assessment period. A review of the resident's care plan, revealed a problem of wandering behaviors dated as initiated August 10, 2018.
According to the RAI User's Manual, Section E0800 Rejection of Care-Presence and Frequency is to be completed for all regularly scheduled assessments.
A quarterly MDS Assessment of Resident 108 dated September 06, 2018, revealed Section E0900 was coded as "0" indicating that the resident exhibited no rejection of care behaviors.
However, a review of Resident 108's clinical record revealed nursing documentation that the resident rejected care on September 2, 2018, during the above assessment period.
Interview with the director of nursing on January 24, 2019, at approximately 11:15 a.m.,confirmed the MDS inaccuracies for the two aforementioned residents with respect to behaviors.


28 Pa. Code 211.5(g)(h) Clinical records.
28 Pa. Code 211.12 (a)(c)(d)(1)(5) Nursing services.
Previously cited 2/16/18









 Plan of Correction - To be completed: 03/15/2019

The Jewish Home of Eastern Pennsylvania (the "Home") submits this Plan of Correction under procedures established by the Department of Health in order to comply with the Department's directive to change conditions which the Department alleges are deficient under State and Federal regulations relating to long-term care. This Plan of Correction should not be construed as either a waiver of the Home's right to appeal or an admission of past or ongoing violations of State and Federal regulatory requirements.



1. Elements detailing how the facility will correct the deficiency as it relates to the individual residents.

Resident # 87 & 108 MDS will be reviewed and corrections will be submitted as needed.

2. Indicate how the facility will act to protect residents in similar situations.

MDS for residents with behaviors for past 30 days will be reviewed to ensure MDS accuracy.

3. The measures the facility will take or the system it will alter to ensure that the problem does not reoccur.

Education to SS and RNACs regarding accuracy of assessments.

4. How the facility plans to monitor its performance to make sure that solutions are sustained.

Audit of MDS Assessments for accuracy of coding of behaviors will be monitored for 30 days and presented at QA.

483.45(c)(1)(2)(4)(5) REQUIREMENT Drug Regimen Review, Report Irregular, Act On: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(c) Drug Regimen Review.
483.45(c)(1) The drug regimen of each resident must be reviewed at least once a month by a licensed pharmacist.

483.45(c)(2) This review must include a review of the resident's medical chart.

483.45(c)(4) The pharmacist must report any irregularities to the attending physician and the facility's medical director and director of nursing, and these reports must be acted upon.
(i) Irregularities include, but are not limited to, any drug that meets the criteria set forth in paragraph (d) of this section for an unnecessary drug.
(ii) Any irregularities noted by the pharmacist during this review must be documented on a separate, written report that is sent to the attending physician and the facility's medical director and director of nursing and lists, at a minimum, the resident's name, the relevant drug, and the irregularity the pharmacist identified.
(iii) The attending physician must document in the resident's medical record that the identified irregularity has been reviewed and what, if any, action has been taken to address it. If there is to be no change in the medication, the attending physician should document his or her rationale in the resident's medical record.

483.45(c)(5) The facility must develop and maintain policies and procedures for the monthly drug regimen review that include, but are not limited to, time frames for the different steps in the process and steps the pharmacist must take when he or she identifies an irregularity that requires urgent action to protect the resident.
Observations:

Based on a review of clinical records and staff interview, it was determined that the physician failed to act upon pharmacist identified irregularities in the medication regimen of one of 31 residents sampled (Resident 94).

Findings include:

A review of the clinical record revealed that Resident 94 was admitted to the facility on November 16, 2018, and had diagnoses that included dementia with behavioral disturbances. The resident had a physician's order from the time of admission for Haloperidol Decanoate ( a long acting, slow release injectable antipsychotic medication ) 50 mg IM ( intramuscular) every 28 days for dementia with behavioral disturbances.

A review of a hospital history and physical completed by the physician dated November 8, 2018, noted in the "impression and plan" that the resident's active problems included dementia due to medical condition with behavioral disturbance, first noted on September 17, 2018. The physician noted the patient seems stable at the present time. She has been receiving Haldol monthly (at home).

A review of the attending physician progress note dated November 18, 2018, noted that Resident 94 had been "very sedate, very quiet." .

A review of a "Medication Regimen Review" conducted by the facility's consultant pharmacist
on November 27, 2018, revealed that the pharmacist noted that federal guidelines for long term care facilities require an evaluation of antipsychotic usage within two weeks of admission to the facility. This resident was recently admitted with an order for Haloperidol decanoate 50 mg IM every 28 days for dementia with behavioral disturbances. The pharmacist requested that the physician please consider a trial dose reduction to assess continued need for treatment.

There was no documented evidence at the time of the survey that the physician responded to the pharmacist's recommendation or documentation that the physician had evaluated this resident's continued use of the antipsychotic medication

In an interview with the Director of Nursing on January 24, 2019, at approximately 11:30 a.m. she confirmed that there was no documentation that the physician had acted upon the pharmacist recommendation or had documented an evaluation of the resident's continued use the antipsychotic medication.


28 Pa. Code 211.9 (k) Pharmacy services.

28 Pa. Code 211.12 (c) Nursing services.
Previously cited 9/25/18, 2/16/18

28 Pa. Code 211.2(a) Physician services

28 Pa. Code 211.5(h) Clinical records









 Plan of Correction - To be completed: 03/15/2019

The Jewish Home of Eastern Pennsylvania (the "Home") submits this Plan of Correction under procedures established by the Department of Health in order to comply with the Department's directive to change conditions which the Department alleges are deficient under State and Federal regulations relating to long-term care. This Plan of Correction should not be construed as either a waiver of the Home's right to appeal or an admission of past or ongoing violations of State and Federal regulatory requirements.



1. Elements detailing how the facility will correct the deficiency as it relates to the individual residents.

Resident # 94 no longer resides at the facility.

2. Indicate how the facility will act to protect residents in similar situations.

An audit of pharmacy recommendations in past 60 days will be conducted to ensure a response was obtained.

3. The measures the facility will take or the system it will alter to ensure that the problem does not reoccur.

Education to Unit Managers regarding response to pharmacist recommendations.


4. How the facility plans to monitor its performance to make sure that solutions are sustained.

Pharmacist recommendations will be audited for 90 days to ensure a response is obtained and presented at QA.

483.55(b)(1)-(5) REQUIREMENT Routine/Emergency Dental Srvcs in NFs: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.
483.55 Dental Services
The facility must assist residents in obtaining routine and 24-hour emergency dental care.

483.55(b) Nursing Facilities.
The facility-

483.55(b)(1) Must provide or obtain from an outside resource, in accordance with 483.70(g) of this part, the following dental services to meet the needs of each resident:
(i) Routine dental services (to the extent covered under the State plan); and
(ii) Emergency dental services;

483.55(b)(2) Must, if necessary or if requested, assist the resident-
(i) In making appointments; and
(ii) By arranging for transportation to and from the dental services locations;

483.55(b)(3) Must promptly, within 3 days, refer residents with lost or damaged dentures for dental services. If a referral does not occur within 3 days, the facility must provide documentation of what they did to ensure the resident could still eat and drink adequately while awaiting dental services and the extenuating circumstances that led to the delay;

483.55(b)(4) Must have a policy identifying those circumstances when the loss or damage of dentures is the facility's responsibility and may not charge a resident for the loss or damage of dentures determined in accordance with facility policy to be the facility's responsibility; and

483.55(b)(5) Must assist residents who are eligible and wish to participate to apply for reimbursement of dental services as an incurred medical expense under the State plan.
Observations:

Based on review of clinical records and staff interview, it was determined that the facility failed to offer routine annual dental services for two Medicaid payor sources out of four residents sampled (Resident 64, and 147) for dental services.

Findings include:

Review of the clinical record of Resident 64 revealed admission to the facility on December 7, 2016, and that the resident's payor source was Medicaid. There was no documented evidence that the resident had been offered dental services in the past year.

Review of the clinical record of Resident 147 indicated that the resident was admitted to the facility on January 23, 2015, and that the resident's payor source was Medicaid. There was no documented evidence that the resident was offered dental services in the past year.

Interview with the Director of Nursing on January 24, 2019, at 1:00 p.m. confirmed that the facility had not offered Residents 64 and 147 routine dental services from a dentist in the past year.




28 Pa. Code 211.12(c)(d)(3)(5) Nursing services
Previously cited 2/16/18, 9/25/18.

28 Pa. Code 211.15(a) Dental services








 Plan of Correction - To be completed: 02/22/2019

The Jewish Home of Eastern Pennsylvania (the "Home") submits this Plan of Correction under procedures established by the Department of Health in order to comply with the Department's directive to change conditions which the Department alleges are deficient under State and Federal regulations relating to long-term care. This Plan of Correction should not be construed as either a waiver of the Home's right to appeal or an admission of past or ongoing violations of State and Federal regulatory requirements.



1. Elements detailing how the facility will correct the deficiency as it relates to the individual residents.

Resident # 64 & Resident # 147 dental services were obtained.

2. Indicate how the facility will act to protect residents in similar situations.

Audit of resident charts for last dental visit completed and dental services obtained for any residents identified without dental services in past year.

3. The measures the facility will take or the system it will alter to ensure that the problem does not reoccur.

Review and update process for tracking dental services and education to staff regarding new process.

4. How the facility plans to monitor its performance to make sure that solutions are sustained.

Audit of dental services for next 90 days to ensure no dental services are missed, report at quarterly QAPI meeting.



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