Nursing Investigation Results -

Pennsylvania Department of Health
WESLEY ENHANCED LIVING MAIN LINE REHAB AND SKD NURSING
Patient Care Inspection Results

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Minimal Citation - No Harm Minimal Harm Actual Harm Serious Harm
WESLEY ENHANCED LIVING MAIN LINE REHAB AND SKD NURSING
Inspection Results For:

There are  47 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.
WESLEY ENHANCED LIVING MAIN LINE REHAB AND SKD NURSING - Inspection Results Scope of Citation
Number of Residents Affected
By Deficient Practice
Initial comments:

Based on Medicare/Medicaid Recertification, State Licensure and Civil Rights Compliance Survey completed on March 11, 2019, it was determined that Wesley Enhanced Living Main Line Rehabilitation and Skilled Nursing 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 for the health portion of the survey process.




 Plan of Correction:


483.40(b)(1) REQUIREMENT Treatment/Srvcs Mental/Psychoscial Concerns: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.
483.40(b) Based on the comprehensive assessment of a resident, the facility must ensure that-
483.40(b)(1)
A resident who displays or is diagnosed with mental disorder or psychosocial adjustment difficulty, or who has a history of trauma and/or post-traumatic stress disorder, receives appropriate treatment and services to correct the assessed problem or to attain the highest practicable mental and psychosocial well-being;
Observations:

Based on clinical record review and staff interview, it is determined the facility failed to provided follow-up psychological consults for three of 5 residents reviewed (Resident 23, 24, and 26)

Findings include:

Review of Resident 23's clinical record revealed diagnosis including but not limited to following: Osteoarthritis (inflammation or loss of cartilage in the joints; characterized by pain and stiffness in the joints, swelling, warm and tender joints and limited movement of affected joints) and Depression (Major loss of interest in pleasurable activities, characterized by change in sleep patterns, appetite, and/or daily routine).

Review of Resident 23's clinical record revealed a consult dated October 25, 2018 revealed resident was being treated for signs and symptoms of depression. Further review of neurology consult revealed resident was requested to have a follow up visit in one month.
Review of Resident 23's entire clinical record revealed no documented evidence that the resident return for a follow up appointment.

Review of Resident 24's neurology consult report, dated August 29, 2018 revealed Resident 24 was being treated for diagnosis of delusions, (a person cannot tell what is real from what is imagined) dementia(a group of symptoms associated with a decline in memory or other thinking skills severe enough to reduce a person's ability to perform everyday activities), and depression (persistently depressed mood or loss of interest in activities, causing significant impairment in daily life).

Further review of the neurology consult report revealed the resident was requested to have a follow-up consult in three months. Review of the clinical record revealed the resident had not returned for a follow-up appointment.

Review of Resident 26's neurology consult report, dated June 14, 2018 revealed Resident 26 was being treated for diagnosis of Alzheimer's dementia (a group of symptoms associated with a decline in memory or other thinking skills severe enough to reduce a person's ability to perform everyday activities), and depression (persistently depressed mood or loss of interest in activities, causing significant impairment in daily life).

Further review of the neurology consult report revealed the resident was requested to have a follow-up consult in two to four weeks. Review of Resident 26's entire clinical record revealed no documented evidence that the resident returned for a follow-up appointment.

Further review of Resident 26's clinical record revealed the resident was again seen for a neurology consult on September 27, 2018 and was requested to have a follow-up in three months. Review of the clinical record revealed the resident had not returned for a follow-up appointment.

Interview with the Nursing Home Administrator on March 8, 2019 at 2:30 p.m. confirmed Residents 24 and 26 had not had follow-up appointments with the neurologist for treatment of their psychological diagnosis.

28 Pa Code 201.18 (b)(1) Management
Previously cited 4/20/18

28 Pa Code: 201.29(j) Resident rights
Previously cited 4/20/18

28 Pa Code 211.12(d)(1)(5) Nursing services
Previously cited 4/20/18









 Plan of Correction - To be completed: 04/01/2019

Follow up recommendations for residents 23, 24 and 26 reviewed with psychiatric nurse practitioner to establish a schedule ensure follow up appointments are adhered to. All residents seen by psychiatric nurse practitioner for follow up at this time.
Binder for Psych Consultations has been revised and reviewed to address residents with F/U appointments per recommendation on report, and maintain list of residents to be seen by Consultant on next visit.
Consultation log includes column indicating date of next F/U appointment
Psychiatrist will place consultation reports in binder
Unit manager/designee will review psych report/recommendations and notify MD/PCP as needed and sign-off reviewed report before document is scanned into permanent records of the resident
Unit clerk will keep log in binder and present running list of residents to be seen by consultant each visit
DON/Unit Manager/Designee will perform weekly audits utilizing audit tool to monitor compliance for 4 weeks; then monthly for further 3 months until 100% compliance reached
Results of all audits will be discussed at the facility's QA Committee meeting quarterly for additional recommendations if necessary

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 clinical record review and staff interview, it was determined that the facility failed to notify a resident's physician of a significant weight gain for one of 15 residents reviewed (Resident 16).

Findings include:

Review of Resident 16's clinical record revealed a diagnosis of congestive heart failure (CHF - a weakness of the heart that leads to a buildup of fluid in the lungs and surrounding body tissues).

Review of Resident 16's August 2018 physician's orders revealed an order dated August 28, 2018 for daily weights for 5 days and to notify the physician if there was a greater than 3 pounds weight gain.

Review of Resident 16's weights revealed that the resident weighed 169 pounds on August 29, 2018 and 174.5 pounds on August 30, 2018, indicating a 5.5 pounds weight gain in 24 hours.

Review of Resident 16's clinical record failed to reveal evidence that the physician was notified of the 5.5 pounds weight gain on August 30, 2018.

Interview with the Director of Nursing on March 11, 2019 at approximately 10:20 a.m. confirmed that there was no evidence that Resident 16's physician was notified of the 5.5 pounds weight gain on August 30, 2018.

28 Pa Code 211.12(d)(1)(5) Nursing services
Previously cited 4/20/18





 Plan of Correction - To be completed: 04/19/2019

Plan of Correction:

Resident 16 currently admitted to hospice services, weights not indicated at this time. Weight orders have been discontinued. Resident to continue to be provided comfort measures.
Residents with orders for daily/weekly weights will be reviewed and an initial list created. This list to be reviewed daily at morning standup by clinical team. Daily weight orders will be reviewed daily; weekly weights to be reviewed weekly; any significant changes per order parameters to be communicated with practitioner as ordered; list to be updated as needed
Nurses will be educated regarding the importance of notifying practitioner/Resident/RR of any change in clinical condition and document accordingly
Random audits to be conducted on residents with change in condition to monitor documentation of communication of any clinical changes with PCP/NP/Resident or RR by DON/Unit Manager/Designee weekly times 4 weeks, monthly times 3 months until 100% compliance is achieved

Results of all audits will be discussed at the facility's QA Committee meeting quarterly for additional recommendations if necessary

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 clinical record review and staff interview, it was determined that the facility failed to clarify a physician's order regarding weights for one of 15 residents reviewed (Resident 16).

Findings include:

Review of Resident 16's clinical record revealed a diagnosis of congestive heart failure (CHF - a weakness of the heart that leads to a buildup of fluid in the lungs and surrounding body tissues).

Review of Resident 16's physician's orders revealed an order dated October 22, 2018 for weekly weights on Mondays and to notify the physician or nurse practitioner of a weight gain greater than 2 pounds in 24 hours or weight gain greater than 5 pounds in 3 days.

Review of Resident 16's weights revealed the resident received weekly weights from October 29, 2018 to February 4, 2019.

Interview with the Director of Nursing on March 11, 2019 at 10:20 a.m. confirmed that weekly weights would not indicate if Resident 16 had a 2 poumds weight gain in 24 hours or 5 pounds weight gain in 3 days, and that the facility should have clarified the weight order with Resident 16's physician.

28 Pa Code 211.12(d)(1)(5) Nursing services
Previously cited 4/20/18








 Plan of Correction - To be completed: 04/19/2019

Plan of Correction:
Resident 16 currently admitted to hospice services, weights not indicated at this time. Weight orders have been discontinued. Resident to continue to be provided comfort measures.

Facility order listing report to be reviewed daily; orders with parameters set by MD to be reviewed daily with IDT to establish validity and identify and correct discrepancies between order parameters and written order

Nurses educated to be mindful of new or revised orders and scrutinize orders as well as question discrepancies and clarify orders with parameters with practitioner as necessary

DON/Unit Manager/Designee will review and audit newly entered orders daily; any orders with parameters will be reviewed for accuracy and clarified with practitioner as needed, daily times 4 weeks, weekly times 3 months, monthly times 3 months until 100% compliance is achieved.

Results of all audits will be discussed at the facility's QA Committee meeting quarterly for additional recommendations if necessary


483.25(e)(1)-(3) REQUIREMENT Bowel/Bladder Incontinence, Catheter, UTI: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(e) Incontinence.
483.25(e)(1) The facility must ensure that resident who is continent of bladder and bowel on admission receives services and assistance to maintain continence unless his or her clinical condition is or becomes such that continence is not possible to maintain.

483.25(e)(2)For a resident with urinary incontinence, based on the resident's comprehensive assessment, the facility must ensure that-
(i) A resident who enters the facility without an indwelling catheter is not catheterized unless the resident's clinical condition demonstrates that catheterization was necessary;
(ii) A resident who enters the facility with an indwelling catheter or subsequently receives one is assessed for removal of the catheter as soon as possible unless the resident's clinical condition demonstrates that catheterization is necessary; and
(iii) A resident who is incontinent of bladder receives appropriate treatment and services to prevent urinary tract infections and to restore continence to the extent possible.

483.25(e)(3) For a resident with fecal incontinence, based on the resident's comprehensive assessment, the facility must ensure that a resident who is incontinent of bowel receives appropriate treatment and services to restore as much normal bowel function as possible.
Observations:

Based on policy review, clinical record review, and staff interview, it was determined that the facility failed to provide appropriate care to prevent urinary tract infections for one of 15 residents reviewed (Resident 10).

Findings include:

Review of facility policy Catheter Care (Indwelling Catheter), effective date January 1, 2009, revealed that the purpose of catheter care was to prevent infection. Under General Documentation Guidelines, it states that the date, time (or shift), procedure, and condition of the perineum and catheter insertion site should be documented.

Review of Resident 10's clinical record revealed the resident was readmitted to the facility from the hospital on November 23, 2018 with diagnoses of sepsis (an infection of the blood stream resulting in a cluster of symptoms such as drop in a blood pressure, increase in heart rate and fever) and kidney stones. Resident 10 returned to the facility with a Foley catheter (tube inserted into the bladder through the urethra that drains urine from the bladder).

Review of Resident 10's progress notes revealed the resident was diagnosed with a urinary tract infection (UTI) on December 11, 2018. Further review of Resident 10's progress notes revealed that the resident's Foley catheter was removed at a urology appointment on December 21, 2018.

Review of Resident 10's November and December 2018 Treatment Administration Records (TARs) revealed that there was no documented evidence that catheter care was being done during the time in which the resident had a Foley catheter (November 23, 2018 to December 21, 2018.)

Interview with the Director of Nursing on March 11, 2019 at 11:35 a.m. confirmed that there was no documented evidence that Resident 10 received catheter care to prevent further UTIs.

28 Pa Code 211.5(f) Clinical recordsPreviously cited 4/20/18

28 Pa Code 211.12(d)(1)(5) Nursing services
Previously cited 4/20/18





 Plan of Correction - To be completed: 04/19/2019

Resident 10 indwelling catheter discontinued at this time

Residents with indwelling catheters will be reviewed for appropriate orders and care documentation.

Nursing staff educated regarding importance of providing adequate indwelling catheter care to prevent infection; indwelling catheter competency to be completed by all licensed nursing staff.

All admissions/readmissions orders will be reviewed at standup by IDT for accuracy/completion, ongoing as admissions/readmissions occur.

DON/Unit Manager/Designee will review indwelling catheter orders for appropriate and thorough documentation weekly, times 4 weeks, monthly times 3 months until 100% compliance is achieved

Results of all audits will be discussed at the facility's QA Committee meeting quarterly for additional recommendations if necessary


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