Nursing Investigation Results -

Pennsylvania Department of Health
RENAISSANCE HEALTHCARE & REHABILITATION CENTER
Patient Care Inspection Results

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RENAISSANCE HEALTHCARE & REHABILITATION CENTER
Inspection Results For:

There are  59 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.
RENAISSANCE HEALTHCARE & REHABILITATION CENTER - Inspection Results Scope of Citation
Number of Residents Affected
By Deficient Practice
Initial comments:

Based on a Medicare/Medicaid Recertification, Civil Rights Compliance and State Licensure Survey, and an abbreviated survey in response to a complaint, completed on February 7, 2019, it was determined that Renaissance Healthcare and Rehabilitation 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 related to the health portion of the survey process.



 Plan of Correction:


483.60(f)(1)-(3) REQUIREMENT Frequency of Meals/Snacks at Bedtime:This is a less serious (but not lowest level) deficiency but was found to be widespread throughout the facility and/or has the potential to affect a large portion or all the residents.  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.
483.60(f) Frequency of Meals
483.60(f)(1) Each resident must receive and the facility must provide at least three meals daily, at regular times comparable to normal mealtimes in the community or in accordance with resident needs, preferences, requests, and plan of care.

483.60(f)(2)There must be no more than 14 hours between a substantial evening meal and breakfast the following day, except when a nourishing snack is served at bedtime, up to 16 hours may elapse between a substantial evening meal and breakfast the following day if a resident group agrees to this meal span.

483.60(f)(3) Suitable, nourishing alternative meals and snacks must be provided to residents who want to eat at non-traditional times or outside of scheduled meal service times, consistent with the resident plan of care.
Observations:

Based on a review of facility documentation and staff and resident interviews, it was determined the facility failed to ensure that there was no more than 14 hours between substantial evening meal and breakfast the following day.

Findings include:

A review of facility's scheduled meal times revealed meal times greater than 14 hours between dinner and breakfast (Arrival times: 1st cart - First Floor at 5:00 PM for Dinner, 1st cart - First Floor at 8:00 AM for Breakfast = 15 hours; 2nd cart - First Floor at 5:15 PM for Dinner, 2nd cart - First Floor at 8:15 AM for Breakfast = 15 hours; 3rd cart - First Floor at 5:25 PM for Dinner, 3rd cart - First Floor at 8:25 AM for Breakfast = 15 hours; 4th cart - Second Floor North at 5:35 PM for Dinner, 4th cart - Second Floor North at 8:35 AM for Breakfast = 15 hours; 5th cart - Second Floor South at 5:45 PM for Dinner, 4th cart - Second Floor South at 8:45 AM for Breakfast = 15 hours.

Observation in the kitchen on February 6, 2018 at 9:45 AM revealed tray-line was still operating for the breakfast meal. Further observation revealed that Cart 5 was delivered to the second floor south at 9:50 AM and staff began to deliver the breakfast trays to the residents over 16 hours after the scheduled delivery time of the supper trays the night before.

An interview with the second floor Unit Manager on February 6, 2018 at 10:00 AM confirmed that the breakfast meal was over an hour late and that the breakfast is sometimes late.

An interview with the Acting Food Service Director on February 6, 2018 at 10:15 AM confirmed that the breakfast was over an hour late and that there was a call off for the Dietary person who sets up the meal tickets and calls the diets on the tickets during tray-line putting the department behind.

An interview on February 6, 2018 at 10:45 AM with Resident R20, who is alert and oriented, confirmed that her breakfast was late today and that breakfast being late is not uncommon. Resident R20 also stated that the evening meal is usually on time, and when asked if she was offered a snack in the evening she indicated that the evening staff were not very friendly and unless she asked she was not offered a snack after supper.

The facility failed to ensure that there was no more than 14 hours between substantial evening meal and breakfast the following day.

28 Pa. Code 211.6(a)(b) Dietary services




 Plan of Correction - To be completed: 03/07/2019

Meal times have been changed to ensure that the evening meal and breakfast will not exceed 14 hours.
Residents not receiving meals timely have the potential to affected.
Dietary and Nursing staff have been reinserviced on new meal times.
Dietary Manager or Designee will audit times of meal service daily for 1 month and then weekly thereafter to ensure timeliness of meals. Any issues will be corrected immediately.
Dietary Manager or Designee will review audits with Administrator on a weekly basis for 1 month and then monthly thereafter for 3 months. Findings of the audit will be submitted to the QAPI for additional review/recommendations.
Date of Compliance: 3/7/19

483.60(i)(1)(2) REQUIREMENT Food Procurement,Store/Prepare/Serve-Sanitary:This is a less serious (but not lowest level) deficiency but was found to be widespread throughout the facility and/or has the potential to affect a large portion or all the residents.  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.
483.60(i) Food safety requirements.
The facility must -

483.60(i)(1) - Procure food from sources approved or considered satisfactory by federal, state or local authorities.
(i) This may include food items obtained directly from local producers, subject to applicable State and local laws or regulations.
(ii) This provision does not prohibit or prevent facilities from using produce grown in facility gardens, subject to compliance with applicable safe growing and food-handling practices.
(iii) This provision does not preclude residents from consuming foods not procured by the facility.

483.60(i)(2) - Store, prepare, distribute and serve food in accordance with professional standards for food service safety.
Observations:

Based on observations, interviews with staff, and a review of facility policies and documentation, it was determined that the facility did not ensure that food was stored, prepared, distributed, and served in accordance with professional standards for food service safety.

Findings include:

The undated "Food Storage" Policy # 4006, states, Leftover food is stored in covered containers or wrapped carefully and securely, clearly labeled, and dated before being refrigerated. Leftover food is used within 48 hours. (No single service containers are to be used to store food.) Scoops cannot be stored in the food containers but stored covered near the containers. Every refrigerator must be equipped with an inside thermometer. Rewrap packages of frozen foods which have been opened to prevent freezer burn and spoilage, re-label if original label has been removed.

An initial tour of the Food Service Department was conducted on February 4, 2019 at 9:30 AM with Employee E3, Acting Food Service Director, which revealed the following:

Observation in the receiving area outside the facility revealed that the food is delivered down a long sidewalk next to residential housing which includes open garbage cans and open recycling containers. Along this sidewalk are stacks of plastic bread racks, set of dollies with wheels for bread racks, stacks of empty milk crates and milk crates scattered along the sidewalk. During the tour of the outside of the facility the door was left propped open with a milk crate.

Observations in the walk-in freezer revealed no internal thermometer, two cases of beef steak fritters with broken boxes and left uncovered and open to the air, frozen cookie dough portions in an open plastic bag with no label or date and open to the air, a clear plastic bag of yellow eggs product in the shape of an omelet with no label or date and hamburger shaped meat patties in clear plastic packaging which were out of the master case with no label or date.

Observations in the dry storage room revealed a white container with a clear lid containing rice with a scoop left inside the container sitting directly in the rice. Further observations in the dry storage room revealed a crack in the wall in the corner near the door to the walk-in cooler, a brownish rust colored stain in the ceiling near above the crack in the wall and a heavy build-up of dust dirt and grime on the floor in the corner near the walk-in cooler door.

An observation in the walk-in cooler revealed no internal thermometer.

Observations in the kitchen revealed broken floor tiles on the step leading from the dry storage room down into the kitchen and more broken floor tiles in the main kitchen area. Further observation behind the cooks line revealed a floor drain which was recessed well below the floor surface and was located behind the steam table creating a tripping hazard, and broken floor tiles around the floor drain. Still further observation in the kitchen revealed that the plate warmer/lowerator had a build-up of yellowish substance on the exterior and interior surfaces, and that the bottom convection oven had a heavy build-up of black burned on substance on the inner surfaces of the oven including the glass door, and that the steamer had a build-up of dark substance on the bottom interior surface and the steamer door gasket had a coating of dark substance and was worn and torn, and the bottom of the gasket was almost completely missing and would not have effectively keep the steam from escaping from the bottom of the door creating a potential burn hazard. Observations of the floor and walls near the steamer revealed floor tiles missing grout and the space around the loose floor tiles was filled with stagnant water causing a slipping hazard and potential breeding ground for bacteria and pests, and a hole in the wall near the floor beside the steamer.

Observations of the three-door reach-in cooler revealed a stainless steel (ss) pan labeled "sauce" which was dated 1/23/19, a ss pan labeled "tomato soup" dated 1/20/19, a Styrofoam single service plate covered with plastic wrap containing two slices of meatloaf with no label or date, a stainless steel pan partially covered with torn plastic wrap contained a light colored meat in a hard, white fat with a label containing only a date of 1/30/19 and no food item name, and a stainless steel pan of a food which resembled applesauce which had only a date of 1/29/19 on the label but no food item name to identify the item. Further observation in the reach-in cooler revealed an open bottle of hot sauce and an open jar of grape jelly with no date when the items were opened.

Interview with Acting Food Service Director on February 4, 2019 at about 9:50 AM confirmed the above observations and indicated that the facility policy was to discard leftovers after 72 hours.

Observation on February 4, 2019, at approximately 10 AM in the pantry on the first-floor dining room revealed a refrigerator which contained three white plastic bags, two black plastic bags and one grey plastic bags all of which contained food items and none of the bags contained a label with a resident name or room number or a date when the bag containing perishable food was placed into the refrigerator. Further observation in the pantry refrigerator revealed a green container with a date of 12/25/18 and no label with identifying information about the food item or resident information. Still further observation in the first-floor pantry revealed a container of margarine portion cups with keep refrigerated on each individual cup which was found on the shelf in the cupboard above the counter and there was no date on the container indicating how long the margarine was in the cabinet at room temperature.

Observation on February 4, 2019, at approximately 10:10 AM in the pantry on the second floor dining room revealed a refrigerator which contained a single service Styrofoam cup with a straw in the lid containing liquid but had no label or date, a yellow plastic bag containing food with no label or date, a blue cloth lunch bag and a striped insulated lunch bag each containing food with no label, date or resident name or room number. Further observation in the second-floor pantry revealed the stainless steel shelf under the counter was dusty and contained food particles and crumbs and the shelf under the steam table had a build-up of yellowish substance along with dust and dirt. Still further observation revealed a hole in the wall near the floor by the steamer.

Interview with the Acting Food Service Director on February 4, 2019 at about 10:15 AM confirmed the above observations and indicated that the pantry refrigerators were for resident food which should be labeled and dated and that most of the food in the bags belonged to staff and that the margarine should not be stored at room temperature. Interview with second floor Unit Manager confirmed that the staff should not keep their lunches in the pantry refrigerators.

Observations in the dish room on February 7, 2019 at approximately 11:30 AM revealed many missing and some broken floor tiles near the dish machine, and a heavy black build-up of dust, dirt and grime on the walls and pipes under the dish tables.

An interview with the Acting Food Service Director on February 7, 2019 at about 10:40 AM confirmed the missing floor tiles and lack of sanitation in the dish room.

The facility failed to store, prepare and serve food in accordance with professional standards for food service safety.


28 Pa. Code 201.14(a) Responsibility of licensee
Previously cited 9/20/18, 3/30/18

28 Pa. Code 201.18(b)(3) Management
Previously cited 3/30/18

28 PA. Code: 207.2(a) Administrator's responsibility





 Plan of Correction - To be completed: 03/07/2019

All unlabeled/undated/outdated/spoiled items and open boxes in any fridge, freezer, or food storage area was discarded immediately. Thermometers were placed in all freezers and refrigerators where resident food is kept. Food delivery pathway has been changed to a location that avoids the residential housing garbage cans and recycling containers. The steamer was thoroughly cleaned and the The ovens were thoroughly cleaned.
Residents receiving meals have the potential to be affected.
Dietary Manager will reeducate dietary staff on ensuring that food is stored prepared, distributed, and served with professional standards for food service safety. Education will include cleaning schedules and audits of food prep and storage areas, food delivery, food storage temperature audits, notification of maintenance services when maintenance issues are identified, and adhering to food storage policy.
The crack in the wall in the corner near the door to the walk in cooler and brownish discolored area on the ceiling in the dry food storage area will be repaired through the roofer repairing the drain line and maintenance staff replacing the damaged wall and repairing the ceiling. Housekeeping staff will thoroughly clean the floor in the dry food storage area. The floor in the dry storage area will be cleaned. The broken tile in the kitchen and the dish machine will be replaced. The plate warmer/lowerator, convection oven, and steamer will be cleaned both interior/exterior surfaces. The drain will be raised to the level of the floor to prevent a trip hazard. The other drain which is capped that contained the stagnant water will also be raised to the level of the floor to prevent water from pooling. Hole in wall by the steamer will be repaired. Both Pantry areas were cleaned. Gasket for the steamer will be replaced.
Dietary Manager or designee will review cleaning schedules and audits of food prep and storage areas, food delivery, food storage temperature audits, notification of maintenance services when maintenance issues are identified, and adhering to food storage policy daily for 1 month and weekly with the Administrator for 3 months.
Findings of the audit will be submitted to the QAPI for additional review/recommendations.
Date of Compliance: 3/7/19

483.60(d)(1)(2) REQUIREMENT Nutritive Value/Appear, Palatable/Prefer Temp: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.
483.60(d) Food and drink
Each resident receives and the facility provides-

483.60(d)(1) Food prepared by methods that conserve nutritive value, flavor, and appearance;

483.60(d)(2) Food and drink that is palatable, attractive, and at a safe and appetizing temperature.
Observations:

Based on a review of facility documentation, and interviews with residents and facility staff, it was determined that the facility failed to serve food at a safe and appetizing temperature (Residents R18 & R54).

Findings include:

During dining observation in the second-floor dining room on February 4, 2019, Resident R18, who had the alternate chicken with mashed potatoes and collard greens, complained that her food was cold. When asked if that happens a lot, she said that the hot foods are often served cold. Resident R54, who also had the alternate chicken, au gratin potatoes and collard greens, said that her food was barely warm today. She confirmed that this was not the first time her food was not warm enough.

An interview with Employee E5, Dietary Aide, confirmed that some of the hot food temperatures taken from steam table in the second-floor dining room were below the standard which was 165 degrees and he acknowledged the low temperatures in the second-floor temperature log book. A review of the Tray Line Taste & Temp Log for February 4, 2019 lunch meal revealed Target temperatures of 165 degrees for hot foods and actual temperatures of 103 degrees for chicken, 147 degrees for au gratin potatoes and 136 degrees for mashed potatoes.

The facility failed to provide foods served at safe and appetizing temperatures.

28 Pa. Code 201.14(a) Responsibility of licensee
Previously cited 9/20/18, 3/30/18

28 Pa. Code 201.18(b)(3) Management
Previously cited 3/30/18

28 Pa. Code 201.29 (j) Resident rights



 Plan of Correction - To be completed: 03/07/2019

Residents R18 and R54 had meals replaced and were given meals at appropriate temperatures upon identification.
Residents with warm meals have the potential to be affected.
Dietary Staff has been reinserviced in regard to checking food temperature.
The steam table will be turned on 30 minutes prior to service in the dining room to ensure that food maintains proper temperature prior to serving. Dietary Manager or designee will audit Temperatures daily and prior to meal service for the steam table in the kitchen and 2nd floor dining room. Dietary Manager or designee will sample trays randomly to ensure proper temperature. Any issues will be corrected immediately.
Dietary Manager or designee will audit temperatures for steam tables and sample trays on a daily basis for 1 month and then weekly thereafter. Dietary Manager will review findings and log book of the temperature audit with the Administrator on a weekly basis for 1 month and then quarterly thereafter. All results will be submitted to the QAPI for additional review/recommendations.
Date of Compliance: 3/7/19

483.10(c)(6)(8)(g)(12)(i)-(v) REQUIREMENT Request/Refuse/Dscntnue Trmnt;Formlte Adv Dir: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(c)(6) The right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.

483.10(c)(8) Nothing in this paragraph should be construed as the right of the resident to receive the provision of medical treatment or medical services deemed medically unnecessary or inappropriate.

483.10(g)(12) The facility must comply with the requirements specified in 42 CFR part 489, subpart I (Advance Directives).
(i) These requirements include provisions to inform and provide written information to all adult residents concerning the right to accept or refuse medical or surgical treatment and, at the resident's option, formulate an advance directive.
(ii) This includes a written description of the facility's policies to implement advance directives and applicable State law.
(iii) Facilities are permitted to contract with other entities to furnish this information but are still legally responsible for ensuring that the requirements of this section are met.
(iv) If an adult individual is incapacitated at the time of admission and is unable to receive information or articulate whether or not he or she has executed an advance directive, the facility may give advance directive information to the individual's resident representative in accordance with State Law.
(v) The facility is not relieved of its obligation to provide this information to the individual once he or she is able to receive such information. Follow-up procedures must be in place to provide the information to the individual directly at the appropriate time.
Observations:

Based on review of clinical records and interviews with facility staff, it was determined the facility failed to ensure that a resident's choice of advanced directives were reflected in physician orders for one of 28 residents reviewed (Resident R20).

Findings include:

Resident R20 was admitted to the facility on December 8, 2017 with diagnoses including heart failure (a progressive heart disease that affects pumping action of the heart muscles), major depressive disorder (known simply as depression, a mental disorder characterized by at least two weeks of low mood that is present across most situations, often accompanied by low self-esteem, loss of interest in normally enjoyable activities, low energy, and pain without a clear cause) and type 2 diabetes mellitus (a chronic disease characterized by high levels of sugar in the blood).

On February 5, 2019, a review of the resident's clinical record revealed a Pennsylvania Orders for Life-Sustaining Treatment (POLST) form, dated September 13, 2017, signed by the resident's daughter and the physician. The POLST form describes the resident's wishes for health care in a medical emergency including whether or not to perform CPR in the event the resident stopped breathing or their heart stopped beating. The resident's wishes per the POLST form were DNR (Do Not Resuscitate), Comfort Measures Only (which includes do not transfer to the hospital.).

A review of Resident R20's medical record revealed a physician's orders dated December 18, 2017 for Full Code (full code status means that all possible measures are taken to revive a person and sustain life).

During an interview with Employee E1, Nursing Home Administrator (NHA), on February 5, 2019 at 2:00 p.m. it was verified that the current physician order for Full Code did not match the POLST Form in the medical record which was for DNR, Comfort Measures Only. The NHA also indicated that the facility does not have a policy on advanced directives.

The facility failed to ensure that a resident's choice of advanced directives were accurately reflected in physician orders.

28 PA Code: 201.29(a) Resident rights.




 Plan of Correction - To be completed: 03/07/2019

Resident R20's code status has been updated to DNR, Comfort Measures.
Social Services Director is completing an audit of all active residents in the facility. Audit will include if the residents' POLST corresponds with the physician's order to ensure the resident's choice of advanced directives are reflected in the physicians order.
Professional Nursing staff and Social Service staff will be re-inserviced on the Advance Directive Policy by the Director of Staff Development or designee. The inservice will also include the need to ensure that the residents' POLST corresponds with the physician's order.
Social Service staff will audit the residents POLST and physician order with each care conference. Results of the audit will be presented to the QAPI Committee for additional review/ recommendations.
Date of compliance: 3/7/19

483.30(a)(1)(2) REQUIREMENT Resident's Care Supervised by a Physician: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.
483.30 Physician Services
A physician must personally approve in writing a recommendation that an individual be admitted to a facility. Each resident must remain under the care of a physician. A physician, physician assistant, nurse practitioner, or clinical nurse specialist must provide orders for the resident's immediate care and needs.

483.30(a) Physician Supervision.
The facility must ensure that-

483.30(a)(1) The medical care of each resident is supervised by a physician;

483.30(a)(2) Another physician supervises the medical care of residents when their attending physician is unavailable.
Observations:


Based on clinical record review, interviews with staff and a review of facility policy and procedure, it was determined that the facility failed to ensure the physician was aware of a substantial weight gain for one out of 28 residents reviewed (Resident R88.)

Finding include:

A review of the facility policy titled " Weight Assessment and Intervention," date revised September 2008, revealed that any weight change of five pounds or more since the last weight assessment will be retaken, preferably at the time the weight was taken or within 48 hours for confirmation. Re-weights are confirmed by charge nurse or supervisor prior to entering the weight in the electronic health record.

A review of Resident R88's clinical record revealed that the resident was admitted to the facility on January 3, 2018 with a diagnosis of dementia, diabetes and difficulty walking. Further review revealed that the resident is cognitively impaired in decision making skills and needs assistance with dressing, bathing and all activities of daily living.

A review of Resident R88's weight graph revealed that on November 7, 2018 the resident's weight was recorded as 180 pounds. Further review revealed that on December 10, 2018 the resident's weight was recorded as 209.4 pounds. On December 18, 2018 the resident's weight was recorded at 208 pounds.

A review of physician progress notes dated October 30, 2018 revealed that the physcian noted that the residents weight was 179.6 pounds . Further review of the physician progress note dated December 19, 2018 revealed the physician noted that the resident's weight was 208 pounds. No other evidence available for review that the physician addressed the 29 pound weight gain in one month for the resident.

An interview with Employee E4, the registered dietician on February 7, 2019, at 12:00 p.m. confirmed that there was no documentation available for review that the physician had addressed the 29 pound weight gain in one month for the resident.

The facility failed to ensure that the physician addressed a 29 pound weight gain in one month for a resident.

28 Pa.Code:211.2(a) Physician services.

28 Pa.Code:211.12(d)(5) Nursing services.
Previously cited 9/20/18, 3/30/18, 2/15/17








 Plan of Correction - To be completed: 03/07/2019

The Physician for Resident R88 has been made aware of the significant weight gain.
The Dietician has audited the residents in the facility for significant weight changes and has notified the Physician for those residents who had a significant weight change.
Professional Nursing staff and the Dietician will be re-inserviced on the Weight Assessment and Intervention Policy by the Director of Staff Development or designee. The Dietician has been re-inserviced to ensure physician notification of significant weight changes.
The Dietician will complete a monthly audit of those residents with significant weight change to ensure physician notification occurred. Results of the audit will be presented to the QAPI Committee for additional review/ recommendations.
Date of compliance: 3/7/19

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 observations, staff interviews and clinical record review it was determined that the facility failed to ensure timely follow up care regarding dental services for one out of 28 residents reviewed (Resident R88.)

Findings include:

A review of Resident R88's clinical record revealed that the resident was admitted to the facility on January 3, 2018, with a diagnosis of dementia, diabetes and difficulty walking. Further review revealed that the resident is cognitively impaired in decision making skills and needs assistance with dressing, bathing and all activities of daily living. An observation of the resident on February 4, 2019 revealed the resident had food debris in his teeth and his teeth were jagged.

A review of Resident R88's clinical record revealed that he was seen by the dentist on May 16, 2018 with recommendations for extraction of root tips numbers 7, 8, 9, 10, 12, 17 and 30. Dental consult also stated that the resident had moderate periodontal disease (a serious gum infection that damages gums and can destroy the jawbone.)

Further review revealed no evidence available for review that the resident had a follow up appointment with the dentist for extractions.

An interview with the Nursing Home Administrator on February 7, 2019 at 11:00 a.m. confirmed that the resident did not have a timely follow up appointment with the dentist.

The facility failed to ensure that the resident saw the dentist in a timely manner.

28 PA. Code:211.12(c) Nursing services.
Previously cited 3/30/18

28 PA. Code:211.12(d)(1) Nursing services.
Previously cited 9/20/18, 3/30/18, 2/15/17

28 PA. Code:211.12(d)(3) Nursing services.
Previously cited 3/30/18, 2/15/17





 Plan of Correction - To be completed: 03/07/2019

Resident R 88 was seen by the Dentist on 2/8/19.
The Unit Managers or designee are completing a house wide audit of all active residents to ensure a timely appointment with the Dentist.
Professional Nursing staff and Social Service staff will be re-inserviced regarding the Dental Services Policy by the Director of Staff Development or designee to include timely follow up regarding dental services.
The Unit Managers or designee will audit Dental consults monthly to ensure timely follow up. Results of the audit will be forwarded to the QAPI Committee for additional review/ recommendations.
Date of compliance: 3/7/19

483.60(i)(3) REQUIREMENT Personal Food Policy: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.
483.60(i)(3) Have a policy regarding use and storage of foods brought to residents by family and other visitors to ensure safe and sanitary storage, handling, and consumption.
Observations:

Based on a review of facility policy review and staff interview it was determined that the facility failed to develop and implement a policy regarding use and storage of foods brought to residents by family and other visitors to ensure safe and sanitary storage, handling, and consumption for the use of all residents in the facility.

Findings include:

Review of established facility policies revealed that the facility did not have a current policy and procedures to address the use and storage of foods brought to residents from visitors.

On February 4, 2019, at approximately 9:30 a.m. during the Entrance Conference, the facility was requested to provide copy of their facility policy regarding use and storage of foods brought to residents from outside sources.

On February 7, 2019, at approximately 8:30 a.m. the Nursing Home Administrator (NHA) and the Director of Nursing were again asked for a copy of their facility policy regarding use and storage of foods brought to residents from outside sources.

Interview with the NHA on February 7, 2019, at approximately 1:45 p.m. confirmed that the facility had not developed a policy regarding the use and storage of foods brought to residents by family and other visitors to ensure safe and sanitary storage, handling, and consumption.


28 Pa. Code 201.18(e)(1) Management
Previously cited 3/30/18

28 Pa. Code 211.10(a) Resident care policies

28 Pa. Code 211.6(c) Dietary services




 Plan of Correction - To be completed: 03/07/2019

Facility has implemented the policy "Foods Brought by Family/Visitors". The Pantry Refrigerators on 1st and 2nd Floor have been audited and outdated food items have been removed.
Nursing staff and Dietary staff will be inserviced regarding the policy "Foods Brought by Family/Visitors".
Unit Manager or designee will audit compliance with the policy via the weekly Pantry Refrigerator Audit for 90 days.Results of the audit will be forwarded to the QAPI Committee for review/recommendations.


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