Nursing Investigation Results -

Pennsylvania Department of Health
GRANDVIEW NURSING AND REHABILITATION
Patient Care Inspection Results

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GRANDVIEW NURSING AND REHABILITATION
Inspection Results For:

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GRANDVIEW NURSING AND REHABILITATION - Inspection Results Scope of Citation
Number of Residents Affected
By Deficient Practice
Initial comments:

Based on a revisit and abbreviated complaint survey completed on June 4, 2019, it was determined that Grandview Nursing and Rehabilitation Center corrected the federal deficiency cited during the survey of March 26, 2019, but continued to be out of compliance with the following 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.




 Plan of Correction:


483.10(a)(1)(2)(b)(1)(2) REQUIREMENT Resident Rights/Exercise of Rights: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(a) Resident Rights.
The resident has a right to a dignified existence, self-determination, and communication with and access to persons and services inside and outside the facility, including those specified in this section.

483.10(a)(1) A facility must treat each resident with respect and dignity and care for each resident in a manner and in an environment that promotes maintenance or enhancement of his or her quality of life, recognizing each resident's individuality. The facility must protect and promote the rights of the resident.

483.10(a)(2) The facility must provide equal access to quality care regardless of diagnosis, severity of condition, or payment source. A facility must establish and maintain identical policies and practices regarding transfer, discharge, and the provision of services under the State plan for all residents regardless of payment source.

483.10(b) Exercise of Rights.
The resident has the right to exercise his or her rights as a resident of the facility and as a citizen or resident of the United States.

483.10(b)(1) The facility must ensure that the resident can exercise his or her rights without interference, coercion, discrimination, or reprisal from the facility.

483.10(b)(2) The resident has the right to be free of interference, coercion, discrimination, and reprisal from the facility in exercising his or her rights and to be supported by the facility in the exercise of his or her rights as required under this subpart.
Observations:

Based on interviews with residents and staff interviews it was was determined that the facility failed to provide care in an environment, which promotes each resident's quality of life by failing to respond timely to residents' request for assistance as reported by 11 residents out of 19 interviewed (Residents 111, 72, 79, 80, 90, 91, 105, 123, 152, 140, and 41).

Findings include:

Interview with Resident 111 on June 4, 2019 at 1:30 p.m. revealed that the resident stated that he waits a minimum of 30 minutes, at times, for staff to answer his call bell. The resident stated that this may occur during any shift or time of day. The resident relayed that he feels the facility is short staff, which results in delays in staff responding to resident needs.

Interview with Resident 72 on June 4, 2019, at 1:15 p.m. revealed that the resident stated that she generally waits 30 minutes or longer for staff to answer her call bell. The resident relayed that the facility does not have enough staff to meet residents' needs timely.

During interview with Resident 79 on June 4, 2019, at 1:20 p.m. the resident stated that he has waited at least 20 minutes and up to 1 hour for staff to answer his call bell because the facility is short staffed.

Interview with Resident 80 on June 4, 2019 at 1:25 p.m. revealed that the resident stated that he has waited up to an hour staff to answer his call bell and provide needed assistance. The resident felt that the facility "could use more staff."

Interview with Resident 90 on June 4, 2019, at 1:40 p.m. the resident stated that she has waited an hour or longer at times for staff to respond to her call bell and provide assistance when needed. The resident explained that she had reported to the facility that her wheelchair has been "squeaking" for some time, but to date, staff have not repaired it.

Interview with Resident 91 on June 4, 2019 at 1:50 p.m. revealed that the resident stated that he has waited at least 30 minutes for staff to answer his call bell and meet his needs for assistance. The resident relayed that he felt that staff were not deployed properly to provide timely care and meet his needs.

Interview with Resident 105 on June 4, 2019 at 2:00 p.m. revealed that the resident stated that he has waited over an hour for staff to respond to his call bell and provide requested care. The resident stated that he feels that the facility "could use more staff."

Interview with Resident 123 on June 4, 2019 at 12:15 p.m. revealed that the resident reported that he has waited a minimum of 30 minutes at times for staff to respond to his call bell and provide assistance. The resident feels that the facility is short staffed and that these delays in staff response to requests for assistance occur at any time, during any shift of nursing duty.

Interview with Resident 152 on June 4, 2019 at 12:30 p.m. revealed that the resident stated that he waits at least a half hour and at times up to an hour for staff to respond to his request for assistance via the nurse call bell system. The resident stated that it was his impression that the facility was short staffed and that insufficient nurse staffing was the cause of the problem.

Interview with Resident 140 on June 4, 2019, at 1:05 p.m. revealed that the resident expressed concerns with the adequacy of nurse staffing because she usually waits more than 30 minutes for staff to answer her call bell and provide assistance when requested.

Interview with Resident 41 on June 4, 2019, at 1:46 p.m. the resident indicated that she also waits at least 1 hour for someone to answer her call bell and the facility could use more staff.

During interview with the Director of Nursing on June 4, 2019, at 2:30 p.m. the DON was unable to explain the residents' concerns regarding staffs' failure to respond to the residents' requests for assistance in a timely manner, which was negatively affecting the residents' quality of life in the facility.


483.10(a)(1)(2)(b)(1)(2) Resident Rights/Exercise of rights
Previously cited: 12/15/18, 7/13/18

28 Pa. Code 211.12 (a)(c)(d)(4)(5) Nursing Services
Previously cited: 3/26/19, 7/13/18, 4/11/18, 1/4/18, 8/4/17

28 Pa. Code 201.29 (j) Resident Rights
Previously cited: 7/13/18, 1/4/18

28 Pa. Code 201.18 (e)(1)(2)(3)(6) Management
Previously cited: 7/13/18








 Plan of Correction - To be completed: 07/08/2019

1. Call Bell Satisfaction surveys were conducted with Residents 111,72,79,80,90,91,105,123,152,140 and 41 and Resident 90's w/c has been repaired. Staffing levels for 3 different weeks were reviewed at the time of this survey and noted to be adequate and ranging between 3.03 to 3.75 hrs/resident.
2. Call Bell Satisfaction surveys will be completed with all capable residents as well as Implementation of a Guardian Angel program for all residents to monitor all aspects of care and satisfaction.
3. All Staff will be re-educated on timely call bell response times and adequate staffing levels to meet individual needs of the residents and promote their quality of life as well as what the Guardian Angel Program entails.
4. Staffing levels will be calculated daily and shared with the residents at their Monthly resident council meeting. Call Bell Response time audits will be conducted weekly on all 3 shifts as well as random Resident call bell satisfaction surveys weekly x 8 weeks to ensure solutions are sustained. All results will be discussed at monthly QA meetings.
5. Completion date: July 8, 2019.

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 a review of the minutes from resident food committee meetings and interviews with residents it was determined that the facility failed to demonstrate sufficient evidence to resolve issues regarding food preparation and palatability brought forth at these resident group meetings.

Findings included:


A review of of the minutes from the April 10, 2019, resident food committee meeting revealed that Resident 68 complained about the palatability of the entree, Swiss chicken, which was served to the residents.

Resident 135 expressed complaints that some of the vegetables are overcooked and some are not cooked long enough.

A review of the minutes from the May 8, 2019, food committee meeting revealed that residents (no names identified) complained that fish was the alternate entree being served too frequently. Residents also complained that carrots not being cooked and have been hard when served lately.

Interview with Resident 111 on June 4, 2019 at 1:30 p.m. revealed that the resident stated that the "food is terrible, there is no taste to the food, and coffee is watered down."

Interview with Resident 72 on June 4, 2019 at 1:15 p.m. revealed that the resident stated that "there is no taste to the food, they need to use more spices."

Interview with Resident 79 on June 4, 2019 at 1:20 p.m. revealed that the resident stated that he would like more variety in the foods served. The resident stated "there is no taste to it and sometimes it's cold. "

Interview with Resident 90 on June 4, 2019 at 1:40 p.m. revealed that the resident stated that she "thinks the food could be better."

Interview with Resident 123 on June 4, 2019 at 12:15 p.m. revealed that the resident stated that the "food does not look appetizing."

Interview with Resident 140 on June 4, 2019 at 1:05 p.m. revealed that the resident stated that " there is no taste to it (the food) and sometimes it's cold."

During interview with Resident 41 on June 4, 2019 at 1:46 p.m. the resident stated that "there is no taste to it (the food)."

Interview conducted on June 4, 2019, at approximately 2:30 p.m. with the Nursing Home Administrator acknowledged that the residents have complaints regarding the palatability and preparation of the food served.



28 Pa. Code: 211.16(c)(d) Dietary Services.
Previously cited 7/13/18, 8/4/17

28 Pa. Code: 201.29(i) Resident Rights.
Previously cited: 7/13/18, 1/4/18




 Plan of Correction - To be completed: 07/08/2019

1. Dietary representative met with Residents 68, 135, 111, 72,7 9, 90, 123,140 and 41 and offered to update their food preferences and discuss individual concerns regarding the food.
2. All residents will be reminded that there is a substitution menu if they do not like a meal that is being served. Menu updated to not include fish as the alternate as often. Residents will be asked at Menu Committee, Resident Council and Careplan meetings if they would like to update their dietary preferences. Any resident concerns regarding food that are brought up at menu committee will be addressed following the meeting with individual residents and then discussed at the next month's meeting in order to assure satisfaction and that issues have been resolved.
3. All Dietary staff will be in-serviced on Proper Food Preparation, seasoning foods, Checking items to ensure they look palatable and appetizing, Proper placement on plate, temperatures.
4. QA Designee will conduct
Meal Satisfaction surveys (10 residents per week will be asked to participate in rating the meals on the appearance, taste, temperature & satisfaction overall) and Random Test trays x 8 weeks to ensure compliance. All results will be discussed at monthly QA meetings.
5. Completion Date: July 8, 2019.

483.25(k) REQUIREMENT Pain Management: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(k) Pain Management.
The facility must ensure that pain management is provided to residents who require such services, consistent with professional standards of practice, the comprehensive person-centered care plan, and the residents' goals and preferences.
Observations:
Based on a review of clinical records and staff interview it was determined that the facility failed to follow physicians orders for pain management for one resident (Resident 111) out of five sampled residents.

Findings include:

A review of Resident 111's clinical record revealed that the resident was admitted to the facility on April 19, 2019, and had current diagnoses to include hydronephrosis (blockage of urine in the urinary tract or when the urine flows back into kidneys, causing pain in the flank and abdomen).

The resident had physician orders upon admission that included Acetaminophen (a non-narcotic pain medication) 325 milligrams (mg) give 2 tablets by mouth every 4 hours as needed for mild pain and Tramadol (a narcotic-like pain medication) 50 mg give 1 tablet by mouth every 6 hours as needed for moderate to severe pain (rated 5-10 on a scale of 1-10 with 10 being the most severe pain).

A review of the resident's medication administration record (MAR) for the month of April 2019, revealed that nursing staff administered Acetaminophen 325 mg, 2 tablets to the resident on April 20, 2019 at 10:34 a.m. for a pain level of 5; on April 21, 2019 at 2:00 p.m. for a pain level of 5; on April 22, 2019, at 7:51 p.m. for a pain level of 6, and April 25, 2019 at 10:05 a.m. with a pain level of five.

According to the physician's orders for the resident's pain management Tramadol 50 mg was prescribed for pain rated at a 5 or above and should have been administered to the resident on the above occasions.

Interview with the Director of Nursing on June 4, 2019 at 12:45 p.m. confirmed that the staff failed to follow the physician orders for pain management and administered acetaminophen for the resident's pain rated at a five or higher.



28. Pa Code: 211.12 (a)(d)(1)(3)(5) Nursing services
Previously cited: 3/26/19, 7/13/18, 4/11/18, 1/4/18, 8/4/17




 Plan of Correction - To be completed: 07/08/2019

1. Unable to retroactively correct the deficiency pertaining to Resident 111. Resident had received Acetaminophen on several occasions with positive effectiveness; however, he also had another medication (tramadol) ordered for a higher pain scale. At the time of the survey, Resident 111's pain management regime was reviewed to ensure appropriateness of all orders in order to provide adequate pain relief.
2. All residents with multiple pain medications will be reviewed for accuracy of orders, Pain scales, and appropriate administration by nursing staff.
3. All Nursing staff will be re-educated on the Pain Management Policy including following pain scales according to Physician orders.
4. QA Designee will audit 3 Medication Administration Records weekly x 8 weeks to monitor performance and ensure compliance. All results will be discussed at monthly QA meetings.
5. Completion Date: July 8, 2019


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