QA Investigation Results

Pennsylvania Department of Health
ERIE INDEPENDENCE HOUSE
Health Inspection Results
ERIE INDEPENDENCE HOUSE
Health Inspection Results For:


There are  35 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.



Initial Comments:
A focused fundamental survey was conducted August 29 - 31, 2018, to determine compliance with the requirements of the 42 CFR Part 483, Subpart I Requirements for Intermediate Care Facilities. The census during the survey was six and the sample consisted of three individuals.


Plan of Correction:




483.460(a)(3)(i) STANDARD
PHYSICIAN SERVICES

Name - Component - 00
The facility must provide or obtain annual physical examinations of each client that at a minimum includes an evaluation of vision and hearing.



Observations:

Based on record review and interview, it was determined the facility failed to ensure an annual physical exam was completed. This applied to one of three individuals (#1) in the sample. Findings included:

A record review was completed for Individual #1 on August 30, 2018, and revealed that the most recent annual physical exam was completed on June 7, 2017.

During an interview on August 31, 2018, at 7:55 AM, the program manager/RN confirmed that Individual #1 did not have a current annual physical exam.





Plan of Correction:

The annual physical for individual #1 was completed on 9/4/2018.

Upon admission to the ICF, the program manager or designee will ensure annual physicals for each consumer occurs within 30 days from date of admission.

Annually from the date of initial physical, the program manager or designee will ensure annual physicals occur.

The QORCP will monitor upon each admission by observing the physician annual document has been completed within 30 days of admission. The QORCP will continue to monitor for a period of two years from the date of initial physical all current and future admissions obtain annual physical exams by direct observation of the annual physical documentation.


483.460(c) STANDARD
NURSING SERVICES

Name - Component - 00
The facility must provide clients with nursing services in accordance with their needs.



Observations:

Based on observations, record review, and interview, it was determined the facility failed to ensure nursing services maintained proper labeling standards. This applied to one of three individuals (#1) in the sample. Findings included:

1. a. During a record review for Individual #1 on August 30, 2018, it was noted that the August 2018 medication administration record (MAR) included "CBD/THC 10:1 capsule 330 mg take one by mouth once daily 2 hours before or 2 hours after other medication *=only 15 minute window." The medication was timed for 6:00 AM, and Individual #1's other medications were timed to be administered at 8:00 AM. Because there was no doctor's order for this medication in the record, the surveyor requested the order from the program manager/RN.

An order for the above medication was provided by the program manager/RN on August 30, 2018, and it read, "Standard Farms 10mg CBD/1mg THC Capsules. Give [Individual #1] 1 capsule by mouth daily, at least two hours after her other medications."

An interview was conducted with the program manager/RN on August 30, 2018. When asked why the doctor's order for Individual #1's CBD/THC did not match what was written on the MAR, the program manager/RN stated that the pharmacist said it was all right to give the medication two hours before other medications. Further interview as to what the "only 15 minute window" written on the MAR indicated, the program manager/RN confirmed he wrote that in so that staff would give the medication 15 minutes before or after the 6:00AM time frame. The program manager/RN further confirmed that a written doctor's order was not obtained to clarify the discrepancy between the original order and what was hand written on the MAR.

1. b. On August 30, 2018, the surveyor requested to observe the label from Individual #1's CBD/THC capsules to ensure the label matched the doctor's order. The box of medication had a hand printed label taped over the printed pharmacy label that read, "1 capsule by mouth once daily 2HR before other meds (or 2 HR after) then titrate to twice daily."

During an interview on August 30, 2018, at 9:45 AM, the program manager/RN confirmed that the label on the medication did not match the instructions on the MAR and did not match the doctor's order for Individual #1's CBD/THC. Further interview confirmed that the program manager/RN failed to obtain clarification in the form of a doctor's order for this medication.









Plan of Correction:

On or before 9/14/2018 physician and pharmacist recommendations for CBD/THC for Individual number 2 were retrieved.
The recommendation, product label, direction and MAR entry were matched and entered on record.

The program manager or designee will ensure any future physician order for CBD/THC are matched with an identical product label and MAR entry.

On a monthly basis(for 6 months) the QORCP will verify by visual comparison the physician/pharmacist recommendation matches the product label and MAR entry.


483.460(c)(4) STANDARD
NURSING SERVICES

Name - Component - 00
Nursing services must include other nursing care as prescribed by the physician or as identified by client needs.



Observations:

Based on record review and interview it was determined that the facility failed to ensure prescribed care by the physician was followed. This applied to one individual (#2) of three individuals in the survey sample. Findings included:

Record review was completed for Individual #2 on August 30, 2018. The record revealed that Individual #2 had a follow up appointment with a physician on October 18, 2016, where the physcian recommended a colonoscopy be followed up in one year. There was no evidence in the record that a follow up colonoscopy was completed.

During and interview on August 31, 2018, at 8:43 AM. The program manager/RN confirmed that there is no record of Individual #2 receiving a follow up colonoscopy.









Plan of Correction:

A gastroenterologist appointment was completed 9/6/18. A colonoscopy procedure was scheduled for 10/26/18.

Monthly, for a period of three months, then every other month for a period of four months, the program manager or designee will submit in writing to the QORCP any/all recommended follow up medical appointments for all ICF consumers. The QORCP will reconcile the follow up appointment with physician office note documentation.

For a period of six months the QORCP will include documentation of scheduled medical appointments with the weekly outing/activities calendar.