QA Investigation Results

Pennsylvania Department of Health
DON GUANELLA HOMES AT 1745 SPROUL ROAD
Health Inspection Results
DON GUANELLA HOMES AT 1745 SPROUL ROAD
Health Inspection Results For:


There are  6 surveys for this facility. Please select a date to view the survey results.

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Initial Comments:


A monitoring visit was conducted on February 8, 2019. The purpose of this visit was to determine compliance with the requirements of 42 CFR, Part 483, Subpart I regulations for Intermediate Care Facilities of Individuals with intellectual disabilities. The census at the time of the survey was 10, and the sample consisted of six Individuals.





Plan of Correction:




483.430(e)(2) STANDARD
STAFF TRAINING PROGRAM

Name - Component - 00
For employees who work with clients, training must focus on skills and competencies directed toward clients' health needs.



Observations:


Based on record review, staff interview and interview, it was determined that the facility failed to ensure that staff demonstrated the skills and techniques necessary directed towards the health needs of Individuals for three of three individuals who require specialized feeding protocols. This practice is specific to Individual #3, #4 and #6.

Findings include:

Individual #3:

1. Observations completed on 02/08/2019 from 8:15 AM to 8:45 AM revealed that Individual #3 was seated at the dining table. In front of this Individual there was
a dining placemat dated 09/25/2018. This placemat indicated that food items consumed by this Individual should have extra moisture added when possible. This Individual
had a serving bowl in front of him that contained farina/cream of wheat hot cereal, and
attempted to place a ladle with cereal from the serving dish into a smaller cereal bowl on the placemat. The cereal was thick, and this individual had a difficult time getting the item to release from the serving bowl to the smaller bowl.

Once this item had been transferred to the smaller bowl, Individual #3 began to consume the cream of wheat without adding any milk or other liquid. Individual# 3 had a second serving of cereal and again did not add any liquid to this cereal before eating. A staff person was sitting at the table directly across from Indivual #3, and did not offer any prompts to add extra moisture to the food.

2. A review of Individual #3's record was completed on 02/08/2019 between 9:00 AM
and 10:00AM. In a review of physcian's 90 day orders and nutrition assessment documentation for the period between 02/21/2018 until 02/2019, it was noted that Individual #3 was prescribed a diet of extra moistened foods when possible. These documents indicated that Individual #3 requires extra moisture with his food items.

Interview with the qualified intellectual developmental professional (QIDP) at approximate 10:00 AM revealed that this staff person was unaware of the dietary prescription outlining the need to add extra moisture to food items consumed by Individual #3. When asked if direct care staff had been trained in this dietary requirement, the QIDP was unable to provide doucmentation that training had occurred regarding this dietary provision.

Individual #4:

1. Observations conducted on 02/08/2019 from 8:15 AM to 8:45 AM revealed that Individual #4 was observed sitting at the dining table. In front of this Individual there was a dining placemat dated 09/25/2018. This placemat noted that Individual #4 should be fed using a cyclic ingestion protocol at a rate of 3 bites of food to one sip of liquid.

During this observation period, Individual #4 was fed a bowl of farina/cream of wheat by direct care staff. Once the bowl of cream of wheat was consumed, staff handed Individual #4 a two handled cup of juice which this Individual consumed. At no time during this observation was cyclic ingestion observed while this Individual was fed his breakfast meal.

2. A review of Individual #4's record was conducted on 02/08/2019 between
9:00 AM and 10:00 AM. In a review of 90 day physician's orders and nutrition assessment documentation for the period between 09/25/2018 until 12/12/2018, it was noted that Individual #4 was prescribed a dining protocol involving cyclic ingestion during meals. The instructions for such outlined as 2 bites of food to one sip of liquid.

Interview with the Director of Social Service at approximately 10:10 AM revealed that direct care staff should implement any special meal protocols outlined on the placemat
for each Individual during mealtime. When further questioned regarding the discrepancy of rate of cyclic ingestion listed on the placemat versus that listed within the record for Individual #4- 3:1 versus 2:1, this interviewee was unable to indicate why the information was not consistent.

Individual #6:

1. Observations conducted on 02/08/2019 from 8:15 AM to 8:45 AM revealed that Individual #6 was observed sitting at the dining table. In front of this Individual there was a dining placemat dated 09/25/2018. This placemat noted that Individual #6 should have close supervision, soft to chew, moist chopped meats, thin liquids, alternate food and liquid every few bites, and allow extra time to complete meal.

Placed on top of Individual #6's placemat was a small cereal bowl, a cup, a spoon and napkin. Staff placed a serving bowl with spoon containing farina/cream of wheat cereal on the table. Individual #6 placed two serving spoons into his cereal bowl.
The farina/cream of wheat was a thick consistency and difficult to get off the serving spoon. After successfully spooning the farina/cream of wheat into the cereal bowl, staff prompted Individual #6 to pour juice in the cup provided for him. At no time during this observation did staff prompt Individual #6 to take small spoonfuls of food or encourage to alternate food and liquid every few bites.

2. A review of Individual #6's record was conducted on 02/08/2019 between 9:00 AM and 10:00 AM. In a review of 90 day physician's orders, nutrition assessment and speech therapy documentation for the period between 05/09/2018 until 12/13/2018, it was noted that Individual #6 is prescribed a dining protocol of a soft to chew texture diet, with alternate food and liquid every few bites, encourage small bites and sips, provide close supervision and, allow extra time to complete meal.

Interview with the Director of Social Service at approximately 10:20 AM revealed that direct care staff should implement any special meal protocols outlined on the placemat
for each Individual during mealtime. When further questioned concerning what "every few bites" would look like to an observer, this interviewee was unable to explain how direct care staff should have implemented Individual #6's feeding protocol.










































Plan of Correction:

The Qualified Intellectual Disability Professional (QIDP) held interdisciplinary team meetings (IDT), for individual #3, #4 and #6 to review final speech therapy recommendations, physician's orders and feeding protocols as listed on individual placemats by the dietician to assist staff with feeding protocols. The IDT reviewed the information and corrected any inconsistencies through revision to the indivduals IPP (up to including; speech re-evaluations, revised physician's orders, revised placemats and goals). Completion date: 2/14/2019
Direct Care Providers (DCP) and any staff working with the indivduals were retrained on the revised feeding protocols for indivduals #3, #4 and #6 per the IDT, and training ensured that DCP'and all staff working with individuals #3, #4 and #6 demonstrated the skills, techniques necessary to ensure competencies for individual specific feeding protocols by the dietician and Health Care Coordinator with the Manager of the home and QIDP present. All trainings are recorded and kept on file in the residence training log. Completion date: 3/15/2019
Interdisciplinary team meetings were held for all other indivduals that reside in the residence to review final speech therapy recommendations, physician's orders and feeding protocols as listed on individual placemats by the dietician to assist staff with feeding protocols. The IDT reviewed the information and corrected any inconsistencies through revision to the indivduals IPP (up to including; speech re-evaluations, revised physician's orders, revised placemats and goals). Completion date: 2/14/2019
Direct Care Providers (DCP) working all other indivduals residing in the residence were retrained on the revised feeding protocols for all other indivduals per the IDT, and training ensured that DCP's working with individuals demonstrated the skills, techniques necessary to ensure competencies for individual specific feeding protocols by the dietician and Health Care Coordinator with the Manager of the home and QIDP present. All trainings are recorded and kept on file in the residence training log. Completion date: 3/15/2019
Going forward, any individual that resides in the home and has a change in feeding status (made by the speech therapist or any other medical professional), the following sequence will occur; received recommendation, IDT meeting, review with physician for written order, placemat revised and staff training will occur within 72 hours of the recommendation made. As emergency sitations arise, the Administrator will direct the sequence of events for health and safety of the individual. All new staff to the facility receive general mealtime and feeding protocol training within the first week of New Employee Orientation. As the new staff complete on the job training, the House Manager and QIDP's complete the individual specific feeding protocols for each individual. All training records for the new employees are kept on file with the training department. Competition Date: ongoing
The House Manager and QIDP's will complete weekly mealtime audit varying meal times of breakfast, lunch and dinner. The audits include; (observation of environment during meals, family style dining, competencies of feeding protocols per placemat direction, food temperatures and meal socialization). If inconsistencies are observed, the Manager or the QIDP will complete training immediately for the staff and document the training on the mealtime audit and training sheet. All trainings are recorded and kept on file in the residence training log. The Audits are handed into the Program Director for review and shared with the Quality Management team, Director of Community Programs and Administrator. Competition Date: ongoing

The Program Director and Residential Coordinators will complete monthly mealtime audits varying meal times of breakfast, lunch and dinner. The audits include; (observation of environment during meals, family style dining, and competencies of feeding protocols per placemat direction, food temperatures and meal socialization). If inconsistencies are observed, the Program Director and Residential Coordinator will complete training immediately for the staff and document the training on the mealtime audit and training sheet. All trainings are recorded and kept on file in the residence training log. The Audits are handed into the Director of Community Programs for review and shared with the Quality Management team, and Administrator. Competition Date: ongoing

The Quality Management (QM) team will complete a monthly mealtime audit for 3 months and quarterly thereafter varying meal times of breakfast, lunch and dinner. The audits include; (observation of environment during meals, family style dining, and competencies of feeding protocols per placemat direction, food temperatures and meal socialization). If inconsistencies are observed, the QM will complete training immediately for the staff and document the training on the mealtime audit and training sheet. All trainings are recorded and kept on file in the residence training log. The Audits are handed into the Administrator for review. Competition Date: ongoing

Individuals responsible; QIDP, Health Care Coordinator, Dietician, House Manager, Residential Coordinator, Program Director, Quality Management team, Director of Training, Director of Community Programs and Administrator.