Pennsylvania Department of Health
ARTMAN LUTHERAN HOME
Patient Care Inspection Results

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Severity Designations


Minimal Citation - No Harm	Minimal Harm	Actual Harm	Serious Harm

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ARTMAN LUTHERAN HOME - Inspection Results	Scope of Citation Number of Residents Affected By Deficient Practice

Initial comments:
Based on a Medicare/Medicaid Recertification Survey, State Licensure Survey, and Civil Rights Compliance Survey completed on August 23, 2024, it was determined that Artman Lutheran Home was not in 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 related to the health portion of the survey process.

Plan of Correction:

483.80(d)(1)(2) REQUIREMENT Influenza and Pneumococcal Immunizations:

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.

§483.80(d) Influenza and pneumococcal immunizations
§483.80(d)(1) Influenza. The facility must develop policies and procedures to ensure that-
(i) Before offering the influenza immunization, each resident or the resident's representative receives education regarding the benefits and potential side effects of the immunization;
(ii) Each resident is offered an influenza immunization October 1 through March 31 annually, unless the immunization is medically contraindicated or the resident has already been immunized during this time period;
(iii) The resident or the resident's representative has the opportunity to refuse immunization; and
(iv)The resident's medical record includes documentation that indicates, at a minimum, the following:
(A) That the resident or resident's representative was provided education regarding the benefits and potential side effects of influenza immunization; and
(B) That the resident either received the influenza immunization or did not receive the influenza immunization due to medical contraindications or refusal.

§483.80(d)(2) Pneumococcal disease. The facility must develop policies and procedures to ensure that-
(i) Before offering the pneumococcal immunization, each resident or the resident's representative receives education regarding the benefits and potential side effects of the immunization;
(ii) Each resident is offered a pneumococcal immunization, unless the immunization is medically contraindicated or the resident has already been immunized;
(iii) The resident or the resident's representative has the opportunity to refuse immunization; and
(iv)The resident's medical record includes documentation that indicates, at a minimum, the following:
(A) That the resident or resident's representative was provided education regarding the benefits and potential side effects of pneumococcal immunization; and
(B) That the resident either received the pneumococcal immunization or did not receive the pneumococcal immunization due to medical contraindication or refusal.

Observations:

Based on review of clinical record, review facility policy, and interview with staff, it was determined that the facility failed to ensure the residents were provided with education regarding the benefits and potential side effects of influenza immunization for two of two residents reviewed (Resident R29 and Resident R14).

Findings:

Review facility policy on "Influenza and Pneumococcal Vaccination" revealed that under section "Policy", it is the policy of Artman that each resident is to be protected against the influenza virus. Influenza vaccine will be offered for each resident annually. Under section "Purpose" to control a potential outbreak and prevent residents, visitors, and employees from being infected by the influenza virus. Under section procedure #1. Up and admission, readmission and annually the residence medical record will be reviewed for a history of influenza pneumococcal vaccination. #3 Each year the influenza vaccination is offered in a high dose for residents over 65 years of age and if indicated, the resident will be offered pneumococcal vaccination. If the resident/resident representative declines education about risk and complications of not receiving the influenza or pneumococcal vaccine will be discussed. #5 An order to administer the influenza vaccination each year will be obtained. #6 The resident will receive the influenza vaccination as ordered.

Review of Resident R29's clinical record revealed no documented evidence that before offering the influenza immunization, Resident R29 received education regarding the benefits and potential side effects of the immunization.

Review of Resident R14's clinical record revealed no documented evidence that before offering the influenza immunization, Resident R14 received education regarding the benefits and potential side effects of the immunization.

Interview with Director of Nursing Employee E2 conducted on August 23, 2024, at 10:46 AM revealed that residents and families are provided with consent forms for vaccinations upon admission only and only asks the residents verbally if they want the vaccines at the beginning of each flu season. Further, Employee E2 confirmed that there was no documented evidence that the residents or the resident representatives received education regarding the benefits and potential side effects of influenza immunization.

28 Pa. Code 201.14(a) Responsibility of licensee

28 Pa. Code 211.12(d)(1)(5) Nursing services

Plan of Correction - To be completed: 10/15/2024

It is the policy of Artman Home to ensure that our residents and families are educated on the Flu vaccine. A new flu vaccine consent form has been developed along with education for the resident and families outlying the benefits and side effects of the vaccine. Education will be provided by the clinical staff prior to the flu vaccine being administered; a signature of the resident/family member will be maintained. We have a flu vaccine clinic scheduled for 10/2/2024 and on-going during the flu season. All consent forms with signatures will be kept on file. All consents will be reviewed by the Director of Nursing/designee this flu season.

483.21(b)(1)(3) REQUIREMENT Develop/Implement Comprehensive Care Plan:

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.

§483.21(b) Comprehensive Care Plans
§483.21(b)(1) The facility must develop and implement a comprehensive person-centered care plan for each resident, consistent with the resident rights set forth at §483.10(c)(2) and §483.10(c)(3), that includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment. The comprehensive care plan must describe the following -
(i) The services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being as required under §483.24, §483.25 or §483.40; and
(ii) Any services that would otherwise be required under §483.24, §483.25 or §483.40 but are not provided due to the resident's exercise of rights under §483.10, including the right to refuse treatment under §483.10(c)(6).
(iii) Any specialized services or specialized rehabilitative services the nursing facility will provide as a result of PASARR recommendations. If a facility disagrees with the findings of the PASARR, it must indicate its rationale in the resident's medical record.
(iv)In consultation with the resident and the resident's representative(s)-
(A) The resident's goals for admission and desired outcomes.
(B) The resident's preference and potential for future discharge. Facilities must document whether the resident's desire to return to the community was assessed and any referrals to local contact agencies and/or other appropriate entities, for this purpose.
(C) Discharge plans in the comprehensive care plan, as appropriate, in accordance with the requirements set forth in paragraph (c) of this section.
§483.21(b)(3) The services provided or arranged by the facility, as outlined by the comprehensive care plan, must-
(iii) Be culturally-competent and trauma-informed.

Observations:

Based on review of facility policy, review of facility documentation, and review of clinical records it was determined that the facility failed to develop a person-center, comprehensive care plan related to impaired skin integrity for one of 15 residents reviewed (Resident R26).

Findings Include:

Review of facility policy "Care Planning", undated, revealed a care plan shall be developed for each resident that includes measurable objectives and timetables to meet the resident's medical, nursing, mental, and psychosocial needs. The resident's comprehensive care plan is developed within 7 days of submission of the complete MDS (Minimum Data Set - federally mandated resident assessment and care screening) assessment.

Review of Resident R26's quarterly MDS dated July 17, 2024, revealed the resident had short and long-term memory problems and was at risk of developing pressure ulcers.

Review of facility "skilled wound report" dated August 15, 2024, by Licensed Nurse, Employee E5, revealed Resident R26 had a deep tissue injury (DTI - localized area of discolored intact skin or blood filled blister due to damage of underlying soft tissue from pressure and/or shear) of the right fifth toe with an onset date of July 11, 2024.

Review of Resident R26's care plan revealed no documented evidence the facility developed or implemented a person-centered, comprehensive care plan with measurable objectives and timetables to address the resident's impaired skin integrity.

211.10 (d) Resident care policies.

Plan of Correction - To be completed: 10/15/2024

It is the policy of Artman Home to ensure that all residents have a comprehensive care plan developed and implemented per the regulations. Resident R26 care plan was immediately updated to reflect the DTI along with interventions and treatment.
All clinical staff will be in serviced on updating care plans by the Director of Nursing. Trainings will be completed by 10/15/2024. An audit was completed of all residents that have skin integrity issues and care plans are up to date. The Director of Nursing or designee will audit resident care plans during each quarterly review to ensure compliance x 6 months

483.60(d)(1)(2) REQUIREMENT Nutritive Value/Appear, Palatable/Prefer Temp:

§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 observations, review of facility policy, and staff interviews it was determined that the facility failed to implement procedures to ensure food was served at safe, appetizing temperatures for one of six residents observed in the dining room (Resident R31).

Findings Include:

Review of facility policy "Food Temperatures", undated, revealed microwave re-heating is appropriate and acceptable when a resident requests to have their food reheated. Upon removal of the food from the microwave, the food will be stirred or rotated and then allowed to stand covered for two minutes before served to assure that the temperature will be under 180 degrees Fahrenheit.

Review of Resident R31's quarterly Minimum Data Set (MDS - federally mandated resident assessment and care screening) revealed the resident had moderate cognitive impairment and had diagnoses of muscle weakness and dementia (group of symptoms affective memory, thinking abilities, and social abilities).

Observations on August 21, 2024, at 12:35 p.m. in the Park dining room revealed dietary aide, E4, heated up a plate of food (hot dog and beans) for Resident R31. Further observations revealed dietary employee, E4, removed the plate from the microwave and handed it directly to the nurse aide to serve to Resident R31 without checking the temperature or letting it sit to come down to the proper temperatures.

Subsequent interview on August 21, 2024, at 12:35 p.m. with dietary aide, Employee E4, confirmed the temperature of the food was not checked to ensure it was being served at safe temperatures.

211.12 (d)(5) Nursing services.

Plan of Correction - To be completed: 10/15/2024

It is the policy of Artman Home to ensure residents receive food that is at a safe, appetizing temperature. The resident did not receive the food directly out of the microwave. The employee was immediately in-serviced on microwave heating requirements. All dining staff will be reeducated on proper, safe food temperatures by the Director of Dining Services, training will be completed by 10/15/2024. Documentation will be kept on file. The Director of Dining Services or designee will audit food temps prior to resident receiving food 3x/week x 6 weeks then random checks will be completed. Audits will be kept on file for review. Results will be reviewed in QAPI.

483.60(d)(6) REQUIREMENT Drinks Avail to Meet Needs/Prefs/Hydration:

§483.60(d) Food and drink
Each resident receives and the facility provides-

§483.60(d)(6) Drinks, including water and other liquids consistent with resident needs and preferences and sufficient to maintain resident hydration.

Observations:

Based on observations, review of clinical record, and staff interview it was determined that the facility failed to provide beverages consistent with resident needs for one of six residents reviewed with altered fluid consistency (Resident R17).

Findings Include:

Review of Resident R17's clinical record revealed a physician order dated August 18, 2024, that revealed Resident R17 was ordered nectar consistency liquids (beverages that are thicker than water and fall slowly from a spoon).

Observations on August 21, 2024, at 10:00 a.m. revealed Resident R17's breakfast tray was sitting on the overbed table in the resident's room. Observations revealed the meal ticket indicated Resident R17 was to be provided nectar thick liquids. Further observations revealed Resident R17 was provided with orange juice that was of thin, regular, consistency.

Interview on August 21, 2024, at 10:05 a.m. with Nurse Aide, Employee E3, confirmed Resident R17 was provided with the wrong beverage.

211.10 (c) Resident care policies.

211.12 (d)(5) Nursing services.

Plan of Correction - To be completed: 10/15/2024

It is the policy of Artman Home to ensure residents receive the proper consistency of liquids.
The resident did not consume the wrong beverage. The employee was immediately in-serviced on proper liquid consistencies and rationale when the consistency is required. All dining staff will be reeducated on proper consistency of liquids by the Director of Dining Services, training will be completed by 10/15/2024. Documentation will be kept on file. The Director of Dining Services or designee will audit liquid/beverage consistency per the doctors' orders prior to resident receiving beverages 3x/week x 6 weeks then random checks will be completed. Audits will be kept on file for review. Results will be reviewed in QAPI.

483.80(b)(1)-(4) REQUIREMENT Infection Preventionist Qualifications/Role:

§483.80(b) Infection preventionist
The facility must designate one or more individual(s) as the infection preventionist(s) (IP)(s) who are responsible for the facility's IPCP. The IP must:

§483.80(b)(1) Have primary professional training in nursing, medical technology, microbiology, epidemiology, or other related field;

§483.80(b)(2) Be qualified by education, training, experience or certification;

§483.80(b)(3) Work at least part-time at the facility; and

§483.80(b)(4) Have completed specialized training in infection prevention and control.

Observations:

Based on review of facility policy/Infection Control Program Overview, interview staff, review of facility record, it was determined that the facility failed to designate one or more individual as the infection preventionist who work at least part time at the facility.

Findings include:

Review facility Infection Control Program Overview, under section "Goals": The goals of the infection control program are to #a Decrease the risk of infection to residents and personnel #b Monitor for occurrence of infection and implement appropriate control measures. #c Identify and correct problems relating to infection control practices #d ensure compliance with the state and federal regulations relating to infection control. Under section Division of Responsibilities for Infection Control Activities: the administrator is ultimately responsible for the infection control program. #A. Infection control practitioner or designee Responsibility is delegated to a staff member acting as the infection control practitioner or to a trained infection control practitioner to carry out the daily functions of the infection control program. Those functions are described in the Infection Control practitioner job description. The infection control practitioner or designee has knowledge and interest in infection control.

Interview with Director of Nursing Employee E2 conducted on August 21, 2024, at 12:45pm confirmed that Employee E2 was the full time Director of Nursing at the facility. Further interview with Employee E2 also revealed that while being the full time Director of Nursing, Employee E2 was also the infection preventionist for the facility and that she was the only employee in the facility with an infection control certification.

Follow-up interview with Employee E2 conducted on August 23, 2024, at 10:46 am revealed that Employee E2 also revealed that she does not clock in because she is a salary employee. Further Employee E2 also revealed that there was no documented evidence that she also worked part time as an infection preventionist.

28 Pa. Code 210.18(e)(1) Management

28 Pa. Code 211.12(d)(1) Nursing Services

Plan of Correction - To be completed: 10/15/2024

Artman Home will ensure that we have a part-time Infection Control Preventionist on staff. A new Infection Control Preventionist was selected, and she is currently attending training to become a certified Infection Control Preventionist. The employee will be certified by 10/15/2024. All aspects of Infection Control have been reviewed with employee by the current Infection Control Preventionist/Director of Nursing. All credentials will be kept on file.

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