Nursing Investigation Results -

Pennsylvania Department of Health
ALLIED SERVICES SKILLED NURSING CENTER
Patient Care Inspection Results

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ALLIED SERVICES SKILLED NURSING CENTER
Inspection Results For:

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ALLIED SERVICES SKILLED NURSING CENTER - Inspection Results Scope of Citation
Number of Residents Affected
By Deficient Practice
Initial comments:

Based on an Abbreviated Complaint Survey completed on June 30, 2022, it was determined that Allied Services Skilled Nursing Center 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



 Plan of Correction:


483.24(a)(2) REQUIREMENT ADL Care Provided for Dependent Residents: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.
483.24(a)(2) A resident who is unable to carry out activities of daily living receives the necessary services to maintain good nutrition, grooming, and personal and oral hygiene;
Observations:

Based on a review of clinical records and select facility policy and resident and staff and resident interview it was determined that the facility failed to ensure that residents dependent on staff for assistance with activities of daily living consistently received showers as planned to maintain good personal hygiene for three of five residents sampled (Residents CR1, 25, and 29).

Findings include:

A review of Resident CR1's clinical record revealed that the resident was admitted to the facility on May 12. 2022, with diagnoses that included end stage renal disease (medical condition in which a person's kidneys cease functioning on a permanent basis leading to the need for a regular course of long-term dialysis or a kidney transplant to maintain life).

An admission Minimum Data Set Assessment (MDS - a federally mandated standardized assessment conducted at specific intervals to plan resident care) of Resident CR1 dated May 19, 2022, indicated that the resident was totally dependent on staff for bathing/showers. The resident was cognitively intact with a BIMS score of 15 (brief interview for mental status, a tool to assess the residents' attention, orientation, and ability to register and recall new information, a score of 15 indicates the resident is cognitive intact.

A review of the resident's shower record revealed that the resident was scheduled to be showered on Tuesdays and Fridays.

A review of the resident's shower schedule from May 12, 2022, through discharge on May 23, 2022, revealed that Resident CR1 received a shower on Saturday May 14, 2022. The resident received a sponge bath on Tues May 17, 2022, and Friday May 20, 2022. There was no documentation to explain why the resident received a sponge bath instead of a shower.

There was no documented evidence that the facility showered the resident twice each week as planned.

There was no documented evidence in the resident's clinical record or care plan of any resident refusals or reasons for not showering this resident as scheduled.

A review of Resident 25's clinical record revealed that the resident was admitted to the facility on June 14, 2022, with diagnoses that included unspecified dementia without behavioral disturbance (a group of symptoms affecting memory, thinking and social abilities severely enough to interfere with your daily life).

An admission Minimum Data Set Assessment of Resident 25 dated June 21, 2022, indicated that the resident required physical assistance of one staff for bathing/showers. The resident was cognitively impaired with a BIMS score of 4, a score of 4 indicates the resident is severely cognitively impaired

A review of the resident's shower record revealed that the resident was to be showered on Mondays and Fridays.

A review of the resident's shower schedule from June 14, 2022, through June 30, 2022, revealed that Resident 25 received a sponge bath on Friday June 17, 2022. The resident had not received a shower during the review period. The documentation on the resident's scheduled shower days, June 25, 2022, none were scheduled and June 27, 2022, noted "not applicable."

There was no documented evidence that the facility showered the resident twice each week as planned.

There was no documented evidence in the resident's clinical record or care plan of any resident refusals or reasons for not showering this resident as scheduled.

A review of Resident 29's clinical record revealed that the resident was admitted to the facility on April 16, 2018, with diagnoses that included depression, muscle weakness, and anemia.

A Quarterly Minimum Data Set Assessment of Resident 29 dated May 15, 2022, indicated that the resident was dependent on staff for bathing/showers. The resident was cognitively intact with a BIMS score of 15, a score of 15 indicates the resident is cognitive intact.

During an interview with Resident 29, on June 30, 2022, at approximately 10:00 a.m., the resident stated "I didn't have a shower for over three weeks, today was the first shower in a long time."

A review of the resident's shower record revealed that the resident was to be showered on Tuesdays and Fridays.

A review of the resident's shower schedule from May 01, 2022, through June 29, 2022, revealed that Resident 29 received a shower on Friday May 13, 2022, May 15, 2022, and May 19, 2022. There was no documented evidence of a shower being given between May 19, 2022, and June 29, 2022. The resident does have a history of refusals of care, however the documentation for why showers were not given did not indicate refusals, the scheduled days of showers were documented as either not applicable or none scheduled.

There was no documented evidence that the facility showered the resident twice each week as planned.

During an interview June 30, 2022, at approximately 1:00 p.m., the Director of Nursing was unable to provide evidence that Residents CR1, 25 and 29 were showered as scheduled, or at least twice a week.


28 Pa. Code 211.12 (a)(c)(d)(5) Nursing services.

28 Pa. Code 211.10(a)(c)(d) Resident care policies




 Plan of Correction - To be completed: 08/16/2022

1. Resident CR1 is discharged from the facility. Resident 25 and Resident 29 will receive showers in accordance with their plan of care.

2.An audit will be completed to ensure residents are receiving showers as planned.

3.Nursing staff will be reeducated to ensure that residents dependent on staff for assistance with activities of daily living (ADL) consistently receive showers as planned.

4.Audits will be completed daily by ADON or designee to ensure residents are bathed in accordance with their plan of care and that the ADL is documented in the clinical record. Results of these audits will be reviewed by the Quality Assurance Committee. Audits will continue until substantial compliance is achieved.

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