§483.70(a) Licensure.
A facility must be licensed under applicable State and local law.
§483.70(b) Compliance with Federal, State, and Local Laws and Professional Standards.
The facility must operate and provide services in compliance with all applicable Federal, State, and local laws, regulations, and codes, and with accepted professional standards and principles that apply to professionals providing services in such a facility.
§483.70(c) Relationship to Other HHS Regulations.
In addition to compliance with the regulations set forth in this subpart, facilities are obliged to meet the applicable provisions of other HHS regulations, including but not limited to those pertaining to nondiscrimination on the basis of race, color, or national origin (45 CFR part 80); nondiscrimination on the basis of disability (45 CFR part 84); nondiscrimination on the basis of age (45 CFR part 91); nondiscrimination on the basis of race, color, national origin, sex, age, or disability (45 CFR part 92); protection of human subjects of research (45 CFR part 46); and fraud and abuse (42 CFR part 455) and protection of individually identifiable health information (45 CFR parts 160 and 164). Violations of such other provisions may result in a finding of non-compliance with this paragraph.
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Observations:
Based on a review of the facility's accounts payable ledger, as well as interviews with staff, it was determined that the facility failed to operate in compliance with state regulations and codes. The facility's failure created a situation which placed the residents in immediate jeopardy of the likelihood of serious bodily injury, harm or death.
Findings include:
28 PA Code Commonwealth of Pennsylvania Long Term Care Licensure Regulations, subsection 201.14(g), dated July 1, 2023, revealed that a facility owner shall pay in a timely manner bills incurred in the operation of a facility that are not in dispute and that are for services without which the resident's health and safety are jeopardized.
Information provided by the facility on February 28, 2024, revealed that they had not paid the employees of the facility their due wages for the payroll due February 23, 2024. The amount due to cover the payroll was $189,422.71. Documentation provided by the facility revealed that they received email notification from the payroll company on February 21, 2024, that a wire transfer was required to distribute the payroll for February 23, 2024.
Interview with facility's union president revealed that there was a significant chance that many staff would walk off the job if not paid by Friday, March 1, 2024, which would leave the residents without proper staffing to care for all of their needs.
The facility's accounts payable ledger, dated February 28, 2024, revealed outstanding balances for:
Penn Highlands Dubois lab for $29,325.03. The last payment was made February 28, 2024, for $3000.00.
Clearfield Jefferson Primary Care Assoc, Dr. Roscoe for $24,500.00. The last payment was made February 28, 2024, for $3000.00.
Schindler Elevator Corporation for $3056.47. The last payment was made February 22, 2024, for $2868.06.
Specialty RX for $45,466.78. The last payment was made on February 22, 2024, for $4000.00.
System Technologies for $3,349.58. The last payment was made on August 4, 2023, for $51.06.
Wellsky for $3,259.50. The last payment was made on October 2, 2023, $4756.17.
On February 28, 2024, at 3:53 p.m. the Director of Nursing was given the Immediate Jeopardy template and informed that the health and safety of the residents were placed in Immediate Jeopardy due to the failure to operate in compliance with state regulations and codes by not paying staff their wages or vendor invoices that were incurred in the operation of the facility.
An immediate action plan was submitted and contained the following:
In response to the Immediate Jeopardy imposed at Ridgeview Healthcare and Rehabilitation Center regarding vendor payments and payroll dated February 23, 2024. The following is the facility response to the identified concerns with remedy listed for immediate resolution.
Penn Highlands DuBois - $29,325.03
Immediate resolution is as follows:
A payment was made in the amount of $3,000 on February 28, 2024. The facility Business Office Manager has been in contact with the accounting department of Penn Highlands Dubois to provide accurate invoices reflecting amounts due under the Medicare fee schedule. Upon receipt, payment arrangements will be made accordingly.
Clearfield Jefferson Primary Care Associates - $24,500
Immediate resolution is as follows:
A payment was made on February 28, 2024, in the amount of $3,000. The Medical Director was contacted by the Nursing Home Administrator on February 28, 2024, regarding past due balances and agreeable to payments to be made monthly moving forward.
Schindler Elevator Corporation - $3,056.47
Immediate resolution is as follows:
A payment was made on February 22, 2024, in the amount of $2,868.06. The vendor is current with outstanding invoices.
SpecialtyRx - $45,466,78
Immediate resolution is as follows:
A payment was made on February 22, 2024, in the amount of $4,000 and in compliance with agreed upon terms with the vendor to be paid $4,000 weekly.
System Technologies - $3,349.58
Immediate resolution is as follows:
The vendor was paid in full on January 22, 2024. The ledger has been updated. Proof of payment provided.
WellSky - $3,259.50
Immediate resolution is as follows:
A payment was made on February 28, 2024, in the amount of $1,629.75. Proof of payment provided. Remaining balance will be paid in March 2024.
February 23, 2024, Employee Payroll
Immediate resolution is as follows:
The CEO notified the Nursing Home Administrator on February 28, 2024, that payroll is to be funded with same day deposits by close of business of Friday, March 1, 2024. The facility instituted an employee fund for any monetary needs until payroll processed. Funds were made available via cash, CashApp, Venmo, and PayPal.
Adequate staffing requirements are in place under federal and Pennsylvania guidelines for resident care as evidenced in day sheets and employee punch records. The organization is working with Empeon, the payroll vendor, on splitting payrolls of the facilities improving cash flow week to week. Currently, all facilities are paid on the same pay schedule. Effectively, Ridgeview Healthcare and Rehabilitation Center will remain on the same pay schedule; however, four of the facilities will be moved to the opposite week for payroll processing and improved cash flow.
Staffing Contingency
The Director of Nursing, Assistant Director of Nursing, Infection Preventionist, and the Registered Nurse Assessment Coordinator are all registered nurses. The Human Resources Director and the Dietary Manager are certified nursing assistants. The Nursing Home Administrator will be returning on Friday and is a registered nurse. Additionally, the facility's Nursing Home Administrator and the Human Resources Director have already spoken with both National Healthcare located in Dubois, Pennsylvania and TLC Staffing in Punxsutawney, Pennsylvania, confirming availability.
Interviews on March 4, 2024, with Nurse Aide 1 at 9:49 a.m.; Licensed Practical Nurse 2 at 9:49 a.m.; Licensed Practical Nurse 3 at 9:50 a.m.; Licensed Practical Nurse 12 at 9:50 a.m.; Licensed Practical Nurse 13 at 9:51 a.m.; Speech Therapist 4 at 9:52 a.m.; Housekeeping Staff 14 at 9:54 a.m.; Occupational Therapist 15 at 9:55 a.m.; Licensed Practical Nurse 5 (the union president), at 10:10 a.m.; Registered Nurse 7 at 10:15 a.m.; Nurse Aide 8 at 12:41 p.m.; Nurse Aide 10 at 12:53 p.m.; and Nurse Aide 11 at 1:00 p.m., all confirmed that payroll was received.
The Immediate Jeopardy was lifted on March 4, 2024, at 3:36 p.m. when it was confirmed that staff received their wages.
28 Pa. Code 201.14(g) Responsibility of Licensee.
28 Pa. Code 201.18(e)(1) Management.
| | Plan of Correction - To be completed: 03/21/2024
Effective 3/7/2024, Ridgeview Healthcare and Rehabilitation Center was appointed a Court Ordered Receiver by the United States District Court for the Western District of Pennsylvania.
Upon notification of employee payroll for the 2/23/2024 pay date being delayed, the facility immediately setup an employee fund to provide monetary support to the employees via cash, CashApp, Venmo, and/or PayPal. The facility maintained adequate staffing meeting both state and federal requirements prior to and since the delayed payroll. Payroll scheduled for 3/8/2024 was funded timely and all employees were paid. Schindler Elevator Corporation, SpecialtyRx, System Technologies, WellSky, and Clearfield Jefferson Primary Care Associates are current with accounts payable.
The facility Business Office Manager will submit invoices from vendors to the Court Appointed Receiver utilizing electronic submission. Upon processing, the facility Nursing Home Administrator will "approve" the invoices to be paid to the vendor and review the facility monthly Accounts Payable ledger for payment dates. Facility administrator will review the Accounts Payable aging which shows what bills have been paid and when they were paid to ensure bills that were submitted to the Court Appointed Receiver were paid timely as follows: weekly x2, monthly x2 for timely processing of vendors with results to the facility Quality Assessment and Assurance Committee.
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