Nursing Investigation Results -

Pennsylvania Department of Health
LOYALHANNA CARE CENTER
Patient Care Inspection Results

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LOYALHANNA CARE CENTER
Inspection Results For:

There are  154 surveys for this facility. Please select a date to view the survey results.

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LOYALHANNA CARE CENTER - Inspection Results Scope of Citation
Number of Residents Affected
By Deficient Practice
Initial comments:


Based on a complaint survey completed on February 21, 2020, it was determined that Loyalhanna Care 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 related to the health portion of the survey process.


 Plan of Correction:


483.90(i) REQUIREMENT Safe/Functional/Sanitary/Comfortable Environ: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.
483.90(i) Other Environmental Conditions
The facility must provide a safe, functional, sanitary, and comfortable environment for residents, staff and the public.
Observations:


Based on observations and staff interviews, it was determined that the facility failed to maintain a safe and sanitary environment for residents and staff.

Findings include:

Observations in the shower room on the 100 hall on February 21, 2020, at 6:46 a.m. and 7:48 a.m. revealed that a 2 x 24 inch metal corner bead on the wall dividing the shower stall nearest the door from the tub area had pulled away from the wall due to the tile under the corner bead being broken. Both upper corners of the corner bead were protruding outward from the wall and had sharp, pointed corners. There were five 8 x 6 inch tiles in the shower stall nearest the toilet that were cracked and broken approximately three inches above the floor, leaving sharp edges, and the shower stall nearest the door had one 8 x 6 inch tile that was cracked/broken approximately three inches above the floor, leaving sharp edges.

Interview with the Regional Director of Maintenance on February 21, 2020, at 12:10 p.m. confirmed the above conditions in the shower room on the 100 unit and confirmed that the pointed corners and sharp tile edges were safety hazards.

Observations on February 21, 2020, between 6:17 a.m. and 10:53 a.m. revealed the following:

The heating vent in the lower section of the wall near the toilet in the 200 unit shower room had an accumulation of dust in it. The heating unit in the main dining room annex had a black and gray, removable substance on the interior plastic section of the vents. There was an accumulation of dust, food crumbs, and candy under the vending machines in the lounge on the 100 unit. The heating units in the following resident rooms had accumulations of dust, dirt, debris, and cobwebs either on the outer surfaces and/or on the floor under the units: 101, 104, 105, 107, 108, 109, 110, 111, 112, 113, 114, 115, 116, 117, 118, 120, 124, 125, 127, 128, 129, 130, 131, 201, 202, 203, 206, 209, 210, 211, 212, 215, 216, 217, 219, 221, 222, 223, 224, 225, 228, 229, 230, 231, 232, and 233. There was also an accumulation of dust and debris under the heating unit in the activity room, as well as under all three heating units in the therapy suite.

Interview with the Laundry/Housekeeping Supervisor on February 21, 2020, at 1:18 p.m. confirmed that the above areas needed cleaned. She stated that there possibly was a miscommunication between housekeeping and maintenance as to whose responsibility it was to clean the heating units.

28 Pa. Code 207.2(a) Administrator's responsibility.




 Plan of Correction - To be completed: 04/21/2020

1. Actions taken for the situation identified:
No residents were affected by the noted areas in the shower room or heating units. The sharp edges in the shower room have been covered as a stop gap measure until a permanent solution can be completed. The facility is actively seeking bids to refurbish the north wing shower room. The identified heating units are being cleaned and a routine cleaning and preventative maintenance schedule has been developed.

2. How the facility will act to protect residents in similar situations:
The facility recognizes that all residents have the potential to be affected. In addition to completing the necessary maintenance and repairs, the facility has implemented daily manager rounds of specific areas throughout the facility, including resident rooms, the shower rooms and heating units, to monitor, identify and address repair, maintenance, and cleanliness issues throughout the facility.

3. System changes and measures to be taken:
The Administrator or designee will re-educate maintenance and housekeeping staff on the importance of the safety and cleanliness of facility equipment and environment. Daily manager rounds and cleaning schedules have also been implemented to monitor, identify and address repair, maintenance, and cleanliness issues.

4. Monitoring mechanisms to assure compliance:
The Director of Housekeeping or designee will audit heating units for cleanliness weekly for four (4) weeks then monthly for two (2) months. Manager rounds reports will be audited by the Nursing Home Administrator weekly for four (4) weeks and then monthly for two (2) months for completion of maintenance and repair issues. Incidents of non-compliance will be addressed immediately, and audit results will be reviewed through monthly Quality Assurance Performance Improvement Committee meetings and further action plans and audits will continue until substantial compliance is achieved. From then on, monthly Quality Assurance Performance Improvement meetings will help to ensure quality standards are met through continual performance analyses and the implementation of systematic efforts to improve those processes that do not meet acceptable levels. This will include self-monitoring of identified deficient practices that shall be reviewed during the monthly Quality Assurance Performance Improvement Committee meetings, as well as the Quarterly Quality Assurance Meetings, until significant corrections are noted and ongoing, as necessary.

5. Date Corrective Action will be completed:
Substantial compliance is expected by April 21, 2020.

483.25(d)(1)(2) REQUIREMENT Free of Accident Hazards/Supervision/Devices: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.
483.25(d) Accidents.
The facility must ensure that -
483.25(d)(1) The resident environment remains as free of accident hazards as is possible; and

483.25(d)(2)Each resident receives adequate supervision and assistance devices to prevent accidents.
Observations:


Based on clinical record reviews, observations and staff interviews, it was determined that the facility failed to ensure that assistive devices were used to prevent accidents during wheelchair transportation for one of nine residents reviewed (Resident 1).

Findings include:

A quarterly Minimum Data Set (MDS) assessment for Resident 1, dated December 19, 2019, revealed that the resident was cognitively impaired and required assistance for locomotion (propelling in her wheelchair).

A current, undated information sheet provided to staff members indicated that staff were to use leg rests for transport according to the resident's orders. Physician's order, dated September 21, 2018, indicated that the resident was to be out of bed to her wheelchair with a gel cushion and bilateral leg rests. The resident's care plan, dated September 24, 2019, revealed that she was at risk for falls, and included that she was to be out of bed to her wheelchair with a gel cushion and bilateral leg rests.

Observations on February 21, 2020, at 6:52 a.m. revealed that Resident 1 was self-propelling her wheelchair in the hallway near the nursing station. A staff member placed herself on the left side of the resident's wheelchair, placed her hand on the arm rest of the wheelchair, and pulled the resident toward the shower room on the unit. The wheelchair was not equipped with leg rests during the transport and the resident's feet were observed to intermittently touch the floor.

Interview with Registered Nurse 1 on February 21, 2020, at 7:38 a.m. confirmed that Resident 1 should have had the leg rests on her wheelchair if staff were assisting her in transportation to the shower room.

Interview with the Director of Nursing on February 21, 2020, at 1:30 p.m. revealed she was not aware of any facility policies related to the use of leg rests while transporting a resident in his/her wheelchair, and that the only information available was the undated information sheet that was provided to staff members. She confirmed that Resident 1 should have had the leg rests on the wheelchair while staff were assisting her to the shower room.

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



 Plan of Correction - To be completed: 04/21/2020

The submission of this plan of correction does not constitute admission or agreement on the part of the provider with the deficiencies or conclusions contained in the Statement of Deficiencies. This plan of correction is prepared and executed solely to respond to the allegation of non-compliance cited during the incident survey ended February 21, 2020.

1. Actions taken for the situation identified:
Resident 1 suffered no ill effect. Staff member involved in the transport of Resident 1 was educated on the proper use of leg rest during staff-assisted wheelchair transports.

2. How the facility will act to protect residents in similar situations:
The facility recognizes that all residents have the potential to be affected. All Residents requiring the use of wheelchairs for transport will have leg rests available for use during staff-assisted wheelchair transports, as per policy, no wheelchair transport assistance may be provided without the use of leg rests. Care plans for residents who use wheelchairs will be updated to include the use of leg rests. Additionally, Licensed nurses and certified nursing assistants, including agency staff, will receive education on the use of leg rests during staff-assisted wheelchair transports. Policy on the use of leg rests during staff-assisted wheelchair transports will be reviewed during new hire orientation.

Wheelchairs will be evaluated to ensure appropriate leg rests are available for each chair. Care plans will also be reviewed and updated to indicate the appropriate transfer status for each resident.

3. System changes and measures to be taken:
The Director of Nursing or designee will re-educate licensed nursing staff and certified nursing assistants, including agency staff, on wheelchair transport policy. Staff members shall follow the policy to ensure resident safety.

4. Monitoring mechanisms to assure compliance:
The Director of Nursing or designee will monitor staff-assisted resident wheelchair transports, weekly for four (4) weeks then monthly for two (2) months to ensure compliance with leg rest policy. Incidents of non-compliance will be addressed immediately, and audit results will be reviewed through monthly Quality Assurance Performance Improvement Committee meetings and further action plans and audits will continue until substantial compliance is achieved. From then on, monthly Quality Assurance Performance Improvement meetings will help to ensure quality standards are met through continual performance analyses and the implementation of systematic efforts to improve those processes that do not meet acceptable levels. This will include self-monitoring of identified deficient practices that shall be reviewed during the monthly Quality Assurance Performance Improvement Committee meetings, as well as the Quarterly Quality Assurance Meetings, until significant corrections are noted and ongoing, as necessary.

5. Date Corrective Action will be completed:
Substantial compliance is expected by April 21, 2020.

483.40(b)(3) REQUIREMENT Treatment/Service for Dementia: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.
483.40(b)(3) A resident who displays or is diagnosed with dementia, receives the appropriate treatment and services to attain or maintain his or her highest practicable physical, mental, and psychosocial well-being.
Observations:


Based on clinical record reviews, observations, and family and staff interviews, it was determined that the facility failed to provide appropriate services, including sufficient supervision, to prevent residents from wandering into other residents' rooms for one of nine residents reviewed (Resident 4) who had a diagnosis of dementia.

Findings include:

A quarterly Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) for Resident 4, dated January 28, 2020, revealed that the resident was admitted to the facility in September 2019 with diagnoses that included Alzheimer's disease (a type of dementia). The assessment indicated that the resident was sometimes understood, was sometimes able to understand others, was severely cognitively impaired, and was able to ambulate (walk) with the supervision of one staff member.

Resident 4's care plan, dated October 18, 2019, revealed that she was at risk for wandering and elopement (attempting to leave the facility) due to attempting to exit doors and wandering into others' rooms. The care plan included that staff were to redirect the resident away from others' rooms. A census record revealed that Resident 4 was moved from the room she shared with Resident 5 on January 22, 2020.

Observations on February 21, 2020, at approximately 9:05 a.m. revealed that Resident 4 entered Resident 5' room and Resident 5 said, "Get the hell out of my bed. Where the hell is my bed, you know I have guests coming this evening." She repeated again for Resident 5 to "Get the hell out of my bed."

No staff intervened to redirect Resident 4 from entering Resident 5's room.

Interview with Resident 5 at that time confirmed that Resident 4 frequently came into her room and accused her (Resident 5) of being in her (Resident 4's) bed. Resident 5 stated that at times Resident 4 would become very angry and tell her to "Get the f**k out of my room. You don't belong here." Resident 5 stated that she would prefer if Resident 4 did not come into her room anymore.

Interview with Unit Clerk 2 on February 21, 2020, at 11:43 a.m. confirmed that Resident 4 was recently moved from the room she shared with Resident 5. Resident 4 was confused and still thought that the old room was where she was supposed to be, and she entered Resident 5's room on occasion.

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




 Plan of Correction - To be completed: 04/21/2020

1. Actions taken for the situation identified:
Resident 5 suffered no adverse effect as a result of Resident 4's behavior. Resident 4 is being monitored by staff for wandering behaviors and redirected as necessary.

2. How the facility will act to protect residents in similar situations:
The facility recognizes that all residents have the potential to be affected. The facility has developed a policy to address wandering residents and those at risk for elopement to ensure the provision of adequate supervision to prevent accidents. Residents who determined to be ask risk for wandering and/or elopement will have their care plans updated to include this information.

The Director of Nursing or designee will assess residents at risk for elopement and wandering behaviors. Those residents identified to be at risk will have care plan interventions developed to mitigate the associated risks and hazards.


3. System changes and measures to be taken:
The Director of Nursing or designee will re-educate facility staff, including agency, on the policy for Elopements and Wandering Residents. Staff shall be responsible for following the policy to identify, assess and evaluate residents at risk for elopement and wandering behaviors and implementing interventions to reduce hazards and risks identified, including updating care plans accordingly.

4. Monitoring mechanisms to assure compliance:
The Director of Nursing or designee will audit 24-hour report and risk management reports for incidents related to resident wandering or elopement for four (4) weeks then monthly for two (2) months to ensure compliance with policy. Incidents of non-compliance will be addressed immediately, and audit results will be reviewed through monthly Quality Assurance Performance Improvement Committee meetings and further action plans and audits will continue until substantial compliance is achieved. From then on, monthly Quality Assurance Performance Improvement meetings will help to ensure quality standards are met through continual performance analyses and the implementation of systematic efforts to improve those processes that do not meet acceptable levels. This will include self-monitoring of identified deficient practices that shall be reviewed during the monthly Quality Assurance Performance Improvement Committee meetings, as well as the Quarterly Quality Assurance Meetings, until significant corrections are noted and ongoing, as necessary.

5. Date Corrective Action will be completed:
Substantial compliance is expected by April 21, 2020.

483.35(g)(1)-(4) REQUIREMENT Posted Nurse Staffing Information:Least serious deficiency but affects more than a limited number of residents, staff, or occurrences. This deficiency has the potential for causing no more than a minor negative impact on the resident but is not found to be throughout this facility.
483.35(g) Nurse Staffing Information.
483.35(g)(1) Data requirements. The facility must post the following information on a daily basis:
(i) Facility name.
(ii) The current date.
(iii) The total number and the actual hours worked by the following categories of licensed and unlicensed nursing staff directly responsible for resident care per shift:
(A) Registered nurses.
(B) Licensed practical nurses or licensed vocational nurses (as defined under State law).
(C) Certified nurse aides.
(iv) Resident census.

483.35(g)(2) Posting requirements.
(i) The facility must post the nurse staffing data specified in paragraph (g)(1) of this section on a daily basis at the beginning of each shift.
(ii) Data must be posted as follows:
(A) Clear and readable format.
(B) In a prominent place readily accessible to residents and visitors.

483.35(g)(3) Public access to posted nurse staffing data. The facility must, upon oral or written request, make nurse staffing data available to the public for review at a cost not to exceed the community standard.

483.35(g)(4) Facility data retention requirements. The facility must maintain the posted daily nurse staffing data for a minimum of 18 months, or as required by State law, whichever is greater.
Observations:


Based on observations and staff interviews, it was determined that the facility failed to ensure that the required nursing staffing posting was current.

Findings include:

Observations on February 21, 2020, at 7:09 a.m. and 7:32 a.m. revealed that the nursing staffing information posted on the bulletin board in the front lobby of the facility was dated February 19, 2020.

Interview with the Director of Nursing on February 21, 2020, at 7:32 a.m. confirmed that the nursing staffing information was not current and should have been updated at the beginning of the shifts on February 20 and February 21, 2020.



 Plan of Correction - To be completed: 04/21/2020

1. Actions taken for the situation identified:
No residents were affected. Staff member responsible for the daily posting of the nursing staff hours has been re-educated on the policy.

2. How the facility will act to protect residents in similar situations:
The facility recognizes that all residents have the potential to be affected. The facility will ensure that nursing staff hours are posted daily to ensure staffing information is readily available to residents and visitors.

3. System changes and measures to be taken:
The Employee Relations Coordinator/Schedule will be responsible for posting the nursing staff hours daily. In the absence of this person, the task will fall to the Assistant Director of Nursing or Director of Nursing. The Administrator will re-educate staff responsible for the daily posting of nursing staff hours on the policy, which will include changes that may occur throughout the day. Staff members shall follow the policy to ensure staffing information is readily available to residents and visitors.

4. Monitoring mechanisms to assure compliance:
The Administrator or designee will audit the daily positing of nursing staff hours weekly for four (4) weeks then monthly for two (2) months to ensure compliance with the nursing hours posting policy. Incidents of non-compliance will be addressed immediately, and audit results will be reviewed through monthly Quality Assurance Performance Improvement Committee meetings and further action plans and audits will continue until substantial compliance is achieved. From then on, monthly Quality Assurance Performance Improvement meetings will help to ensure quality standards are met through continual performance analyses and the implementation of systematic efforts to improve those processes that do not meet acceptable levels. This will include self-monitoring of identified deficient practices that shall be reviewed during the monthly Quality Assurance Performance Improvement Committee meetings, as well as the Quarterly Quality Assurance Meetings, until significant corrections are noted and ongoing, as necessary.

5. Date Corrective Action will be completed:
Substantial compliance is expected by April 21, 2020.

205.67(k) LICENSURE Electric requirements.:State only Deficiency.
(k) Calls shall register by a signal receiving and indicating device at the nurses' station, and shall activate a visible signal in the corridor at the resident's door. In multicorridor nursing units, additional visible signal indicators shall be installed at corridor intersections.
Observations:


Based on staff interviews, it was determined that the facility failed to provide a call bell system that functioned properly to register an activation of the call bell system by a resident.

Findings include:

Interviews with Registered Nurse 1 and Unit Clerk 2 on February 21, 2020, at 12:55 p.m. revealed that the call bell system for resident rooms 112, 127 and 132 did not always function properly. They stated that there were instances of "ghost bells" where the system activated itself. Unit Clerk 2 stated that the facility kept a supply of cow bells on the unit in the event the malfunction occurred.

Interview with the Nursing Home Administrator on February 21, 2020, at 4:05 p.m. revealed that she was not aware of any concerns with the call bell system.



 Plan of Correction - To be completed: 04/21/2020

1. Actions taken for the situation identified:
No residents were affected. The call bell system was inspected and is functioning properly at this time.

2. How the facility will act to protect residents in similar situations:
The facility recognizes that all residents have the potential to be affected. Call bells in all rooms will be placed on routine monitoring and the rooms identified (112, 127, 132) will be monitored more frequently. Facility staff have been reeducated to report to maintenance any call bell malfunction immediately for repair. Call bell monitoring is part of the facility's routine preventative maintenance program.

3. System changes and measures to be taken:
The Maintenance Director or designee will implement routine call bell testing. The rooms identified as having issues will be tested weekly. Facility staff have been re-educated on reporting any call bell malfunction to maintenance immediately. Daily manager rounds will include routine call bell checks. Call bell monitoring is part of the facility's routine preventative maintenance program.

4. Monitoring mechanisms to assure compliance:
The Administrator or designee will audit call bells for functionality weekly for four (4) weeks then monthly for two (2) months. Manager rounds reports will be audited by the Nursing Home Administrator weekly for four (4) weeks and then monthly for two (2) months for reports of call bell malfuctions. Incidents of non-compliance will be addressed immediately, and audit results will be reviewed through monthly Quality Assurance Performance Improvement Committee meetings and further action plans and audits will continue until substantial compliance is achieved. From then on, monthly Quality Assurance Performance Improvement meetings will help to ensure quality standards are met through continual performance analyses and the implementation of systematic efforts to improve those processes that do not meet acceptable levels. This will include self-monitoring of identified deficient practices that shall be reviewed during the monthly Quality Assurance Performance Improvement Committee meetings, as well as the Quarterly Quality Assurance Meetings, until significant corrections are noted and ongoing, as necessary.

5. Date Corrective Action will be completed:
Substantial compliance is expected by April 21, 2020.

211.10(a) LICENSURE Resident care policies.:State only Deficiency.
(a) Resident care policies shall be available to admitting physicians, sponsoring agencies, residents and the public, shall reflect an awareness of, and provision for, meeting the total medical and psychosocial needs of residents. The needs include admission, transfer, and discharge planning.
Observations:


Based on review of clinical records, as well as observations and staff interviews, it was determined that the facility failed to develop resident care policies related to the use of wheelchair leg rests.

Findings include:

A quarterly Minimum Data Set (MDS) assessment for Resident 1, dated December 19, 2019, revealed that the resident was cognitively impaired and required assistance for locomotion (propelling in her wheelchair). A current, undated information sheet provided to staff members indicated that staff were to use leg rests for transport according to the resident's orders. Physician's order, dated September 21, 2018, indicated that the resident was to be out of bed to her wheelchair with a gel cushion and bilateral leg rests. The resident's care plan, dated September 24, 2019, revealed that she was at risk for falls, and included that she was to be out of bed to her wheelchair with a gel cushion and bilateral leg rests.

Observations on February 21, 2020, at 6:52 a.m. revealed that Resident 1 was self-propelling her wheelchair in the hallway near the nursing station. A staff member placed herself on the left side of the resident's wheelchair, placed her hand on the arm rest of the wheelchair, and pulled the resident toward the shower room on the unit. The wheelchair was not equipped with leg rests during the transport and the resident's feet were observed to intermittently touch the floor.

Interview with Registered Nurse 1 on February 21, 2020, at 7:38 a.m. confirmed that Resident 1 should have had the leg rests on her wheelchair if staff were assisting her in transportation to the shower room.

Interview with the Director of Nursing on February 21, 2020, at 1:30 p.m. revealed that she was not aware of any facility policies related to the use of leg rests while transporting a resident in his/her wheelchair, and that the only information available was the undated information sheet that was provided to staff members. She confirmed that Resident 1 should have had the leg rests on the wheelchair while staff were assisting her to the shower room.



 Plan of Correction - To be completed: 04/21/2020

1. Actions taken for the situation identified:
Resident 1 suffered no ill effect. Staff member involved in the transport of Resident 1 was educated on the proper use of leg rest during staff-assisted wheelchair transports.

2. How the facility will act to protect residents in similar situations:
The facility recognizes that all residents have the potential to be affected. Facility has developed and implemented a policy on the use of wheelchair leg rests during staff-assisted resident transfers. All residents requiring the use of wheelchairs for transports will have leg rests available for wheelchairs during staff-assisted wheelchair transports, as per policy. No wheelchair transport assistance will be provided without the use of leg rests. Care plans for residents who use wheelchairs will be updated to indicate the use of leg rests. Facility and agency staff will receive education on this policy and it will be added to the new hire orientation process.

3. System changes and measures to be taken:
The Director of Nursing or designee will re-educate licensed nursing staff and certified nursing assistants, including agency staff, on the new policy regarding the proper use of leg rests during staff-assisted wheelchair transports. Staff members shall follow the policy to ensure resident safety.

4. Monitoring mechanisms to assure compliance:
The Director of Nursing or designee will monitor staff-assisted resident wheelchair transports, weekly for four (4) weeks then monthly for two (2) months to ensure compliance with leg rest policy. Incidents of non-compliance will be addressed immediately, and audit results will be reviewed through monthly Quality Assurance Performance Improvement Committee meetings and further action plans and audits will continue until substantial compliance is achieved. From then on, monthly Quality Assurance Performance Improvement meetings will help to ensure quality standards are met through continual performance analyses and the implementation of systematic efforts to improve those processes that do not meet acceptable levels. This will include self-monitoring of identified deficient practices that shall be reviewed during the monthly Quality Assurance Performance Improvement Committee meetings, as well as the Quarterly Quality Assurance Meetings, until significant corrections are noted and ongoing, as necessary.

5. Date Corrective Action will be completed:
Substantial compliance is expected by April 21, 2020.


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