Nursing Investigation Results -

Pennsylvania Department of Health
BONHAM NURSING CENTER
Patient Care Inspection Results

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Severity Designations

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Minimal Citation - No Harm Minimal Harm Actual Harm Serious Harm
BONHAM NURSING CENTER
Inspection Results For:

There are  41 surveys for this facility. Please select a date to view the survey results.

Surveys don't appear on this website until at least 41 days have elapsed since the exit date of the survey.
BONHAM NURSING CENTER - Inspection Results Scope of Citation
Number of Residents Affected
By Deficient Practice
Initial comments:
A COVID-19 Focused Emergency Preparedness Survey was conducted by The Department of Health (DOH) on January 29, 2021. Bonham Nursing Center was in compliance with 42 CFR 483.73 related to E-0024(b)(6)



 Plan of Correction:


Initial comments:

Based on a Medicare/Medicaid Recertification, State Licensure, COVID-19 Focused Infection Control and Civil Rights Compliance Survey completed on January 29, 2021, it was determined that Bonham 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:


483.25(k) REQUIREMENT Pain Management: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.
483.25(k) Pain Management.
The facility must ensure that pain management is provided to residents who require such services, consistent with professional standards of practice, the comprehensive person-centered care plan, and the residents' goals and preferences.
Observations:

Based on clinical record review and staff interview, it was determined that the facility repeatedly failed to attempt non-pharmacological interventions to alleviate pain prior to the administration of a narcotic pain medication prescribed on an as needed basis for one resident (Resident 50) of 16 residents reviewed.

Findings include:

A review of Resident 50's clinical record revealed current physician's orders, initially dated January 1, 2021, for Hydrocodone-Acetaminophen 5-325 mg (combination medication used to relieve moderate to severe pain. It contains an opioid pain reliever \ and a non-opioid pain reliever one tablet by mouth every 4 hours, as needed, for moderate pain.

A review of the resident's January 2021 Medication Administration Records (MARs) through January 29, 2021, revealed that staff administered this prn pain medication 21 times during the month of January 2021. Of the 21 doses given, all were administered without attempting non-pharmacological interventions to relieve the resident's prior to administering the pain medication.

Interview with the DON (director of nursing) on January 29, 2021, at approximately 12:00 PM confirmed that there was no evidence that non-pharmacological interventions were consistently attempted and proved ineffective prior to administration of prn pain medication.


28 Pa. Code 211.5(f)(g) Clinical records

28 Pa. Code 211.12(a)(c)(d)(1)(5) Nursing Services






 Plan of Correction - To be completed: 03/17/2021

The facility recognizes that it must offer non-pharmacological interventions to alleviate pain.

1. Residents receiving as needed narcotics have been evaluated and will be offered non-pharmacological interventions prior to administration of an as needed narcotic.

2.Going forward, residents will be offered non-pharmacological interventions to alleviate pain prior to administration of an as needed narcotic.

3.Nurses have been educated on offering non-pharmacological interventions prior to the administration of a narcotic pain medication to a resident.

4.A QA audit will be completed on all resident's who receive as needed narcotic pain medications. Changes will be made to Point Click Care as necessary to prompt nurses to offer non-pharmacological interventions prior to giving an as need narcotic.

5.Completion date 3/17/2021

483.24(a)(2) REQUIREMENT ADL Care Provided for Dependent Residents: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.
483.24(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 review of clinical records and resident and staff interview, it was determined that the facility failed to consistently provide assistance with activities of daily living for those residents dependent on staff to maintain adequate grooming and personal hygiene for two of 20 clinical records reviewed (Residents 26 and 44).

Finding include

A review of Resident 26's clinical record revealed that the resident was admitted to the facility on January 9, 2020, with diagnoses that included Cerebral Vascular Accident and arthritis.

Review of Resident 26's Annual Minimum Data Set (MDS- assessment used to assess and plan care for residents) dated November 12, 2020, revealed that the resident needed extensive assistance of two staff members for bed mobility, transferring, needed extensive assistance with a staff member for dressing, eating, toileting, personal hygiene and was totally dependent on staff to physically assist her with bathing.

Documentation of staff assistance provided to Resident 26 with activities of daily living during the month December 2020 revealed that on December 23, 2020 and December 31, 2020, no staff assistance with morning personal care, grooming, bathing, and bed mobility was provided on December 23, 2020, and December 31, 2020.

A review of Resident 44's clinical record revealed that the resident was admitted to the facility on December 3, 2013 with diagnoses that included Arthritis.

Review of Resident 44's Quarterly Minimum Data Set (MDS- assessment used to assess and plan care for residents) dated December 30, 2020, revealed that the resident needed extensive assistance with two staff members for bed mobility, transferring, needed extensive assistance of one staff member for dressing, eating, toileting, personal hygiene and was totally dependent on staff to physically assist her with bathing.

Review of Resident 44's December 2020 documentation of ADL assistance provided revealed that no assistance was provided for morning care, grooming, bathing, and bed mobility on December 16, 23, and 31, 2020.

An interview with the Director of Nursing on January 29, 2021, at 9:07 AM confirmed that the facility's documentation failed to demonstrate that staff consistently provided necessary assistance with activities of daily living to above residents as required to maintain good grooming, personal and oral hygiene.


28 Pa. Code 211.5 (f)(h) Clinical records.

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





 Plan of Correction - To be completed: 02/15/2021

The facility recognizes that it must consistently provide assistance with activities of daily living for resident's dependent on staff to maintain adequate grooming, personal hygiene, good nutrition, and oral hygiene.

1.Residents that receive assistance with activities of daily living will be reviewed to ensure they receive the necessary services to maintain good grooming, personal and oral hygiene.

2.Going forward, residents who receive assistance with activates of daily living will receive the necessary services to maintain adequate grooming, personal hygiene, good nutrition, and oral hygiene.

3.CNA's have been re-educated on carrying out the residents activities of daily living to maintain good nutrition, grooming, and oral hygiene. There is an in-service on ADL coding to be held on 2/17/2021 for CNA's.

4.A QA audit will be completed twice weekly x 3 months.

5.Completion date 3/17/2021.
483.25(c)(1)-(3) REQUIREMENT Increase/Prevent Decrease in ROM/Mobility: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(c) Mobility.
483.25(c)(1) The facility must ensure that a resident who enters the facility without limited range of motion does not experience reduction in range of motion unless the resident's clinical condition demonstrates that a reduction in range of motion is unavoidable; and

483.25(c)(2) A resident with limited range of motion receives appropriate treatment and services to increase range of motion and/or to prevent further decrease in range of motion.

483.25(c)(3) A resident with limited mobility receives appropriate services, equipment, and assistance to maintain or improve mobility with the maximum practicable independence unless a reduction in mobility is demonstrably unavoidable.
Observations:

Based on clinical record review and staff interview, it was determined that the facility failed to consistently provide services planned to maintain mobility/range of motion for two of four sampled residents receiving restorative nursing services (Resident 26 and 44).

Findings include:

A review of Resident 26's clinical record revealed that the resident was admitted to the facility on January 9, 2020, with diagnoses that included Cerebral Vascular Accident and arthritis.

Resident 26 had a current physician order initially dated November 3, 2020, to receive a Restorative Nursing Program for ambulation with a rollator walker BID (twice a day), bed mobility BID, grooming daily and transfer QID (four times) daily.

A review of the provision of the restorative nursing programs provided to the resident from November 1, 2020, to January 01, 2021, revealed that on November 15, 2020, December 23, 2020, December 31, 2020, the resident received the planned RNP only once daily for ambulation. On November 15, 2020, RNP for bed mobility was provided only once and the RNP for grooming had not been provided. On December 23, and December 31, 2020 RNP for grooming was not completed.

A review of Resident 44's clinical record revealed that the resident was admitted to the facility on December 3, 2013, with diagnoses that included Arthritis.

Resident 44 had a current physician order dated April 3, 2020, for a RNP for ambulation with rolling walker daily, grooming daily, and transfer BID and bed mobility BID.

A review of the documented records of the provision of Resident 44's restorative nursing program from November 1, 2020 to January 01, 2021, indicated that on November 18, 2020, November 29, 2020, December 13, 2020, December 16, 2020, December 23, and December 31, 2020, the facility failed to provide the resident's RNP for grooming.

Interview with the Director of Nursing on January 29, 2021 at approximately 9:45 a.m. confirmed that the above residents' restorative nursing programs were not provided as ordered on the above dates.



28 Pa. Code: 211.5(f) Clinical records

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








 Plan of Correction - To be completed: 03/17/2021

The facility recognizes that it must ensure that residents with limited range of motion will receive the appropriate treatment and services to increase range of motion or prevent further decrease in range of motion.

1.The facility recognizes that it cannot retroactively correct the deficiency as it relates to residents 26 and 44.

2.Going forward, residents with limited mobility will be evaluated and receive the appropriate services to maintain or improve mobility unless a reduction in mobility is demonstrably unavoidable.

3.CNA's have been re-educated on consistently providing services to the residents to maintain or improve mobility/range of motion.

4.A QA audit will be completed twice weekly x 3 months.

5.Conmpletion date 3/17/2021.

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 a review of clinical records and staff interview, it was determined that the facility failed to develop and implement an individualized person-centered plan to address a resident's dementia-related behavioral symptoms for one out of 13 residents (Resident 27).

Findings include:

A review of the clinical record revealed that Resident 27 was admitted to the facility on July 26, 2020, with diagnoses to include Alzheimer's disease (A progressive disease that destroys memory and other important mental functions. Brain cell connections and the cells themselves degenerate and die, eventually destroying memory and other important mental functions).

A Quarterly MDS (Minimum Data Set, an assessment completed periodically to plan resident care) dated December 3, 2020, revealed that Resident 27 was severely cognitively impaired. According to the MDS assessment the resident exhibited physical behaviors ( hitting, kicking, pushing, scratching, grabbing), verbal behaviors (threaten, screaming, cursing), other behavioral symptoms (pacing, rummaging, disrobing), and rejection of care.

A review of Resident 27's nursing progress notes from August 2020 through the survey ending January 29, 2021, revealed that the resident exhibited behaviors of crawling out of bed, trying to get out of his recliner, self-transferring, attempting to self-ambulate. The resident incurred six falls in the facility from August 2020 until November 2020 related to these behavioral symptoms.

A review of the resident's current care plan to address the problem of the resident's cognitive impairment and mood failed to address the specific behaviors exhibited by the resident. There was no documented evidence that the facility had developed individualized person-centered interventions to address the resident's dementia-related behavioral symptoms.

An interview with NHA (Nursing Home Administrator) at approximately 2:00 PM confirmed the facility failed to develop and implement an individualized person-centered plan to address a resident's dementia-related behavioral symptoms.



28 Pa Code 211.12 (a)(c)(d)(1)(3)(5) Nursing services


28 Pa Code 211.11(d) Resident care plan





 Plan of Correction - To be completed: 03/17/2021

The facility recognizes that it must develop and implement an individualized and person-centered plan to meet the individual needs of residents.

1.The facility recognizes that it cannot retroactively correct the deficiency as it relates to resident 27.

2.Going forward, residents that have a diagnosis of dementia will have a comprehensive person-centered care plan.

3.Nurses and RNAC have been re-educated on developing and implementing comprehensive care plans to address a resident's dementia-related behavioral symptoms.

4.A QA audit will be completed monthly x 3 months.

5.Completion date 3/17/2021.

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