Nursing Investigation Results -

Pennsylvania Department of Health
MID-VALLEY HEALTH CARE CENTER
Patient Care Inspection Results

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Minimal Citation - No Harm Minimal Harm Actual Harm Serious Harm
MID-VALLEY HEALTH CARE CENTER
Inspection Results For:

There are  51 surveys for this facility. Please select a date to view the survey results.

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

Based on a Medicare/Medicaid Recertification, State Licensure, Civil Rights Compliance and Abbreviated Complaint Survey completed on November 27, 2019, it was determined that Mid Valley 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.



 Plan of Correction:


483.10(f)(5)(i)-(iv)(6)(7) REQUIREMENT Resident/Family Group and Response: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.
483.10(f)(5) The resident has a right to organize and participate in resident groups in the facility.
(i) The facility must provide a resident or family group, if one exists, with private space; and take reasonable steps, with the approval of the group, to make residents and family members aware of upcoming meetings in a timely manner.
(ii) Staff, visitors, or other guests may attend resident group or family group meetings only at the respective group's invitation.
(iii) The facility must provide a designated staff person who is approved by the resident or family group and the facility and who is responsible for providing assistance and responding to written requests that result from group meetings.
(iv) The facility must consider the views of a resident or family group and act promptly upon the grievances and recommendations of such groups concerning issues of resident care and life in the facility.
(A) The facility must be able to demonstrate their response and rationale for such response.
(B) This should not be construed to mean that the facility must implement as recommended every request of the resident or family group.

483.10(f)(6) The resident has a right to participate in family groups.

483.10(f)(7) The resident has a right to have family member(s) or other resident representative(s) meet in the facility with the families or resident representative(s) of other residents in the facility.
Observations:

Based on review of select facility policy and minutes from Resident Council meetings and resident and staff interviews it was determined that the facility failed to put forth sufficient efforts to promptly resolve continued resident complaints/grievances expressed during Resident Council Meetings including those voiced by three of three residents attending a group meeting (Residents 20, 6, and 22).

Findings include:

Review of the facility's Grievance policy indicated that it is the facility's policy to provide an opportunity for residents to express concerns at any time. The facility's goal is to resolve resident and family concerns in a timely basis.

Review of the minutes from the June 26, 2019, through November 20, 2019, Resident Council meetings revealed that residents in attendance at these resident group meetings voiced their concerns regarding resident care and facility services during the meetings.

During the June 26, 2019, Resident Council meeting the residents relayed concerns that snacks are not consistently offered to them.

During the August 28, 2019, Resident Council meeting the residents relayed concerns regarding snacks not being offered and with timeliness of staff response to their requests for assistance via the nurse call bell system.

During the October 23, 2019, Resident Council meeting the residents relayed continued concerns that snacks are not offered to them.

During the November 20, 2019, Resident Council meeting the residents relayed continued concerns regarding snacks not being offered and the timeliness of call bell response by staff.

During a group meeting held on November 26, 2019 at 10:30 a.m., with three (3) alert and oriented residents, all residents in attendance complained that the facility does not consistently offer evening snacks. The residents also stated that untimeliness of staff response to their call bells and meeting their needs for assistance in a timely manner remains a problem for them. The residents stated that they have repeatedly brought these particular complaints to the facility's attention without resolution to date.

The facility was unable to provide documented evidence that the facility had determined if the residents' felt that their complaints/grievances had been resolved through any efforts taken by the facility in response to the residents' expressed concerns regarding untimely staff response to call bells and delays in meeting residents' needs for assistance and consistent offering of evening snacks.

During an interview with the Nursing Home Administrator (NHA) and Director of Nursing (DON) on November 26, 2019, at 2:30 p.m. the NHA and DON were unable to provide documented evidence that the facility had followed-up with the residents' to ascertain the effectiveness of the facility's efforts in resolving their complaints regarding facility services.



28 Pa. Code 201.18(e)(1)(3)(4) Management

28 Pa. Code 201.29(i)(j) Resident Rights









 Plan of Correction - To be completed: 12/27/2019

- Preparation and submission of this POC is required by state and federal law. This POC does not constitute an admission for purposes of general liability, professional malpractice or any other court proceeding.


1. All grievances and resident council minutes in the last 6 months will be reviewed for intervention and resolution.
2. To identify other residents with the potential to be affected, the DON/designee has interviewed all residents with the ability to be interviewed to ensure any complaint/grievances have been resolved on a timely basis. No negative findings were noted.
3. To prevent from recurring, DON/designee will educate current staff on call bells response time and HS snack policy.
4. To monitor and maintain ongoing compliance, the DON/designee will interview 5 residents with the ability to be interviewed to ensure adequate call bell response time and that HS snacks are provided per resident preference weekly x4 then monthly x 2. Any negative findings will be immediately corrected. The results of the audits will be forwarded to the facility QAPI committee for further review and recommendations.

483.10(i)(1)-(7) REQUIREMENT Safe/Clean/Comfortable/Homelike Environment: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.
483.10(i) Safe Environment.
The resident has a right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.

The facility must provide-
483.10(i)(1) A safe, clean, comfortable, and homelike environment, allowing the resident to use his or her personal belongings to the extent possible.
(i) This includes ensuring that the resident can receive care and services safely and that the physical layout of the facility maximizes resident independence and does not pose a safety risk.
(ii) The facility shall exercise reasonable care for the protection of the resident's property from loss or theft.

483.10(i)(2) Housekeeping and maintenance services necessary to maintain a sanitary, orderly, and comfortable interior;

483.10(i)(3) Clean bed and bath linens that are in good condition;

483.10(i)(4) Private closet space in each resident room, as specified in 483.90 (e)(2)(iv);

483.10(i)(5) Adequate and comfortable lighting levels in all areas;

483.10(i)(6) Comfortable and safe temperature levels. Facilities initially certified after October 1, 1990 must maintain a temperature range of 71 to 81F; and

483.10(i)(7) For the maintenance of comfortable sound levels.
Observations:

Based on observations and interviews with residents and staff, it was determined that the facility failed to maintain comfortable temperatures in two out 18 resident rooms (Residents 6 and 84).

Findings include:

During a group meeting with residents conducted on November 26, 2019, at 10:30 a.m. Resident 6 stated that her room was often too cold. Resident 6 stated that she asks for staff assistance to turn up the temperature in her room due to her poor vision. The resident stated that she cannot adjust the room temperature herself. Resident 6 stated even when she requests the heat be turned up, staff does not adjust the temperature to her liking and she remains cold.

Observation of Resident 6's room (room 17) on November 26, 2019 at approximately 11:30 a.m. revealed that the room temperature of Resident 6's room was 68 degrees F (Fahrenheit).

Observation of Resident 6's (room 17) on November 27, 2019 at approximately 10:37 a.m. revealed that the room temperature of Resident 6's room was 65 degrees F (Fahrenheit).

Observation of Resident 84's room (room 5) on November 27, 2019, at approximately 8:17 a.m. revealed that the room temperature of Resident 84's room was 58 degrees F (Fahrenheit). Resident 84's PTAC unit (A Packaged Terminal Air Conditioner is a type of self-contained heating and air conditioning system commonly found in hotels, motels, senior housing facilities and hospitals. PTACs are commonly installed in window walls and masonry walls) was off at time of the observation. Resident 84 stated that she was cold at that time.

Interview with the DON (Director of Nursing) on November 27, 2019, at 12:00 p.m. confirmed the observed temperatures of the above resident rooms and that the facility failed to maintain comfortable temperatures in resident rooms.



28 Pa. Code 201.18(b)(3) Management

28 Pa. Code 207.2(a) Administrator's responsibility
Previously cited 6/26/2019






 Plan of Correction - To be completed: 12/27/2019

1. The PTAC unit in Residents 6 and 84 room has been inspected to ensure adequate function. Residents 6 and 84 room temperature was adjusted to their preference and to meet federal regulation.

2. To identify other residents that have the potential to be affected, all PTAC units have been inspected to ensure adequate functioning. The DON/designee completed an audit of all residents with the ability to be interviewed and family members of residents who do not have the ability to be interviewed to ensure temperature of room meets their preference and federal regulation. No negative findings were noted.

3. To prevent this from recurring, the DON/designee will educate current staff on the federal tag of maintaining safe, homelike environment with emphasis on temperature guidelines and honoring resident preference for room temperatures within guidelines.

4. To monitor and maintain compliance, the DON/designee will interview 5 residents with the ability to be interviewed to ensure room temperature meets preference and regulation weekly x 4 then monthly x 2. The DON/designee will interview 5 family member of residents who do not have the ability to be interviewed to ensure room temperature meets preference and regulation weekly x4 then monthly x2. Any negative findings will be immediately corrected. The results of the audits will be forwarded to the facility QAPI committee for further review and recommendations.

483.20(g) REQUIREMENT Accuracy of Assessments: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.
483.20(g) Accuracy of Assessments.
The assessment must accurately reflect the resident's status.
Observations:

Based on a review of clinical records and interviews with residents and staff it was determined that the facility failed to ensure that the MDS Assessment accurately reflected the status of one resident out of 12 sampled (Resident 17).

Findings included:

A review of Resident 17's admission Minimum Data Set Assessment (MDS- a federally mandated standardized assessment process conducted periodically to plan resident care) dated March 13, 2019, revealed that the resident was continent of bowel and bladder. The resident's BIMS score (Brief Interview for Mental Status- a tool to assess cognitive function) score was 15, indicating that the resident was cognitively intact.

A review of Resident 17's activity of daily living documentation for the month of October 2019 revealed that the resident was frequently incontinent of both urine and bowel.

A review of a 3-day bowel and bladder record dated October 3, 2019 through October 5, 2019 revealed that Resident 17 did not have an episode of incontinence.

A review of Resident 17's evaluation for continence and retraining/scheduled toileting determination dated October 7, 2019, revealed that the resident was continent of bowel and bladder and did not require a toileting program.

A review of nursing documentation dated October 6, 2019, at 4:00 p.m. revealed that the resident was continent of bladder and bowel and did not "require set up of physical help from staff for toilet use."

However, a review of Resident 17's quarterly MDS Assessment dated October 8, 2019, revealed that the resident was frequently incontinent of urine (7 or more episodes of urinary incontinence, but at least one episode of continent voiding) and bowel (2 or more episodes of bowel incontinence, but at least one episode of continent bowel). The MDS Assessment also revealed that the resident was not on a toileting program, a toileting program was not trialed to prevent episodes of incontinence and the resident required staff supervision with set-up help only for toileting.

Interview with Resident 17 on November 26, 2019, at approximately 11:30 a.m. revealed that he does not have episodes of urinary or bowel incontinence or require staff assistance with toileting.

Interview with Director of Nursing on November 27, 2019, at approximately 1:30 p.m. confirmed that Resident 17's October 8, 2019, MDS assessment was inaccurate in the areas of bowel and bladder functioning and toileting assistance needs.

Refer F842



28 Pa. Code 211.5(f)(h) Clinical records.
Previously cited 10/12/18

28 Pa. Code 211.12 (a)(c)(d)(5) Nursing services.
Previously cited 10/12/18










 Plan of Correction - To be completed: 12/27/2019


1. Resident 17's ADL flow record documentation cannot be retroactively corrected. Moving forward the facility will ensure accurate ADL documentation.

2. To identify other residents that have the potential to be affected, the DON/designee will complete an audit to ensure that current residents bowel and bladder documentation reflects resident status. No negative findings were noted.

3. To prevent this from recurring, the DON/designee will educate current licensed nursing staff and CNAs on the importance of documentation accuracy on ADL flow records.

4. To monitor and maintain ongoing compliance, 5 resident ADL flow records will be reviewed by the DON/designee to ensure accuracy weekly x4 then monthly x 2. Any negative findings will be immediately corrected. The results of the audits will be forwarded to the facility QAPI committee for further review and recommendations


483.20(f)(5), 483.70(i)(1)-(5) REQUIREMENT Resident Records - Identifiable Information: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.
483.20(f)(5) Resident-identifiable information.
(i) A facility may not release information that is resident-identifiable to the public.
(ii) The facility may release information that is resident-identifiable to an agent only in accordance with a contract under which the agent agrees not to use or disclose the information except to the extent the facility itself is permitted to do so.

483.70(i) Medical records.
483.70(i)(1) In accordance with accepted professional standards and practices, the facility must maintain medical records on each resident that are-
(i) Complete;
(ii) Accurately documented;
(iii) Readily accessible; and
(iv) Systematically organized

483.70(i)(2) The facility must keep confidential all information contained in the resident's records,
regardless of the form or storage method of the records, except when release is-
(i) To the individual, or their resident representative where permitted by applicable law;
(ii) Required by Law;
(iii) For treatment, payment, or health care operations, as permitted by and in compliance with 45 CFR 164.506;
(iv) For public health activities, reporting of abuse, neglect, or domestic violence, health oversight activities, judicial and administrative proceedings, law enforcement purposes, organ donation purposes, research purposes, or to coroners, medical examiners, funeral directors, and to avert a serious threat to health or safety as permitted by and in compliance with 45 CFR 164.512.

483.70(i)(3) The facility must safeguard medical record information against loss, destruction, or unauthorized use.

483.70(i)(4) Medical records must be retained for-
(i) The period of time required by State law; or
(ii) Five years from the date of discharge when there is no requirement in State law; or
(iii) For a minor, 3 years after a resident reaches legal age under State law.

483.70(i)(5) The medical record must contain-
(i) Sufficient information to identify the resident;
(ii) A record of the resident's assessments;
(iii) The comprehensive plan of care and services provided;
(iv) The results of any preadmission screening and resident review evaluations and determinations conducted by the State;
(v) Physician's, nurse's, and other licensed professional's progress notes; and
(vi) Laboratory, radiology and other diagnostic services reports as required under 483.50.
Observations:

Based on review of clinical records and select facility policy and resident and staff interview, it was determined that the facility failed to maintain accurate clinical records of one of 12 sampled residents (Resident 17).

Findings include:

A review of Resident 17's admission Minimum Data Set Assessment (MDS- a federally mandated standardized assessment process conducted periodically to plan resident care) dated March 13, 2019, revealed that the resident was always continent of bowel and bladder. The resident's admission MDS assessment also revealed that the resident's BIMS score (Brief Interview for Mental Status- a tool to assess cognitive function) score was 15, indicating that the resident was cognitively intact.

A review of Resident 17's activity of daily living documentation for the month of October 2019 revealed that the resident was frequently incontinent of both urine and bowel.

A review of a 3-day bowel and bladder record dated October 3, 2019 through October 5, 2019 revealed that Resident 17 did not have an episode of incontinence.

A review of Resident 17's evaluation for continence and retraining/scheduled toileting determination dated October 7, 2019, revealed that the resident was continent of bowel and bladder and did not require a toileting program.

A review of nursing documentation dated October 6, 2019, at 4:00 p.m. revealed that the resident was continent of bladder and bowel and did not "require set up of physical help from staff for toilet use."

However, a review of Resident 17's quarterly MDS Assessment dated October 8, 2019, revealed that the resident was frequently incontinent of urine (7 or more episodes of urinary incontinence, but at least one episode of continent voiding) and bowel (2 or more episodes of bowel incontinence, but at least one episode of continent bowel).
The MDS Assessment also revealed that the resident was not on a toileting program, a toileting program was not trialed to prevent episodes of incontinence and the resident required staff supervision with set-up help only for toileting.

Interview with Resident 17 on November 26, 2019, at approximately 11:30 a.m. revealed that he does not have episodes of urinary or bowel incontinence or require staff assistance with toileting.

Interview with Director of Nursing on November 27, 2019, at approximately 1:30 p.m. confirmed that the facility failed to accurately document the Resident 17's bowel and bladder functioning and that Resident 17's activity of daily living documentation for the month of October 2019 was inaccurate.

Refer 641



28 Pa. Code 211.5(f)(h) Clinical records.
Previously cited 10/12/18

28 Pa. Code 211.12 (a)(d)(5) Nursing services.
Previously cited 10/12/18









 Plan of Correction - To be completed: 12/27/2019

1. Resident 17s MDS was modified to reflect accurate bowel and bladder assessments. Resident 17's ADL flow records cannot be retroactively corrected. Moving forward the facility will ensure accurate ADL documentation.
2. To identify other residents that have the potential to be affected, the DON/designee completed an audit to ensure the ADL flow record accurately reflects results of completed 3 day bowel and bladder assessments. The DON/designee completed an audit MDS assessments completed over the last 30 days to ensure bowel and bladder assessments are completed accurately. No negative findings were monitored.
3. To prevent this from recurring, the DON/designee educated current licensed nursing staff and CNAs on completing the three day bowel and bladder diary and assessment. The DON/designee educated current licensed nursing staff and CNAs on accurate ADL documentation. The DON/designee educated the MDS nurse on accurate completion of bowel and bladder assessments in the MDS.
4. To monitor and maintain ongoing compliance, the DON/designee will complete 5 resident audits to review bowel and bladder assessment and ADL documentation weekly x 4 then monthly x 2.The DON/designee will audit 5 MDS assessments for accuracy of completion of bowel and bladder assessments. Any negative findings will be immediately corrected. The results of the audit will be forwarded to the facility QAPI committee for further review and recommendations.

211.12(f)(1) LICENSURE Nursing services.:State only Deficiency.
(f) In addition to the director of nursing services, the following daily professional staff shall be available:

(1) The following minimum nursing staff ratios are required:

Census Day Evening Night
59 and under 1 RN 1 RN 1 RN or 1 LPN
60/150 1 RN 1 RN 1 RN
151/250 1 RN and 1 LPN 1 RN and 1 LPN 1 RN and 1 LPN
251/500 2 RNs 2 RNs 2 RNs
501/1,000 4 RNs 3 RNs 3 RNs
1,001/Upward 8 RNs 6 RNs 6 RNs



Observations:

Based on review of facility nurse staffing and staff interview, it was determined that the facility failed to ensure that, in addition to the Director of Nursing, there was a registered nurse on duty during the day shift on three of 21 days reviewed.

Findings include:

A review of nursing time schedules revealed that aside from the DON (Director of Nursing) there was no registered nurse on duty, on the day tour of duty, on the following dates November 14, 18 and 27, 2019.

Interview with the Director of Nursing on November 27, 2019, at approximately 2:00 p.m. confirmed, no registered nurse had been scheduled to work the day tour of duty work on November 14 and 18, 2019 and on November 27, 2019, the scheduled registered nurse called-off and had not been replaced.



 Plan of Correction - To be completed: 12/27/2019

1. Previous nursing schedule cannot be fixed.
2. No residents were effected.
3. To prevent from recurring , the NHA educated DON on the staffing requirements of PA
4. To monitor and maintain compliance audits will be completed to review schedules in advance to ensure facility is meeting RN requirements. Any negative findings will be immediately corrected. The results of the audits will be forwarded to the facility QAPI committee for further review and recommendations.



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