Pennsylvania Department of Health
CHAPEL MANOR
Patient Care Inspection Results

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Severity Designations


Minimal Citation - No Harm	Minimal Harm	Actual Harm	Serious Harm

CHAPEL MANOR
Inspection Results For:

There are 178 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.


CHAPEL MANOR - Inspection Results	Scope of Citation Number of Residents Affected By Deficient Practice

Initial comments:

Based on an Abbreviated survey in response to four complaints completed on June 13, 2024, it was determined that Chapel Manor was not in compliance with the following requirements of 42 CFR Part 483, Subpart B, Requirements for Long Term Care and the 28 Pa. Code, Commonwealth of Pennsylvania Long Term Care Licensure Regulations.

Plan of Correction:

483.10(f)(1)-(3)(8) REQUIREMENT Self-Determination:

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) Self-determination.
The resident has the right to and the facility must promote and facilitate resident self-determination through support of resident choice, including but not limited to the rights specified in paragraphs (f)(1) through (11) of this section.

§483.10(f)(1) The resident has a right to choose activities, schedules (including sleeping and waking times), health care and providers of health care services consistent with his or her interests, assessments, and plan of care and other applicable provisions of this part.

§483.10(f)(2) The resident has a right to make choices about aspects of his or her life in the facility that are significant to the resident.

§483.10(f)(3) The resident has a right to interact with members of the community and participate in community activities both inside and outside the facility.

§483.10(f)(8) The resident has a right to participate in other activities, including social, religious, and community activities that do not interfere with the rights of other residents in the facility.

Observations:

Based on review of select facility policy and procedures, observations, and resident and staff interviews, it was determined that the facility failed to ensure that residents could make choices about aspects of their lives that were significant to them, such as smoking and outdoor fresh air times were provided and or honored consistent with interests of the residents for four of six residents reviewed (Resident R1, R2, R3 and R4).

Findings include:

Review of facility policy "Resident Rights Under Federal Law" revealed that "On admission each residents will be informed orally and in writing of his/her Resident Rights.

Purpose:
-To incorporate the residents goals, preference, and choices into care
-To promote rights of the residents.
Self Determination.
The resident has the right to and the facility must promote and facilitate resident self-determination through support of resident choice, including but not limited to: 6.1. The resident has a right to choose activities, schedules (including sleeping and waking times), health care and providers of health care services consistent with his/her interests, assessments, plan of care and other applicable provisions.
6.2. The resident has the right to make choices about aspects of his/her life in the facility that are significant to the resident.
6.3. The resident has a right to interact with members of the community and participate in community activities both inside and outside the facility."

Review of facility policy "Recreation Services Policies and Procedures" dated August 7, 2023 revealed that "Centers/Communities must provide, based on the comprehensive assessment and care plan and the preferences of each patient/resident (hereinafter "patient"), an ongoing program to support residents/patients in their choice of activities, both facility-sponsored group and individual activities and independent activities, designed to meet the interests of and support the physical, mental, and psychosocial well being of each patient, encouraging both independence and interaction in the community.

Recreation services will be designed to meet the individual ' s interests, abilities, and preferences
through group and individual programs and independent leisure activities.

1. The Recreation Program design is based upon the assessed abilities, needs, interests, and preferences of the patient population and is reflective of the person ' s comprehensive assessments, care plans, and participation.
2. Group, individual, and independent programs are reflective of the resident ' s/patient ' s comprehensive assessments and care plans and the preferences of each resident/patient and will be adapted to ensure participation.
3. Individual and independent programming is offered for patients who are unable or unwilling to participate in activities within the group setting, and/or prefer independent leisure involvement"

Review of facility document "Smoking Times" revealed that effective April 6, 2024, smoking times were Morning 9 a.m. to 9:30 am for A and B wing residents and 9:30 to 10 a.m. for C and D wing residents. Afternoon 1:00p.m. to 1:30 p.m. for A and B wing residents and 1:30 p.m. to 2 p.m. for C and D wing residents. Evening 6:00p.m. to 6:30 p.m. for A and B wing residents and 6:30 p.m. to 7 p.m. for C and D wing residents.

Review of a letter addressed to residents dated March 29, 2024, revealed that "Dear Residents, "Chapel Manor wants to inform you of an upcoming change to our smoking schedule, effective April 6th, 2024. This decision follows discussions held during the Resident Council meeting on March 22nd, where concerns regarding the increased census and number of smokers in the building were raised.

In order to maintain safety and accommodate the needs of all residents, it has been decided to divide smoke breaks into two separate groups. Each group will be allocated one half-hour smoking break throughout the day. This adjustment aims to reduce congestion and ensure a more organized approach to smoking breaks."

An interview with the Nursing Home Administrator (NHA) on June 12, 2024, at 2:30 p.m. stated the facility offered smoking to the resident. Smoking for residents was offered smoking an hour after breakfast and lunch and half an hour after dinner. NHA stated the number of residents who smoked reached around 50 which was an unsafe number of residents in a small area. Facility had more residents admitted who smoked. Facility did not have any other smoking areas, and did not want activity staff, who was assigned for smoking supervision, spend more time supervise residents outdoor so the facility decided to cut the smoking time in half.

Interview with activity staff, Employee E3, on June 13, 2024, at 1:20 p.m. who was assigned for smoking stated one group of residents were allowed to go out for 30 min, then they should go inside before the other group comes out for smoking. Residents who smoke and did not smoke are provided outdoor time together in the same area. Employee E3 stated after smoking time was over, the door gets locked, and the key was kept with activity department.

Observation of the smoking area on June 12, 2024, at 12:35 p.m. revealed that the area for outdoor time for smokers and non-smokers were locked.

Observation of the smoking area on June 12, 2024, at 3:00 p.m. revealed that the area for outdoor time for smokers and non-smokers were locked.

Interview with Resident R1 on June 12, 2024, at 11:00 a.m. stated he used to out and smoke three times a day for an hour. He stated that was the only time residents were allowed outdoor. He stated he don't smoke all the time, but after smoking for few minutes he sits outdoor for some fresh air. Resident stated facility cut the smoking time because facility stated they did not have staff to supervise all the residents while smoking. Resident stated facility violated his rights by not allowing to choose his preferred activity because of staffing and space issue. Resident showed a copy of resident rights with some of the rights highlighted and stated these were the rights the facility violated.

Interview with Resident R2 on June 12, 2024, at 10:30 a.m. stated he would like to go outdoor and sit for fresh air an hour as previously provided. He stated facility offered smoking for an hour but later reduced the time without providing any extra activities which he liked.

Interview with Resident R3 on June 13, 2024, at 12:30 p.m. stated he wanted to go outside and sit outside but he didn't want to sit near the smokers, he stated facility did not provide outdoor times other than smoking times at the smoking location.

Interview with Resident R4 on June 13, 2024, at 12:40 p.m. stated she wanted to sit out for fresh airtime, however there was no time and space available to sit outside.

Observation of the smoking area on June 13, 2024, at 12:45 p.m. revealed that the area for outdoor time for smokers and non-smokers were locked.

Interview with Ombudsman on June 12, 2024 at 1:30 p.m. stated residents were allowed to smoke outdoor for an hour three times a day, facility cut the smoking time to half. Residents had reported that they wanted their one hour smoke break time which included the only outdoor times, but they did not have a choice facility made the decision and notified the residents.

Observation of the smoking area on June 13, 2024, at 1:05 p.m. revealed that there were residents smoking outside in the designated smoking area, the area was fenced, and a staff was observed supervising the resident. There was strong odor of smoking in the area. There were two residents sitting in the area who did not smoke.

Interview with Resident R5, who was sitting at the smoking area while other residents smoked on June 13, 2024, at 1:10 p.m. stated she did not have other times to go out other than smoking times. She needs fresh air to relax her mind so she would still come out even though other residents are smoking.

Interview with the receptionist on June 13, 2024, at 1:30 p.m. stated residents wee not allowed to go any outdoor areas other than the smoking area. The area is only open during smoke break times. After that the door gets locked and staff keeps the key.

Interview with the Nursing Home Administrator (NHA) on June 13, 2024, at 2:00 p.m. stated residents can go out in front of the building only if family was present. NHA confirmed that the residents were offered an hour smoking time before and it was cut short to half an hour and residents were notified. NHA confirmed that some residents did not like the facility reducing smoking time which was offered when they were admitted to the facility.

Continued interview with the Nursing Home Administrator (NHA) stated facility did not offer outdoor activity or fresh-air time for non-smokers. She stated they were planning to start the outdoor time for non-smokers, but it was not started yet.

28 Pa. Code 201.29(a) Resident rights

Plan of Correction - To be completed: 07/10/2024

1. There were no adverse effects on residents
2. NHA/Designee re-educated recreation staff on the importance of fresh air time for residents.
3. Scheduled fresh air time is added to the calendar. Department heads are given a scheduled time to assist with Fresh Air time. All residents are welcome to go out for fresh air time
4. Weekly audits will be performed by the director of recreation to ensure fresh air time completion.
5. Findings will be reported to QAPI monthly X2

483.10(i)(1)-(7) REQUIREMENT Safe/Clean/Comfortable/Homelike Environment:

§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 81°F; and

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

Observations:

Based on observation, review of facility documentation, interview with staff and residents, it was revealed that the facility failed to ensure a safe, clean and homelike environment for resident for one of four nursing units reviewed, A nursing unit.

Findings Include:

During an initial tour of the facility on June 12, 2024, Resident R5, requested surveyor to come to his friend's room, A 115 to look at his bathroom. Observation inside resident's bathroom revealed that the ceiling tiles were removed and there was a hole to the ceiling, some of the ceiling tiles had brown colored discoloration.

Interview with Resident R5, on June 12, 2024, at 10:00 stated his friend's bathroom had a leak from bathroom from the above floor, it was leaking for almost a month. Facility did not fix it, there was dirty water from the above floor toilet.

Further observation of the resident's room A115 with Maintenance Director revealed that the ceiling tiles were closed, but there was still brown colored discoloration on the ceiling tiles. Maintenance Director stated the toilet on the second floor was leaking, it was fixed by one of his staff, but did not replace the dirty and stained ceiling tiles, He stated it should have been replaced. He stated he was not aware of the leaking before today as staff did not report it.

Review of facility maintenance log revealed no evidence that the staff reported and or facility addressed the maintenance issue in the bathroom resident room of A 115.

28 Pa. Code 201.29(j) Resident Rights.

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

Plan of Correction - To be completed: 07/10/2024

1. The ceiling tile was immediately replaced
2. NPE will educate Housekeeping and nursing staff on placing repair requests on Tels.
3. Maintenance assistant staff are re-educated on proper ceiling repair by the maintenance director.
4. Maintenance/Designee will perform an initial audit to ensure no leaks are present in the building, then random weekly audits x 4.
5. Findings will be reported to QAPI monthly X2

483.21(c)(1)(i)-(ix) REQUIREMENT Discharge Planning Process:

§483.21(c)(1) Discharge Planning Process
The facility must develop and implement an effective discharge planning process that focuses on the resident's discharge goals, the preparation of residents to be active partners and effectively transition them to post-discharge care, and the reduction of factors leading to preventable readmissions. The facility's discharge planning process must be consistent with the discharge rights set forth at 483.15(b) as applicable and-
(i) Ensure that the discharge needs of each resident are identified and result in the development of a discharge plan for each resident.
(ii) Include regular re-evaluation of residents to identify changes that require modification of the discharge plan. The discharge plan must be updated, as needed, to reflect these changes.
(iii) Involve the interdisciplinary team, as defined by §483.21(b)(2)(ii), in the ongoing process of developing the discharge plan.
(iv) Consider caregiver/support person availability and the resident's or caregiver's/support person(s) capacity and capability to perform required care, as part of the identification of discharge needs.
(v) Involve the resident and resident representative in the development of the discharge plan and inform the resident and resident representative of the final plan.
(vi) Address the resident's goals of care and treatment preferences.
(vii) Document that a resident has been asked about their interest in receiving information regarding returning to the community.
(A) If the resident indicates an interest in returning to the community, the facility must document any referrals to local contact agencies or other appropriate entities made for this purpose.
(B) Facilities must update a resident's comprehensive care plan and discharge plan, as appropriate, in response to information received from referrals to local contact agencies or other appropriate entities.
(C) If discharge to the community is determined to not be feasible, the facility must document who made the determination and why.
(viii) For residents who are transferred to another SNF or who are discharged to a HHA, IRF, or LTCH, assist residents and their resident representatives in selecting a post-acute care provider by using data that includes, but is not limited to SNF, HHA, IRF, or LTCH standardized patient assessment data, data on quality measures, and data on resource use to the extent the data is available. The facility must ensure that the post-acute care standardized patient assessment data, data on quality measures, and data on resource use is relevant and applicable to the resident's goals of care and treatment preferences.
(ix) Document, complete on a timely basis based on the resident's needs, and include in the clinical record, the evaluation of the resident's discharge needs and discharge plan. The results of the evaluation must be discussed with the resident or resident's representative. All relevant resident information must be incorporated into the discharge plan to facilitate its implementation and to avoid unnecessary delays in the resident's discharge or transfer.

Observations:

Based on the review of clinical records, facility policies, and interview with staff, it was determined that the facility failed to develop and implement an effective discharge planning process that focuses on the resident's discharge goals, the preparation of residents to be active partners and effectively transition them to post-discharge care, and the reduction of factors leading to preventable readmissions. Facility failed to update a resident's comprehensive care plan and discharge plan, as appropriate, in response to information received from referrals to local contact agencies or other appropriate entities for one of one residents reviewed for discharge planning process. (Resident R5)

Findings Include:

Review of facility policy "Discharge Planning Process: dated November 15, 2022 revealed that "The Center must develop and implement an effective discharge planning process that focuses on the patient ' s/resident ' s (hereinafter "patient") discharge goals, preparation of patients to be active partners and effectively transition them to post-discharge care, and the reduction of factors leading to preventable re-admissions.
The Center ' s discharge planning process must be consistent with the patient ' s discharge rights.
Refer to Resident Rights Under Federal Law policy.
Upon admission, all patients will be asked about their discharge goals and anticipated length of stay, and assessed for discharge potential. Discharge planning will begin upon admission and be completed as part of the Person-Centered Care Plan process.
Within 72 hours of admission, evaluation of discharge potential will be reviewed at the Post
Admission Patient/Family Conference.
Interprofessional Utilization Management (UM) and Discharge Planning meeting will be conducted to continue evaluation of discharge potential.
All patients being discharged to home, to an assisted living facility, or another community based setting will be given a Discharge Transition Plan and Discharge Packet.
The Discharge Transition Plan must include, but not be limited to:
A recapitulation of the patient ' s stay that includes, but is not limited to, diagnoses, course of illness/treatment or therapy, and pertinent lab, radiology, and consultation results.
A final summary of the patient ' s status at the time of discharge that is available for release to authorized persons and agencies, with the consent of the patient or patient representative.
Reconciliation of all pre-discharge medications with the patient ' s post-discharge medications (both prescription and over-the-counter).
A post-discharge plan of care that is developed with the participation of the patient and, with the patient ' s consent, the patient representative(s), which will assist the patient to adjust to his/her new living environment.
Where the patient plans to reside, any arrangements that have been made for the patient ' s follow-up care and any post-discharge medical and non-medical services.

The PCC Discharge Plan Documentation UDA will begin as early as admission and no later
than seven days prior to patient discharge. Refer to the Guidelines for Discharge Transition
Plan Process.
4. Nursing or Social Services:
4.1 Initiates the Discharge Plan Documentation UDA for completion by the interprofessional care team;
4.2 Communicates the discharge date to the patient and/or patient representative; and
4.3 Prepares the patient and/or resident representative for transition.
5. Once the Discharge Plan Documentation UDA is completed, a Discharge Transition Plan will be generated.
6. The Discharge Transition Plan will be reviewed with and given to the patient and/or patient representative along with the Discharge Packet upon discharge."

Review of "Notice of Involuntary Discharge" dated May 23, 2024 revealed that "Dear Resident R5, Pursuant to regulatory requirements, we are hereby notifying you that effective date of discharge June 24, 2024, which is thirty (30) days from the date of this letter May 23rd 2024, you will be discharged from Chapel Manor facility (hereinafter referred to as "the Facility") to (City funded homeless intake center)"
Discharge is being made pursuant to:
-42 C.F.R. $ 483.15 (c)()(B) which states, the transfer or discharge is appropriate because the resident's health has improved sufficiently so the resident no longer needs the service's provid ed by the facility .
-42 C.F.R. $ 483.15 (c)(i)(C) which states, the safety of individuals in the facility is endangered due to the clinical or behavioral status of the resident
You have the right to appeal the discharge to the Department of Public Welfare"

Review of progress note for Resident R5 dated May 23, 2024, revealed that social worker returned a call to the City of Philadelphia, homeless services department. Worker reported that resident was approved to go to the shelter intake on June 3, 2024.. SS will inform the IDT team and follow up accordingly.

Review of physician progress note dated June 3, 2024, for Resident R5 revealed that "54 year old male seen for Homelessness, major depressive disorder. Social Work asked if a discharge order could be placed for patient. He was given a 30 day notice and needs to be out later this month. They have him set up at a shelter, shelter has a bed. Patient is refusing to leave until 30 days up. He is irritable and agitated on exam.

Review of physician progress note dated June 6, 2024 for Resident R5 revealed that "Patient is a 54 y/o Male with past medical history of significant for coronary artery disease, scoliosis, type 1 diabetes, hyperlipidemia, NSTEMI. long term care resident at this facility. Patient was seen for complaints of low back pain.

Review of care plan for Resident R5 dated November 11, 2022 revealed that the resident had a history of elopement related to impulsive behavior and frustration. Resident/patient had impaired/decline in cognitive function or impaired thought processes related to a condition other than delirium: Short term memory loss. The Resident/Patient had potential for impaired communication as English was not his primary language.

Continued review of the care plan revealed that the resident had a diagnosis of diabetes and was Insulin Dependent. Resident was at risk for falls. Resident/patient exhibited or was at risk for distressed/fluctuating mood symptoms related to: Sadness/depression caused by self-reports of feelings of depression occasionally due to health issues. Resident was at nutritional risk. Resident had poor safety awareness and impulsive behavior related to additive behavior and history of substance abuse.

Further review of the care plan revealed that there was no care plan initiated for Resident R5 for discharge planning process which focused on the resident's discharge goals, the preparation of residents to be active partners and effectively transition them to post-discharge care, and the reduction of factors leading to preventable readmissions.
Review of clinical records also revealed no documented evidence that the facility documented, completed on a timely basis based on the resident's needs, and include in the clinical record, the evaluation of the resident's discharge needs and discharge plan. There was no documented evidence of a discharge plan with all relevant resident information to facilitate its implementation and to avoid unnecessary delays in the resident's discharge or transfer.

A request for resident's discharge plan was requested to the administrator on June 13, 2024. Facility did not provide a discharge plan that focuses on the resident's discharge goals, the preparation of residents to be active partners and effectively transition them to post-discharge care, and the reduction of factors leading to preventable readmissions as required.

28 Pa. Code 201.14 (a) Responsibility of licensee.

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

Plan of Correction - To be completed: 07/10/2024

1. There was no adverse effect on Residen R5
2. NHA/Designee will re-educate Social services on discharge planning process
3. Social services/Designee will ensure short stay residents have discharge planning in place. Then will perform random weekly audits x4,then monthly X3.
4. Social services/Designee will report findings to QAPI monthly x2

483.25 REQUIREMENT Quality of Care:

§ 483.25 Quality of care
Quality of care is a fundamental principle that applies to all treatment and care provided to facility residents. Based on the comprehensive assessment of a resident, the facility must ensure that residents receive treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the residents' choices.

Observations:

Based on the review of clinical records, interview with resident and staff, it was determined that the facility failed to administer the medications as ordered by the physician for One of One resident reviewed. (Resident R1).

Findings Include:

Review of facility policy "General Dose Preparation and Medication Administration", revealed that "Prior to administration of medication, Facility staff should take all measures required by Facility policy and Applicable Law, including, but not limited to the following: 4.1 Facility staff should: 4.1.1 Verify each time a medication is administered that it is the correct medication, at the correct dose, at the correct route, at the correct rate, at the correct time, for the correct resident, as set forth in facility's medication administration schedule. During medication administration, Facility staff should take all measures required by Facility policy and Applicable Law, including, but not limited to the following: Administer medications within timeframes specified by Facility policy or manufacturer's information."

Interview with Resident R1 on June 12, 2024, at 11:00 a.m. stated he did not receive his morning medication on June 5, 2024. Resident stated the nurse came to him around 1:30 p.m.. to administer his morning medication. He stated he saw the nurse standing at the cart next to his room at around 12:00 p.m. or 12:30 p.m. He asked for the medications, and she did not give the medication to him at that time and ignored his request and continued to stand at the cart. Resident stated he was very upset that she ignored his request, and he did not respond to her later when she came with his medications, approximately an hour later. During the interview Resident R1 requested to his roommate Resident R2 to speak to the surveyor about the incident.

Interview with Resident R2 on June 12, 2024, at 11:30 a.m. confirmed that the nurse did not offer Resident R1 his medication timely. He stated nurse had a bad attitude when Resident R1 ignored him.

Resident stated she was very loud, and the resident did not respond when she asked if you want to take your meds, she said she was going to document in the clinical record that he refused the medication. She stated to the roommate that he was her witness.

Review of active physician orders for Resident R1 for June 5, 2024 revealed the following orders.
- Ammonium Lactate Cream 12 % Apply to B/L LE topically every day and evening shift for dry skin at daytime and evening
- Ativan Oral Tablet 0.5 MG (Lorazepam) Give 1 tablet by mouth every 6 hours for anxiety at 12 midnight, 6 a.m, 12 noon and 6 p.m.
- Brimonidine Tartrate Ophthalmic Solution 0.2 % (Brimonidine Tartrate) Instill 1 drop in both eyes two times a day for glaucoma at 9 a.m and 9 p.m..
- Magnesium Oxide Tablet 400 MG Give 1 tablet by mouth one time a day for Supplement at 9 a.m. and 9 p.m.
Metoprolol Tartrate Tablet 100 MG Give 1 tablet by mouth two times a day for hypertension at 10 a.m. and 10 p.m.

Review of Medication Administration Record for resident R1 for June 2024 revealed that the above medications were documented as refused.

Review of clinical record revealed that the nurse documented the resident refused the medication at 1:41 p.m. on June 5, 2024.

Further review of the clinical record revealed no documented evidence that the staff offered or attempted to administer the medication as ordered by the physician in a timely manner.

A request for an interview with Employee E6, Registered Nurse was made to the administrator. Administrator stated the employee was no longer working at the facility.

28 Pa. Code 211.12 (d)(1)(2)(3)(5) Nursing services

Plan of Correction - To be completed: 07/10/2024

1. There were no adverse effects on Resident R3
2. NHA/Designee re-educated nursing staff on timely medication administration, focusing on the importance of patient safety, compliance with policies.
3. DON/Designee will perform an initial audit to ensure timely medication administration, then random weekly audits x4. Then monthly x3
4. DON/Designee will report findings to QAPI x2

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