Nursing Investigation Results -

Pennsylvania Department of Health
RICHBORO REHABILITATION & NURSING CENTER
Patient Care Inspection Results

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RICHBORO REHABILITATION & NURSING CENTER
Inspection Results For:

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RICHBORO REHABILITATION & NURSING CENTER - Inspection Results Scope of Citation
Number of Residents Affected
By Deficient Practice
Initial comments:

Based on a Medicare/Medicaid Recertification survey, State Licensure survey, Civil Rights Compliance survey, and an Abbreviated complaint survey completed on February 12, 2020, it was determined that Richboro Nursing and Rehabilitation Center 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:


483.12(a)(1) REQUIREMENT Free from Abuse and Neglect: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.
483.12 Freedom from Abuse, Neglect, and Exploitation
The resident has the right to be free from abuse, neglect, misappropriation of resident property, and exploitation as defined in this subpart. This includes but is not limited to freedom from corporal punishment, involuntary seclusion and any physical or chemical restraint not required to treat the resident's medical symptoms.

483.12(a) The facility must-

483.12(a)(1) Not use verbal, mental, sexual, or physical abuse, corporal punishment, or involuntary seclusion;
Observations:

Based on clinical record review and staff interview, it was determined that the facility failed to prevent resident to resident sexual abuse and ensure that a resident was free from sexual abuse for one of 17 sampled residents.
(Resident 12)

Finding include:

Clinical record review revealed that Resident 12 was admitted to the facility on December 10, 2015, with diagnoses that included Alzheimer's disease, anxiety disorder, depression, psychotic disorder, and mood disorder. Review of Resident 12's Minimum Data Set (MDS) assessment completed November 4, 2019, revealed that the resident's cognition was severely impaired.

Clinical record review revealed that Resident 53 was admitted to the facility on March 6, 2018, with diagnoses that included dementia, major depressive disorder, and adjustment disorder with depressed mood. Review of Resident 53's MDS assessment completed January 15, 2020, revealed that his cognition was intact, and that he was able to understand others.

A review of Resident 53's care plan, developed on February 4, 2019, included a problem area for behavior related to Resident 53's history of touching other female residents. An intervention included that staff check the resident every 15 minutes to prevent him from having contact with female residents.

On January 20, 2020, Resident 53 was evaluated by a psychologist who documentated that the resident had a preoccupation with sexual thoughts directed towards other female residents, and that he lacked the ability to control his actions. The psychologist recommended staff closely monitor Resident 53 when in close contact with female residents. On January 25, 2020, at 7:30 p.m., staff (CNA 1) witnessed Resident 53 "putting his hand down Resident 12's blouse and rubbing."

In an interview on February 12, 2020, at 10:05 a.m., the Director of Nursing confirmed that there was no documentation to support that the resident was consistently being monitored for behaviors and that the facility failed to ensure that Resident 12 was free from sexual abuse.

28 Pa. Code 201.18 (b)(1) Management.

28 Pa. Code 211.12(d)(1) Nursing services.























 Plan of Correction - To be completed: 03/23/2020

1. R 53 discharged from the facility; (R12 was offered emotional support and prevented from any sexual abuse)
2. Any residents identified as having/showing that exhibits behaviors of potential sexual abuse will be monitored by staff to assure that residents are free from abuse.
3. Education was provided by staff educator/designee for all staff on the importance of keeping all residents free from sexual abuse. abuse prevention. Residents will be informed during care conference of resident rights and abuse prohibition.
4. Audits will be done by DON/designee weekly x4, monthly x3, then quarterly or until compliance is achieved of residents exhibiting behaviors of potential sexual abuse to assure that all residents are free from abuse. Findings will be reviewed with QAPI committee monthly.
5. Date of compliance: - 3/23/20

483.60(i)(1)(2) REQUIREMENT Food Procurement,Store/Prepare/Serve-Sanitary: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.
483.60(i) Food safety requirements.
The facility must -

483.60(i)(1) - Procure food from sources approved or considered satisfactory by federal, state or local authorities.
(i) This may include food items obtained directly from local producers, subject to applicable State and local laws or regulations.
(ii) This provision does not prohibit or prevent facilities from using produce grown in facility gardens, subject to compliance with applicable safe growing and food-handling practices.
(iii) This provision does not preclude residents from consuming foods not procured by the facility.

483.60(i)(2) - Store, prepare, distribute and serve food in accordance with professional standards for food service safety.
Observations:

Based on observation and staff interview, it was determined that the facility failed to store food properly on one of three nursing units. (Front Hall nursing unit)

Findings include:

An initial tour of the facility on February 9, 2020, at 10:11 a.m., revealed a small refrigerator behind a work station on the Front Hall nursing unit. The refrigerator door was labeled with an orange sticker that indicated "biohazard" and that "absolutely no food or drink to be stored" inside. Contents stored inside the refrigerator included five, four-ounce containers of apple sauce, and one, four-ounce container of yogurt.

In an interview on February 11, 2020, at 10:50 a.m., the Director of Nursing confirmed that food should not have been stored in the refrigerator.

28 Pa.Code 201.18(b)(1)(3) Management.

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



 Plan of Correction - To be completed: 03/23/2020

1. Front Hall nursing unit refrigerator was checked to assure that all food was disposed of properly.
2. All nursing unit refrigerators were reviewed to assure that food is properly stored.
3. Education was provided by staff educator/designee for all licensed nursing all staff on the importance of proper food storage keeping food in a safe environment.
4. Audits will be done by Director of Nursing/Designee weekly x4 monthly x3 then quarterly or until compliance is achieved to ensure proper food storage in designated areas no food is being stored in Bio Hazard refrigerator. Findings will be reviewed with QAPI committee monthly.
5. Date of compliance 3/23/20

483.60(i)(4) REQUIREMENT Dispose Garbage and Refuse Properly:Least serious deficiency but was found to be widespread throughout the facility and/or has the potential to affect a large portion or all the residents. This deficiency has the potential for causing no more than a minor negative impact on the resident.
483.60(i)(4)- Dispose of garbage and refuse properly.
Observations:

Based on observation and staff interview, it was determined that the facility failed to properly dispose of garbage and refuse properly.

Findings include:

Observation during an initial tour of the facility on February 9, 2020, at 9:38 a.m., revealed two dumpsters located adjacent to the front entrance of the facility had an excessive accumulation of trash, on the ground outside of the dumpster, that included empty beverage containers, disposable utensils, single-use gloves, a tied plastic grocery bag. There was also an excessive accumulation of cigarette butts and other trash located in vicinity of the dumpster area.

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




 Plan of Correction - To be completed: 03/23/2020

1. All trash in and around the dumpsters have been cleaned up. (please address areas cited on 2567).
2. Dumpsters and surrounding area have been checked and found to be to assure that it is clean and free from debris.
3. Housekeeping/Dietary staff was educated by Staff Educator/designee on the importance of keeping the dumpster and surrounding area clean and free from Debris.
4. Audits will be completed by Administrator/designee Housekeeping Director/designee daily x 4 weeks and then monthly x3 then quarterly or until compliance is achieved to ensure dumpster area is clean and free from debris. Findings will be reviewed with QAPI committee monthly.
5. Date of compliance 3/23/20


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