Nursing Investigation Results -

Pennsylvania Department of Health
YORKVIEW NURSING AND REHABILITATION
Patient Care Inspection Results

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YORKVIEW NURSING AND REHABILITATION
Inspection Results For:

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YORKVIEW NURSING AND REHABILITATION - Inspection Results Scope of Citation
Number of Residents Affected
By Deficient Practice
Initial comments:
Based on an Abbreviated Survey in response to six complaints completed on November 24, 2021, it was determined that Yorkview Nursing and Rehabilitation 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:


483.20(f)(5), 483.70(i)(1)-(5) REQUIREMENT Resident Records - Identifiable Information: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.
483.20(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 clinical record review and staff interview it was determinied that the facility failed to ensure each resident record is complete and accurately documented for four of five residents reviewed ( Residents 2 4, 6, and 7).


Findings Include:

Review of Resident 2's clinical record revealed diagnoses that included dementia and hypertension (elevated blood pressure). Further review of Resident 2's clinical record revealed no task documentation for Resident 2's hygiene, toileting or bathing on November 5, 2021.

Review of Resident 4's clinical record revealed staff failed to document tasks related to resident care on November 5, 2021. The tasks included resident dressing and toileting.

Review of Resident 6's clinical record revealed staff failed to document tasks related to resident care on November 5, 2021. The tasks included resident dressing, hygiene, bathing and toileting.

Review of Resident 7's clinical record revealed staff failed to document tasks related to resident care on November 5, 2021. The tasks included personal hygiene and toileting.

In an email correspondence from the Nursing Home Administrator on November 24, 2021, at 2:07 PM she stated that the facility was "having spotty internet connection issues that day." No additional information was provided.

28 Pa. Code 211.5 (f) Clinical records
28 Pa. Code 211.12 (d) (5) Nursing services


 Plan of Correction - To be completed: 12/27/2021

1. No adverse affects were found with residents R2, R4, R6 and R7 from incomplete documentation on November 5, 2021.
2. DON/Designee will conduct a facility wide audit to ensure that resident task documentation was completed for residents on November 5, 2021. If any incomplete documentation is identified, the resident(s) will be reviewed by the facility IDT for any adverse affects and corrective action will be taken.
3. Staff Development/Designee will educate nursing staff that each resident record must be completed and accurately documented daily. In the event the electronic record is not accessible, documentation will be completed on paper.
4. Staff Development /Designee will conduct 2 random audits weekly for 1 month, and then 2 random audits monthly x2, to ensure that resident task documentation has been completed. Staff Development /Designee will report audit results monthly x3 for Quality Assurance and Performance Improvement Committee to address any trends or patterns, need for further review, and or recommendations.
5. Date of compliance 12/27/21.


483.60(d)(6) REQUIREMENT Drinks Avail to Meet Needs/Prefs/Hydration: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(d) Food and drink
Each resident receives and the facility provides-

483.60(d)(6) Drinks, including water and other liquids consistent with resident needs and preferences and sufficient to maintain resident hydration.
Observations:

Based on observation, clinical record review and staff interview it was determined that the facility failed to ensure each resident receives drinks consistent with resident needs and preferences for two of seven residents reviewed (Residents 4 and 7).

Findings Include:

Review of Resident 4's November 2021 physician orders revealed diagnoses including hypertension (elevated blood pressure) and muscle weakness.

An observation of resident 4's meal tray, during the lunch meal, on November 17, 2021, at 1:30 PM revealed the ticket to read "Juice Orange (base) (4 FL [fluid] OZ [ounces]."

The observation also revealed Resident 4 was not served orange juice during the lunch meal as outlined on the meal ticket.

Review of Resident 7's November 2021 physician orders revealed diagnoses including dementia (a chronic or persistent disorder of the mental processes caused by brain disease or injury and marked by memory disorders, personality changes, and impaired reasoning) and dysphagia (difficulty or discomfort in swallowing, as a symptom of disease).

Review of Resident 7' interdisciplinary plan of care revealed a focus area reading " Inadequate po [by mouth] intake related to dementia and dysphagia."

Continued review of the care plan revealed interventions including extra items on her tray including "chocolate milk and mashed potatoes."

An observation of Resident 7's tray, during the lunch meal, on November 17, 2021, at 1:30 PM revealed the tray ticket specifying "Chocolate Milk (8 FLOZ .)"

The observation also revealed Resident 7 to receive regular whole milk on her tray instead of the chocolate milk per the care plan and meal ticket.

An interview with the Nursing Home Administrator, on November 17, 2021, at 1:46 PM revealed she would "follow up" regarding the residents' missing tray items.

28 Pa. Code 201.14 (a) Responsibility of licensee
28 Pa. Code 211.11 (d) Resident care plan
28 Pa. Code 211.12 (d) (5) Nursing services


 Plan of Correction - To be completed: 12/27/2021

1. R4 and R7 will receive drinks, including water and other liquids consistent with resident needs and preferences and sufficient to maintain resident hydration.
2. Dietitian/Designee will conduct a random facility observation audit to ensure that residents are receiving the appropriate drinks consistent with resident needs and preferences and sufficient to maintain resident hydration.
3.Food Director/Designee will educate dietary staff that residents are to receive drinks, including water and other liquids consistent with resident needs and preferences and sufficient to maintain resident hydration.
4. Dietitian/Designee will conduct 2 random audits weekly for 1 month, and then 2 random audits monthly x2, to ensure that residents are receiving the appropriate drinks consistent with resident needs and preferences and sufficient to maintain resident hydration.
Dietitian/Designee will report audit results monthly x3 for Quality Assurance and Performance Improvement Committee to address any trends or patterns, need for further review, and or recommendations.
5. Date of compliance 12/27/21.

483.60(f)(1)-(3) REQUIREMENT Frequency of Meals/Snacks at Bedtime: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(f) Frequency of Meals
483.60(f)(1) Each resident must receive and the facility must provide at least three meals daily, at regular times comparable to normal mealtimes in the community or in accordance with resident needs, preferences, requests, and plan of care.

483.60(f)(2)There must be no more than 14 hours between a substantial evening meal and breakfast the following day, except when a nourishing snack is served at bedtime, up to 16 hours may elapse between a substantial evening meal and breakfast the following day if a resident group agrees to this meal span.

483.60(f)(3) Suitable, nourishing alternative meals and snacks must be provided to residents who want to eat at non-traditional times or outside of scheduled meal service times, consistent with the resident plan of care.
Observations:

Based on observations, review of select facility documents and staff interviews, it was determined that the facility failed to ensure each resident receives at least three meals daily, at regular times comparable to normal mealtimes in the community, for two of two meal cart deliveries observed.

Findings Include:

Review of facility provided document titled "Tray Delivery Schedule", undated, revealed that on the A-back hallway of the 100 unit (Rosemont Unit), the lunch cart is to leave the kitchen between 12:20-12:30 PM. Further review of the "Tray Delivery Schedule" revealed that on the A-front hallway of the 100 unit (Rosemont Unit), the lunch cart is to leave the kitchen between 12:30-12:45 PM.

Observation of the Rosemont dining room on November 17, 2021, at approximately 12:15 PM revealed Residents sitting in the dining room waiting for lunch to arrive. Further observation revealed that the first meal cart arrived on the Rosemont Unit at 1:12 PM (42-52 minutes after the cart was scheduled to leave the kitchen) and the second meal cart arrived on the Rosemont Unit at 1:18 PM (33-48 minutes after the cart was scheduled to leave the kitchen).

On November 17, 2021, at 1:45 PM the Nursing Home Administrator (NHA) and Director of Nursing (DON) were made aware of the times the meal carts were delivered to the Rosemont Unit.

In an email correspondence from the NHA on November 17, 2021, at 5:05 PM she stated that "A dietary staff member quit during the tray line and walked out of the building. This slowed down the process for delivery."

Pa. Code 201.18 (b) (3) Management

Pa. Code 201.29 (j) Resident rights


 Plan of Correction - To be completed: 12/27/2021

1. No adverse affects were found with any resident from the Rosemont Unit who received the late lunch meal on November 17, 2021.
2. Dietitian/Designee will conduct a facility observation audit to ensure that lunch meal carts are delivered to their perspective units according the facility tray delivery schedule.
3. Staff Development/Designee will educate nursing and dietary staff on the facility tray delivery schedule.
4. Staff Development /Designee will conduct 2 random audits weekly for 1 month, and then 2 random audits monthly x2, to ensure that the lunch meal carts are delivered according to the facility tray delivery schedule.
Staff Development /Designee will report audit results monthly x3 for Quality Assurance and Performance Improvement Committee to address any trends or patterns, need for further review, and or recommendations.
5. Date of compliance 12/27/21.

211.12(i) LICENSURE Nursing services.:State only Deficiency.
(i) A minimum number of general nursing care hours shall be provided for each 24-hour period. The total number of hours of general nursing care provided in each 24-hour period shall, when totaled for the entire facility, be a minimum of 2.7 hours of direct resident care for each resident.
Observations:

Based on review of nursing schedules and staffing information furnished by the facility, it was determined that the facility failed to provide 2.7 hours of direct resident care for each resident for nine of 15 days (24-hour periods) reviewed.

Findings Include:

Review of staffing information provided by the facility dated October 25, 2021-November 7, 2021, and November 17, 2021, revealed that the facility provided less than 2.7 hours of direct care for each resident on the following days:

October 30- 2.53
October 31- 1.97
November 2- 2.34
November 3- 2.28
November 4- 2.47
November 5- 2.34
November 6- 2.69
November 7- 2.13
November 17- 2.38

The staffing hours for the 15 days reviewed, to include the nine days listed above, were provided by the Nursing Home Administrator on November 19, 2021, at 9:04 AM.


 Plan of Correction - To be completed: 12/27/2021

1. The total number of hours of general nursing care provided in each 24-hour period shall, when totaled for the entire facility, be a minimum of 2.7 hours of direct resident care for each resident.
2. The facility has identified that all the residents have the potential to be affected by the average nursing care hours falling below 2.7 in a 24-hour period of direct resident care for each resident.
3. Facility will implement the critical staffing plan which includes staff from other non-nursing departments and utilize four agency contracts that are new to the facility to ensure the average nursing care hours are met at a minimum of 2.7 hours of direct resident care for each resident in a 24-hour period. Admissions have been placed on hold and will be reviewed daily to ensure the facility is able to maintain the 2.7 ppd.
4. HR Director/Designee will conduct 3 random audits weekly for 1 month, and then 3 random audits monthly, to ensure that a minimum of 2.7 hours of direct resident care is provided for each resident in a 24-hr period. HR/Designee will report audit results monthly for Quality Assurance and Performance Improvement Committee to address any trends or patterns, need for further review, and or recommendations.
5. Date of compliance 12/27/21.


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