Pennsylvania Department of Health
HARMONY HILLS HEALTHCARE AND REHABILITATION CENTER
Patient Care Inspection Results

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Severity Designations


Minimal Citation - No Harm	Minimal Harm	Actual Harm	Serious Harm

HARMONY HILLS HEALTHCARE AND REHABILITATION CENTER
Inspection Results For:

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HARMONY HILLS HEALTHCARE AND REHABILITATION CENTER - Inspection Results	Scope of Citation Number of Residents Affected By Deficient Practice

Initial comments:

Based on an Abbreviated survey in response to a complaint completed on August 7, 2024, it was determined that Harmony Hills Healthcare and Rehabilitation 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:

483.45(a)(b)(1)-(3) REQUIREMENT Pharmacy Srvcs/Procedures/Pharmacist/Records:

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.

§483.45 Pharmacy Services
The facility must provide routine and emergency drugs and biologicals to its residents, or obtain them under an agreement described in §483.70(g). The facility may permit unlicensed personnel to administer drugs if State law permits, but only under the general supervision of a licensed nurse.

§483.45(a) Procedures. A facility must provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of each resident.

§483.45(b) Service Consultation. The facility must employ or obtain the services of a licensed pharmacist who-

§483.45(b)(1) Provides consultation on all aspects of the provision of pharmacy services in the facility.

§483.45(b)(2) Establishes a system of records of receipt and disposition of all controlled drugs in sufficient detail to enable an accurate reconciliation; and

§483.45(b)(3) Determines that drug records are in order and that an account of all controlled drugs is maintained and periodically reconciled.

Observations:
Based on review of facility policy, clinical records, resident and staff interviews it was determined that the facility failed to implement pharmaceutical services to ensure availability and administration of prescribed medications for one of four sampled residents (Residents R1). This deficiency is cited as past non-compliance.

Findings include:

The facility "Medication packaging" policy dated 6/17/24, indicated that medications are provided in packaging to facilitate accurate administration and accountability of medication. It is suggested that nurses review the medication administration records (MAR) prior to passing medications in order to prevent errors.

Review of Residents R1's admission record indicated she was admitted on 1/27/22.

Review of Residents R1's MDS assessment (MDS-Minimum Data Set assessment: periodic assessment of resident care needs) dated 5/18/24, indicated that she had diagnoses that included paraplegia (paralysis of the legs and lower body), anxiety disorder (a medical condition creating a sense of acute fear, restlessness, and worry), history of TIA (Transient ischemic attack-blockage of blood flow in the brain), hyperlipidemia (elevated lipid levels within the blood), diabetes (metabolic disorder impacting organ function related to glucose levels in the human body), disfunction of bladder, and a history of Urinary Tract Infection (an infection in any part of the kidneys, bladder or urethra). The review found these diagnoses to be the most current.

Review of Residents R1's care plan dated 6/20/24, indicated to provide medications as ordered and document effectiveness.

Review of Residents R1's physician orders dated 3/5/24, indicated to administer Tizanidine (Zanaflex) 2 mg, three times a day for spasms

Review of Residents R1's medication administration record (MAR) for July 2024, indicated a "9-see note" on 7/8/24 and 7/9/24.

Review of Residents R1's medication administration notes dated 7/8/24 and 7/9/24, indicated that Tizanidine (Zanaflex) 2mg ordered for three times a day for spasms was not available to give.

During an interview on 8/7/24, at 10:49 a.m. Resident R1 stated the following: I've been here for three years. I think I missed my medications in July for maybe two weeks. The medication is Tizanidine/Zanaflex, on a Thursday night, the fourth of July weekend. They ran out of the medication and they told me that I was ordered it from pharmacy. Never got the medications until Tuesday of the following week. I take it three times a day. I am not sure why the medications are not ordered before they run out."

The pharmaceutical report dated 7/15/24, indicated that the Omnicell (automated medication dispensing machine use to hold and account for medication) now had the Tizanidine for use.

On 7/9/24, the facility administration initiated plan of correction actions. The facility plan of correction actions included:
1) Audits of Medication carts for Nursing units A, B, C/D per week for four weeks starting 7/9/24 and ending
8/2/24.
2) Re-education on 7/10/24 with nursing staff about pharmacy services, ordering medications, and Omnicell
3) Listing of medications available in the Omnicell on each medication cart
in the event that a medication is unavailable
4) Investigation about insurance dropping medication starting on 7/9/24.
5) Discussion with Resident R1's family about the medication not being available.
6) The DON spoke to pharmacy about adding the medication Tinizdine to the Omnicell.
7) The nurse supervisor called pharmacy on 7/7/24 and 7/8/24 about the Tinizdine. The nurse supervisor did notify
the doctor about Tinizidine not being available.
8) Quality Assurance Performance Improvement (QAPI) creation of a PIP (Performance improvement plan) for
starting 7/10/24 and ending 7/17/24 to ensure medication availability.

Review of facility documentation on 8/7/24, indicated corrective actions had taken place and that the facility had demonstrated compliance with the regulation as of 8/2/24.

During an interview on 8/7/24, at 11:42 a.m. the Director of Nursing (DON) confirmed that the facility failed to implement pharmaceutical services to ensure availability and administration of prescribed medications for Resident R1. The facility had implemented a plan of correction and achieved compliance on 8/2/24 ensuring the availability and administration of prescribed medications.

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

28 Pa. Code 211.9(a)(1)(k)(l)(1)(2)(3)(4) Pharmacy services

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

28 Pa Code 211.12(d)(1)(5) Nursing services

Plan of Correction - To be completed: 08/27/2024

Past noncompliance: no plan of correction required.

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