Nursing Investigation Results -

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

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GWYNEDD HEALTHCARE AND REHABILITATION CENTER
Inspection Results For:

There are  37 surveys for this facility. Please select a date to view the survey results.

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GWYNEDD HEALTHCARE AND REHABILITATION CENTER - Inspection Results Scope of Citation
Number of Residents Affected
By Deficient Practice
Initial comments:

Based on a Medicare/Medicaid Recertification Survey, Civil Rights Compliance Survey and a State Licensure Survey, completed on March 18, 2021, it was determined that Gwynedd Healthcare and Rehabilitation Center, was not in compliance with the 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:


483.60(i)(1)(2) REQUIREMENT Food Procurement,Store/Prepare/Serve-Sanitary:This is a less serious (but not lowest level) 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 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 interviews with staff, it was determined that the facility did not ensure that food was stored, prepared, and served in accordance with professional standards for food service safety.

Findings Include:

A tour of the Food Service Department conducted on March 15, 2021, at approximately 11:45 a.m. with Employee E4, the Food Service Director (FSD), revealed the following:

Observations of the receiving area behind the building revealed two dumpsters with both lids open, overflowing with trash bags so that the dumpsters could not be closed shut.

Observation of the loading dock and receiving area revealed an old refrigerator in disrepair, and a wooden ramp with no handrails which was very shaky and unsteady.

Observation in the hallway leading to the loading dock revealed a stainless-steel food cart loaded with late trays, which had food splattered on the surface and a broken door hanging loose on the left side.

Observation of the dry storage room revealed a cardboard box of Frito's chips, which was stored on the top shelf underneath a sprinkler head less than 18" from the sprinkler.

Observation of the walk-in freezer revealed a sheet pan of brownies which was covered with a single layer of plastic wrap that had come loose on the corners exposing the food product to the circulating air.

Observation in the dish room revealed a buildup of food particles and white substance on the walls under the dish counter on both sides of the machine.

Observation of the reach-in freezer closest to the entrance of the kitchen revealed there was no thermometer on the inside of the freezer.

An interview on March 15, 2021 with Employee E4, following the conclusion of the initial tour of the Food Service Department confirmed the above findings.

42 CFR - Store, prepare, distribute and serve food in accordance with professional standards for food service safety

28 Pa. Code 201.14(a) Responsibility of licensee

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

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

28 Pa. Code 211.6(d) Dietary services





 Plan of Correction - To be completed: 04/14/2021

1. The facility contracted trash removal company came that day and emptied the dumpsters, the facility has ensured that the contracted trash removal company will come according to the schedule agreed upon and an additional bin has been added. The old refrigerator identified near the loading dock is awaiting pick up, and the ramp has been removed. The food cart in the clock room utilized for late trays (dirty) has been cleaned and the door has been removed. The box in the storage room was immediately removed at time of the walk through. The brownies identified were thrown out immediately. The dish room which was noted with food particles and the white substance was cleaned and a thermometer was placed in the reach in freezer.
2. Maintenance Director/Designee will ensure that the dumpsters are not overflowing with trash preventing the lids from closing. Director of Dietary/Designee will ensure that the late tray cart is clean and in good repair. Dietary Dietary/Designee will ensure that boxes in the storage room will not be stored less than 18" from the sprinkler. Dietary Director/Designee will ensure that food is properly covered in the freezer and the Director/Designee will ensure that the dish-room will be cleaned routinely and as needed. Dietary Director/Designee will ensure that there is a thermometer in the reach in freezer.
3. Dietary Staff have been reeducated by the Director of Dietary regarding the deficient practices identified.
4. Audits will be completed weeklyx4 then monthly x3 by the Director Dietary/Designee to ensure that the dumpsters are not overflowing, that the late tray cart is clean and in good repair, that in the storage room boxes are below 18 inches from sprinkler head, and that food is covered in the walk- in freezer. Additionally, audits will be completed in the same schedule to ensure that the dish room is cleaned routinely and as need as well as ensuring the thermometer is in the freezer.
5. Audits will be discussed and reviewed by the facility QAPI committee meeting x3 to ensure compliance.

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 observation, clinical record review and staff interview, it was determined that the facility failed to ensure the resident assessment accurately reflected the resident status related to oxygen usage for two of 30 residents reviewed (Residents R41 and R148).

Findings include:

During an initial tour of the facility on March 15, 2021, at 12:55 p.m. it was observed that resident R148 was utilizing oxygen via a nasal cannula (device used to deliver supplemental oxygen) .

Review of Resident R148's clinical record revealed the resident was admitted to the facility on March 2, 2021, with a diagnosis to include chronic hypoxemic respiratory failure (Low blood oxygen levels). The resident's active physician orders included oxygen therapy via nasal cannula to target a saturation level of greater than 91 %. Rate of 4.0 liters per minute.

Review of Resident R148's admission Minimum Data Set (MDS - assessment tool utilized to identify a residents' physical, mental, and psychosocial deficits), with the Assessment Reference Date of March 9, 2021, revealed that Section O - Special Treatments, Procedures, and Programs - oxygen use - was not checked off as as being utilized as a resident in the facility under Respiratory Treatments.

Observation on March 16, 2021, at 1030 a.m. revealed Resident R41 was sitting in her wheelchair by her room with her oxygen nasal cannula (device used to deliver supplemental oxygen) hanging down by her neck that was not connected to her nose as ordered by her physician. Employee E3, Activities staff, adjusted the resident's oxygen back onto her nose.

Review of Resident R41's clinical record indicated that the resident was admitted to the facility on December 29, 2020, with a diagnosis to include Atrial Fibrillation (An irregular, often rapid heart rate that commonly causes poor blood flow) and Asthma (a person's airways become inflamed, narrow and swell, and produce extra mucus, which makes it difficult to breathe). The resident had an admission order and an active order as of March 15, 2021, for oxygen at 2 liters per minute via a nasal cannula (device used to deliver supplemental oxygen) as needed to maintain a saturation level of greater than 91%.

Review of Resident R41's admission Minimum Data Set (MDS - assessment tool utilized to identify a residents' physical, mental, and psychosocial deficits), with the Assessment Reference Date of January 1, 2021, revealed that section Section O - Special Treatments, Procedures, and Programs - oxygen use - was not checked off as as being utilized as a resident in the facility under Respiratory Treatments.

Interview with the administrator on March 17, 2021, at 9:30 a.m., confirmed that both Resident R41 and R148 MDS's did not accurately reflect their oxygen usage.


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




 Plan of Correction - To be completed: 04/14/2021

1. Facility reviewed and modified the MDS's accordingly for resident R148 and R41.
2. MDS's for current residents who have a physician order for oxygen will be reviewed and modified if needed.
3. MDS Coordinators will be re-educated by the Administrator/Designee to ensure that the Minimum Data Set (MDS) for residents on oxygen will be reflected on their MDS.
4. Random Audits will be completed weekly x4 then monthly x3 by the Administrator/Designee to ensure that residents with a physician order for oxygen are reflected on their MDS.
5. Audits will be discussed and reviewed by the facility QAPI committee meeting x3 to ensure compliance.

483.21(b)(1) REQUIREMENT Develop/Implement Comprehensive Care Plan: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.
483.21(b) Comprehensive Care Plans
483.21(b)(1) The facility must develop and implement a comprehensive person-centered care plan for each resident, consistent with the resident rights set forth at 483.10(c)(2) and 483.10(c)(3), that includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment. The comprehensive care plan must describe the following -
(i) The services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being as required under 483.24, 483.25 or 483.40; and
(ii) Any services that would otherwise be required under 483.24, 483.25 or 483.40 but are not provided due to the resident's exercise of rights under 483.10, including the right to refuse treatment under 483.10(c)(6).
(iii) Any specialized services or specialized rehabilitative services the nursing facility will provide as a result of PASARR recommendations. If a facility disagrees with the findings of the PASARR, it must indicate its rationale in the resident's medical record.
(iv)In consultation with the resident and the resident's representative(s)-
(A) The resident's goals for admission and desired outcomes.
(B) The resident's preference and potential for future discharge. Facilities must document whether the resident's desire to return to the community was assessed and any referrals to local contact agencies and/or other appropriate entities, for this purpose.
(C) Discharge plans in the comprehensive care plan, as appropriate, in accordance with the requirements set forth in paragraph (c) of this section.
Observations:

Based on observation, a review of clinical records, and staff interview, it was determined that the facility failed to develop and implement a person-centered plan to address a resident's oxygen use for one of 30 residents reviewed (Resident 41).

Findings included:

Review of clinical records revealed that Resident R41 was admitted to the facility on December 29, 2020, with a diagnosis to include Atrial Fibrillation (An irregular, often rapid heart rate that commonly causes poor blood flow) and Asthma (a person's airways become inflamed, narrow and swell, and produce extra mucus, which makes it difficult to breathe). The resident had an admission order and an active order as of March 15, 2021, for oxygen at two liters per minute via a nasal cannula (device used to deliver supplemental oxygen) as needed to maintain a saturation level greater than 91%.

Observation on March 16, 2021, at 1030 a.m. revealed Resident R41 was sitting in her wheelchair by her room with her oxygen nasal cannula hanging down by her neck, that was not connected to her nose, as ordered by her physician. Employee E3, Activities staff, assisted the resident's oxygen back onto her nose and the resident stated the oxygen was uncomfortable. Employee E3, Activities staff, stated she would inform the nursing staff.

Review Resident R41's clinical record nursing note dated March 3, 2021, revealed : " ... on oxygen 2 lt/min [liters / minute] via nasal canula on resident takes it off at times explain and educated resident for need of oxygen on ..."

Further review of of Resident R41's clinical record revealed no comprehensive care plan had been developed or implemented for the care and maintenance of the the oxygen use.

An interview on March 17, 2021, at 2:45 p.m. with the administrator confirmed that Resident R41 had an order for oxygen use and the facility did not develop or implement a comprehensive care plan for the care and maintenance of oxygen usage.

28 Pa Code 211.11(d) Resident care plan

28 Pa Code 211.12 (c)(d)(3)(5)Nursing Services




 Plan of Correction - To be completed: 04/14/2021

1. Facility reviewed and updated accordingly the care plan for resident R41 in relation to the care and maintenance of oxygen use.
2. Care Plans for residents with oxygen orders will be reviewed to ensure that their care plan reflects the care and maintenance of their oxygen use.
3. Licensed Nurses will be re-educated by the Director of Nursing/Designee to ensure that nurses are implementing resident care plans that includes the care and maintenance of oxygen use for resident's who have physician orders for oxygen.
4. Random Audits will be completed weekly x4 then monthly x3 by the Director of Nursing/Designee to ensure that residents with a physician order for oxygen are reflected on their care plan.
5. Audits will be discussed and reviewed by the facility QAPI committee meeting x3 to ensure compliance.

483.60(i)(4) REQUIREMENT Dispose Garbage and Refuse Properly: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)(4)- Dispose of garbage and refuse properly.
Observations:

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

Findings Include:

An initial tour was conducted of the Food Service Department on Monday March 15, 2021, at 11:45 a.m. with Employee E4, the Food Service Director. During the initial tour, the review of the following revealed:

An observation of the loading dock revealed two large dumpsters, both which were overflowing with trash bags stacked so high that the lids would not close and one trash bag lying outside of the dumpster on the ground.

An interview with Employee E4 on March 15, 2021 at approximately 11:45 a.m. confirmed there should not be any visible trash in or around the dumpster area. During the interview, Employee E4 revealed this is the typical state of the dumpster area for a Monday morning.


42 CFR Dispose of garbage and refuse properly

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

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







 Plan of Correction - To be completed: 04/14/2021

1. The Administrator has ensured that contracted trash removal company came that day and emptied the dumpsters, the facility has ensured that the contracted trash removal company will come according to the schedule agreed upon and an additional bin has been added.
2. The Director of Maintenance will ensure that the dumpsters are not overflowing with trash preventing the lids from closing.
3. Dietary, EVS staff, and Maintenance will be re-educated on the importance ensuring that the dumpsters are not overflowing and not preventing the lids from closing.
4. Audits will be completed weekly x4 then monthly x3 by the Dietary/ Maintenance Director/Designee to ensure the dumpsters are not overflowing.
5. Audits will be discussed and reviewed by the facility QAPI committee meeting x3 to ensure compliance.


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