Nursing Investigation Results -

Pennsylvania Department of Health
HARSTON HALL
Patient Care Inspection Results

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HARSTON HALL
Inspection Results For:

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HARSTON HALL - 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 February 3, 2020, it was determined that Harston Hall 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:


483.15(c)(7) REQUIREMENT Preparation for Safe/Orderly Transfer/Dschrg: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.
483.15(c)(7) Orientation for transfer or discharge.
A facility must provide and document sufficient preparation and orientation to residents to ensure safe and orderly transfer or discharge from the facility. This orientation must be provided in a form and manner that the resident can understand.
Observations:

Based on review of the closed clinical record, facility documentation, and interviews with staff, it was determined that the facility failed to provide a safe discharge plan for one out of three residents reviewed (Resident CL1).

Findings include:

Review of the facility's policy, "Discharge Against Medical Advice," revised January 31, 2020, revealed that the facility will honor requests for discharge against medical advice (AMA) by the resident. This policy further indicated that discharges will be processed in accordance with the resident's request to arrange for a safe discharge and that a Discharge Transition Plan will be provided to the resident.

Review of the clinical record revealed that Resident CL1, a 50 yo male, was admitted to the facility on May 8, 2019. Review of a consult report by a psychiatric mental health nurse practitioner, dated December 4, 2019, indicated that Resident CL1 was diagnosed with a major recurrent major depressive disorder and that he had had repeated episodes of losing interest in all activities, remaining indoors. This consult indicated that the resident's thought process was confused and that had illogic thought content, and that his fund of knowledge was impaired.

Review revealed a quarterly Minimum Data Set (MDS - assessment of resident needs), dated December 17, 2019, indicated that Resident CL1 had diagnoses that included, but not limited to, depression, diabetes, hypertension, and morbid obesity. This MDS also indicated that Resident CL1 was feeling down, that he was tired, and they he felt bad about himself. Review of the resident's care plan revealed that he was at risk for cardiovascular symptoms or complications, dehydration related to hypertension and pulmonary edema, and falls. This MDS also indicated that Resident CL1 was feeling down, that he was tired, and they he felt bad about himself.

Review of a Social Services Assessment and Documentation, dated December 11, 2019, indicated that Resident CL1 had recently lost a significant other that may have been affecting the resident and that he had depressive symptoms. This assessment also indicated that Resident CL1 would require skilled home care upon discharge. It also indicated that he would need housing.

A nursing note on December 16, 2019 revealed that Resident CL1 had requested to speak to a nurse regarding his planned leave of absence. The resident stated that he was going to celebrate both his birthday (December 23rd) and Christmas. It was reiterated that the leave of absence was for 5 hours.

Continued record review revealed a social service progress note, on December 19, 2019 at 13:18 p.m., indicating that Resident CL1 had come to social services to speak about his planned leave of absence to attend a pro football game (in South Philadlephia).

Continued clinical record revealed a progress note, on December 20, 2019 at 11:45 a.m., indicating that the Director of Nursing met with the resident who indicated he would probably be staying out overnight. Resident CL1 was informed that he would be discharged against medical advice (AMA) if he did not return within 5 hours of leaving. Resident CL1 verbalized understand but did not agree.

A progress note, on December 22, 2019 at 7:44 p.m. revealed that Resident CL1 went on a leave of absence at 1:30 p.m. that day.Review of the team's internet site regarding game times revealed that the game started at 4:25 p.m.

A progress note later that day at 10:21 p.m. indicated that the resident had left the facility (located in northwest suburb of Philadelphia), by public transportation and had been instructed to return by 6:30 p.m. This note also indicated that the resident had not yet returned from the scheduled leave of absence.

A progress note on December 23, 2019 at 9:15 a.m. by the Administrator indicated that the resident had called requesting to return to the facility after staying at his brother's house overnight. This note indicated that the Administrator stated the resident would be considered discharged against medical advice. The Administrator further indicated that this decision to discharge the resident would not be reconsidered.

An Administrative Note on December 31, 2019 indicated that the facility contacted Resident CL1 regarding his belongings, which were still at the facility, and that Resident CL1 indicated that he still did not have a place to which his belongings could be sent. A subsequent Administrative Note, on January 2, 2020 at 13:02 p.m., indicated that the resident's belongings, including his hearing aids and glasses, had been shipped to an address in Philadelphia. A subsequent Administrative Note, on January 14, 2020 at 11:35 a.m. indicated that Resident CL1 had contacted the facility regarding his discharge paperwork and that it was explained that the facility did not have a discharge packed since he left AMA.

In an interview with the Administrator and Director of Nursing on February 3, 2020 at approximately 3:30 p.m., it was confirmed that the facility had no documentation for review that indicated that it had developed a safe discharge plan for Resident CL1.

28 Pa. Code 201.14(a) Responsibility of licensee
Previously cited 12/19/19

28 Pa. Code 201.18(b)(2) Management
Previously cited 9/25/19

28 Pa. Code 201.25 Discharge policy




 Plan of Correction - To be completed: 03/17/2020

1. Resident CL1 is discharged from the facility.

2.The Center will review current residents with an approaching discharge to ensure a safe discharge plan has been provided

3.The Nurse Practice Educator/designee will re-educate the Interdisciplinary team on the facility policy for Resident Discharge Process focusing on providing a safe discharge plan

4.Center Nurse Executive/designee will conduct random weekly audits of residents with a scheduled discharge to ensure that a safe discharge plan has been provided

5.Results of the audits will be reviewed at the monthly Quality Assurance Meeting.


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