Pennsylvania Department of Health
MOUNTAIN CITY NURSING & REHAB CTR
Patient Care Inspection Results

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MOUNTAIN CITY NURSING & REHAB CTR
Inspection Results For:

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MOUNTAIN CITY NURSING & REHAB CTR - Inspection Results Scope of Citation
Number of Residents Affected
By Deficient Practice
Initial comments:


Based on an abbreviated complaint survey completed on March 20, 2024, it was determined that Mountain City Nursing & 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:


483.10(a)(1)(2)(b)(1)(2) REQUIREMENT Resident Rights/Exercise of Rights: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.
483.10(a) Resident Rights.
The resident has a right to a dignified existence, self-determination, and communication with and access to persons and services inside and outside the facility, including those specified in this section.

483.10(a)(1) A facility must treat each resident with respect and dignity and care for each resident in a manner and in an environment that promotes maintenance or enhancement of his or her quality of life, recognizing each resident's individuality. The facility must protect and promote the rights of the resident.

483.10(a)(2) The facility must provide equal access to quality care regardless of diagnosis, severity of condition, or payment source. A facility must establish and maintain identical policies and practices regarding transfer, discharge, and the provision of services under the State plan for all residents regardless of payment source.

483.10(b) Exercise of Rights.
The resident has the right to exercise his or her rights as a resident of the facility and as a citizen or resident of the United States.

483.10(b)(1) The facility must ensure that the resident can exercise his or her rights without interference, coercion, discrimination, or reprisal from the facility.

483.10(b)(2) The resident has the right to be free of interference, coercion, discrimination, and reprisal from the facility in exercising his or her rights and to be supported by the facility in the exercise of his or her rights as required under this subpart.
Observations:


Based on review clinical records, facility provided documentation, grievances lodged with the facility, and the minutes from Resident Council meetings, and resident and staff interviews it was determined that the facility failed to provide care in a manner and environment, which promotes each resident's quality of life by failing to respond timely to residents' requests for assistance as reported by 15 residents out of 33 interviewed (Residents 6, 17, 24, 27, 43, 53, 54, 58, 72, 77, 112, 113,117, 141 and 163).

Findings include:

A review of the minutes from the Resident Council meeting dated January 23, 2024, revealed that the residents in attendance voiced concerns that staff do not answer their requests for assistance, via the nurse the call bell system, in a timely manner.

A review of grievances lodged with the facility revealed a grievance filed on January 23, 2024, on behalf of a resident, indicating that the resident's call bell was on for an extended period of time with no response from staff.

A grievance was lodged with the facility on January 30, 2024, indicating that a resident's call bell was on for an extended period of time with no response from staff.

A review of a grievance filed on February 2, 2024, indicating that the resident was "full of (saturated) with urine" and staff told the resident that the resident would have to wait, they are busy, passing trays at lunch time.

A review of resident clinical records, and a facility provided BIMS (brief interview mental status - to assess cognitive status) report, and random interviews conducted on March 20, 2024, with 33 alert and oriented residents, to include seven residents residing on the 100 unit, 14 residents residing on the 200 unit in the "White Building", three residents residing on the 300 unit, and two residents residing on the 400 unit in the "Blue Building", revealed that 15 residents' interviewed expressed complaints regarding staff's failure to respond to their requests for assistance and provide needed care and services in a timely manner.

During the random interviews, the residents stated that they feel the facility is not adequately staffed because they wait extended periods of time for staff to respond to their requests for assistance, including untimely responses to their requests via the nurse call bell system.

Of those residents interviewed on March 20, 2024, 3 of 7 residents residing on the 100 unit, 7 of 14 residents residing on the 200-unit, three out of four residing on the 300 unit, and two out of eight residing on the 400 unit, expressed similar complaints regarding untimely staff response to their requests for care and assistance.

Interview with Resident 141 on March 20, 2024, at approximately 9:47 AM, revealed that she has waited over an hour at times for staff to answer her call bell. More recently on March 17, 2024, she stated that she was "soaked with urine" after being incontinent and then 2nd shift (3:00 PM - 11:00 PM) "got mad" that they had to change her and all her bed linens because of the urine.

Interview with Resident 6 on March 20, 2024, at approximately 10:02 AM, revealed that he feels that short staffing is a problem in the facility because he waits 20 -30 minutes, 2 or 3 times a week, for staff to answer his call bell. The resident stated that these waits occur mostly on 1st (day shift) of nursing duty, during lunch time.

Interview with Resident 17 on March 20, 2024, at approximately 10:09 AM, revealed she waits "long time", greater than 30 minutes, for staff to answer her call bell, and that there have been times she has soiled herself while waiting for the call bell to be answered. Resident 17 indicated the extended wait time is daily, and occurs at any time (day, evening, or night shift).

Interview with Resident 163 on March 20, 2024, at approximately 10:15 AM, revealed she has waited over for staff to answer her call bell waiting for as needed medication. Resident 163 states "I become very frustrated when it gets to an hour, because I am in pain. I know the staff are busy with other patients, but I am a patient too."

Interview with Resident 24 on March 20, 2024, at approximately 10:17 AM, revealed that she feels the building "needs more help", because she has waited greater than 1 hour for assistance. The resident stated that these waits occur weekly, mostly on 1st (day shift) of nursing duty.

Interview with Resident 112 on March 20, 2024, at approximately 10:40 AM, revealed that he has waited as recent as last week for 30 minutes to get some water.

Interview with Resident 113 on March 20, 2024, at approximately 10:42 AM, revealed that he waits up to an hour for someone to answer his call bell. The resident states "I would do things myself, but I need staff to help me, that is why I am here".

Interview with Resident 117 on March 20, 2024, at approximately 10:46 AM, revealed that she waits a minimum of 30 minutes on 2nd shift and 3rd shift (11:00 PM - 7:00 AM) on a regular basis. About a month ago she waited over an hour for staff to assist her. This resident requires extensive assistance with transfers, repositioning, toileting, and activities of daily living (ADLs).

Interview with Resident 27 on March 20, 2024, at approximately 1:15 PM, revealed that he waits 30 - 45 minutes, weekly, for staff to answer his call bell. The resident stated that these waits occur mostly on 2nd (evening shift) of nursing duty.

Interview with Resident 43 on March 20, 2024, at approximately 10:38 AM, revealed that she feels that short staffing is a problem in the facility because "they are slow" to answer the call bell. Resident 43 stated she waits up to 1 hour, daily, for staff to answer her call bell. The resident stated that these waits occur mostly on 1st (day shift) of nursing duty, and that there have been times she has soiled herself while waiting for the call bell to be answered.

Interview with Resident 53 on March 20, 2024, at approximately 11:06 AM, revealed that she waits 30 - 40 minutes, "once in a while", for staff to answer her call bell. The resident stated that these waits occur mostly on 3rd (night shift) of nursing duty.

Interview with Resident 54 on March 20, 2024, at approximately 11:11 AM, revealed that she can wait greater than 1 hour, daily, for staff to answer her call bell. The resident stated that these waits occur mostly on 3rd (night shift) of nursing duty.

Interview with Resident 58 on March 20, 2024, at approximately 11:24 AM, stated you can "wait till your dead", "hours", for staff to answer the call bell. According to Resident 58, this occurs 1 or 2 times a week. The resident stated that these waits occur mostly on 1st (day shift) of nursing duty, morning, after breakfast.

Interview with Resident 72 on March 20, 2024, at approximately 10:55 AM, revealed that he waits greater than 30 minutes, 2 or 3 times a week, for staff to answer his call bell. The resident stated that these waits occur mostly on 1st (day shift) of nursing duty, during lunch time.

Interview with Resident 77 on March 20, 2024, at approximately 10:49 AM, revealed that she waits 30 - 45 minutes, twice weekly, for staff to answer her call bell. The resident stated that these waits occur mostly on 2nd (evening shift) of nursing duty.

Interview on March 20, 2024, at approximately 3:15 PM with the Nursing Home Administrator (NHA) verified that it is her expectation that all residents be treated with dignity and respect. The NHA was unable to explain why multiple residents are reporting untimely staff response times to their requests for care and assistance, resulting in the residents' feelings that the facility is not adequately staffed, which was negatively affecting the residents' quality of life in the facility.



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

28 Pa. Code 201.29 (a) Resident rights.

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





 Plan of Correction - To be completed: 04/16/2024

1. Interdisciplinary Staff met with residents 6, 17, 24, 27, 43, 53, 54, 58, 72, 77, 112, 113, 117, 141, & 163 to review any concerns they have currently. Concerns addressed, if necessary.
2. To identify other residents that have the potential to be affected, the DON/designee interviewed interviewable residents to identify any concerns grievances at this time.

To identify other residents that have the potential to be affected, the DON/designee completed random call bell audits on non-interview-able residents to identify if extended call bell times occur.
3. To prevent this from reoccurring, the DON/designee educated staff on the call bell policy. Staff will on the call bell pledge.
4. To monitor and maintain ongoing compliance, the DON/designee will interview 5 interview-able residents to identify any concerns related to call bells weekly x 4 then monthly x 2

To monitor and maintain ongoing compliance, the DON/designee will complete 5 random call bell audits/floor, on non-interview-able residents q shift x 4 weeks then monthly x 2 to identify if extended call bell times occur. The results of the audits will be forwarded to the facility QAPI committee for further review and recommendations.

483.10(i)(1)-(7) REQUIREMENT Safe/Clean/Comfortable/Homelike Environment: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.
483.10(i) Safe Environment.
The resident has a right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.

The facility must provide-
483.10(i)(1) A safe, clean, comfortable, and homelike environment, allowing the resident to use his or her personal belongings to the extent possible.
(i) This includes ensuring that the resident can receive care and services safely and that the physical layout of the facility maximizes resident independence and does not pose a safety risk.
(ii) The facility shall exercise reasonable care for the protection of the resident's property from loss or theft.

483.10(i)(2) Housekeeping and maintenance services necessary to maintain a sanitary, orderly, and comfortable interior;

483.10(i)(3) Clean bed and bath linens that are in good condition;

483.10(i)(4) Private closet space in each resident room, as specified in 483.90 (e)(2)(iv);

483.10(i)(5) Adequate and comfortable lighting levels in all areas;

483.10(i)(6) Comfortable and safe temperature levels. Facilities initially certified after October 1, 1990 must maintain a temperature range of 71 to 81F; and

483.10(i)(7) For the maintenance of comfortable sound levels.
Observations:


Based on observations and staff interviews, it was determined that the facility failed to provide housekeeping and maintenance services to maintain a clean and orderly environment in resident areas on four of five nursing units (Blue Building Unit 200, 300, White Building Unit 100 and 200).

Findings included:

An observation of resident lounge area on the third floor of the Blue Building on March 20, 2024, at 12:51 PM, revealed a dried brown fecal-like substance on the seat cushion of a teal-colored dining chair, that had a foul odor.

An observation of resident dining area on the second floor of the Blue Building on March 20, 2024, at 12:55 PM, revealed a large soiled area from an unknown substance on the seat cushion of a teal-colored dining chair.

An observation of resident sitting area on the second floor of the Blue Building on March 20, 2024, at 12:56 PM, revealed multiple brown and white stained areas of from an unknown substance on the seat cushion of a teal-colored chair.

An observation of resident sitting area on the second floor of the White Building on March 20, 2024, at 1:07 PM, revealed a worn armrest of a cushioned sofa chair.

An observation of resident dining area on the second floor of the White Building on March 20, 2024, at 1:09 PM, revealed multiple brown stains from an unknown substance on the seat cushions of two beige colored dining chairs.

An observation of resident dining area on the first floor of the White Building on March 20, 2024, at 1:11 PM, revealed multiple brown and white stained areas of from an unknown substance on the seat cushion of a teal-colored dining chair.

An observation of resident sitting area on the first floor of the White Building on March 20, 2024, at 1:13 PM, revealed a cushioned fabric recliner to have multiple stained areas on the seat and the fabric was worn. A sofa couch was observed to be worn and torn on the left and right side of the armrests exposing the underlying cushion of the couch.

An interview with the DON on March 19, 2024 at approximately 1:20 PM in the third floor resident lounge in the Blue Building confirmed the brown fecal-like substance on the seat cushion of a chair and stated she would inform maintenance staff to have it cleaned immediately.

During an interview on March 19, 2024, at approximately 2:45 PM, the Nursing Home Administrator (NHA) and Director of Nursing (DON) confirmed that the facility's environment should be kept in good repair and maintained in a clean and homelike manner.


28 Pa Code 201.18 (e)(2.1) Management




 Plan of Correction - To be completed: 04/16/2024

1. The teal dining chair identified in the 3rd Floor lounge area of the Blue Building was cleaned, the teal dining chair identified in the 2nd Floor resident sitting area of the Blue Building was cleaned, the sofa chair in the resident sitting area on the 2nd floor of the White Building was removed, the 2 beige colored dining chair identified in the 2nd floor dining area of the White Building was cleaned, the teal dining chair identified in the 1st Floor dining are the White Building was cleaned, and the couch identified in the resident sitting area on the 1st floor of the White Building was removed.
2. To identify other areas of the building that have the potential to be affected, the Maintenance Director reviewed furniture in both buildings to ensure that the furniture in resident common areas are in good repair and is maintain in a clean and homelike manner.
3. To prevent this from reoccurring, Staff Development/Maintenance or designee will educate housekeeping staff re: ensuring furniture is in good repair and maintain a clean and homelike environment. Visualizing furniture in resident common area has been added to the daily routine to ensure it is in good repair and to maintain a clean and homelike environment.
4. To monitor and maintain ongoing compliance, the maintenance/designee review furniture in resident common areas weekly x 4 then monthly x 2 to ensure furniture is in good repair and is in a clean and homelike environment
The results of the audits will be forwarded to the facility QAPI committee for further review and recommendations.

211.12(f.1)(2) LICENSURE Nursing services. :State only Deficiency.
(2) Effective July 1, 2023, a minimum of 1 nurse aide per 12 residents during the day, 1 nurse aide per 12 residents during the evening, and 1 nurse aide per 20 residents overnight.

Observations:


Based on a review of nurse staffing and staff interview, it was determined that the facility failed to ensure the minimum Nurse Aides (NA) staff to resident ratio was provided on the evening and night shifts for 16 shifts out of 42 reviewed.

Findings include:

A review of the facility's weekly staffing records February 14, 2024, through February 20, 2024, and March 13, 2024, through March 19, 2024, revealed that on the following dates the facility failed to provide minimum nurse aides (NA) staff of 1:12 on the evening shift, and 1:20 on night shift based on the facility's census.

Review of facility census data indicated that on February 14, 2024, the facility census was 235, which required 19.58 nurse aides (NA) during evening shift. Review of the nursing time schedules revealed 19.53 NA worked the evening shift on February 14, 2024.

Review of facility census data indicated that on February 14, 2024, the facility census was 235, which required 11.75 NA during night shift. Review of the nursing time schedules revealed 10.53 NA worked the night shift on February 14, 2024.

Review of facility census data indicated that on February 15, 2024, the facility census was 233, which required 19.42 NA during evening shift. Review of the nursing time schedules revealed 19.10 NA worked the evening shift on February 15, 2024.

Review of facility census data indicated that on February 15, 2024, the facility census was 233, which required 11.65 NA during night shift. Review of the nursing time schedules revealed 10.60 NA worked the night shift on February 15, 2024.

Review of facility census data indicated that on February 16, 2024, the facility census was 232, which required 11.60 NA during night shift. Review of the nursing time schedules revealed 11.10 NA worked the night shift on February 16, 2024.

Review of facility census data indicated that on February 17, 2024, the facility census was 231, which required 19.25 NA during evening shift. Review of the nursing time schedules revealed 19.20 NA worked the evening shift on February 17, 2024.

Review of facility census data indicated that on February 18, 2024, the facility census was 232, which required 19.33 NA during evening shift. Review of the nursing time schedules revealed 19.00 NA worked the evening shift on February 18, 2024.

Review of facility census data indicated that on February 18, 2024, the facility census was 232, which required 11.60 NA during night shift. Review of the nursing time schedules revealed 10.67 NA worked the night shift on February 18, 2024.

Review of facility census data indicated that on February 20, 2024, the facility census was 234, which required 11.70 NA during night shift. Review of the nursing time schedules revealed 11.10 NA worked the night shift on February 20, 2024.

Review of facility census data indicated that on March 13, 2024, the facility census was 238, which required 11.90 NA during night shift. Review of the nursing time schedules revealed 11.33 NA worked the night shift on March 13, 2024.

Review of facility census data indicated that on March 14, 2024, the facility census was 236, which required 19.67 NA during evening shift. Review of the nursing time schedules revealed 19.50 NA worked the evening shift on March 14, 2024.

Review of facility census data indicated that on March 14, 2024, the facility census was 237, which required 11.85 NA during night shift. Review of the nursing time schedules revealed 11.60 NA worked the night shift on March 14, 2024.

Review of facility census data indicated that on March 15, 2024, the facility census was 236, which required 11.80 NA during night shift. Review of the nursing time schedules revealed 1.20 NA worked the night shift on March 15, 2024.

Review of facility census data indicated that on March 16, 2024, the facility census was 234, which required 11.70 NA during night shift. Review of the nursing time schedules revealed 11.33 NA worked the night shift on March 16, 2024.

Review of facility census data indicated that on March 18, 2024, the facility census was 233, which required 19.42 NA during evening shift. Review of the nursing time schedules revealed 19.33 NA worked the evening shift on March 18, 2024.

Review of facility census data indicated that on March 18, 2024, the facility census was 233, which required 11.65 NA during night shift. Review of the nursing time schedules revealed 11.10 NA worked the night shift on March 18, 2024.

During an interview on March 20, 2024, at approximately 1:20 p.m., the Nursing Home Administrator (NHA) confirmed that the facility failed to provide a minimum nurse aide staffing ratios on the above shifts.




 Plan of Correction - To be completed: 04/16/2024

1. Facility can't retroactively correct
2. To identify other areas of concern the facility reviewed 1 weeks' worth of schedules to review CNA staffing ratios.
3. To prevent this from reoccurring, Staff Development will educate staff responsible for the nursing schedule on required CNA ratios. Facility will utilize staff incentives and staffing agencies to assist in meeting required CNA ratios.
4. To monitor and maintain ongoing compliance the NHA/designee will audit the nursing schedule related to CNA staffing ratios 5x's/week for 2 weeks and then weekly for 4 weeks, and monthly for 3 months. The results of the audits will be forwarded to the facility QAPI committee for further review and recommendations.



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