Nursing Investigation Results -

Pennsylvania Department of Health
MCMURRAY HILLS MANOR
Patient Care Inspection Results

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Severity Designations

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Minimal Citation - No Harm Minimal Harm Actual Harm Serious Harm
MCMURRAY HILLS MANOR
Inspection Results For:

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MCMURRAY HILLS MANOR - Inspection Results Scope of Citation
Number of Residents Affected
By Deficient Practice
Initial comments:

Based on a Medicare/Medicaid Recertification, State Licensure, and Civil Rights Compliance Survey completed on December 3, 2021, it was determined that McMurray Hills Manor 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(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 interview, it was determined that the facility failed to maintain a clean, homelike environment in six of 10 resident bathrooms (Room 114-116, 201-203, 202-204, 207-209, 208-210, and 211).

Findings include:

During an observation of resident rooms on 12/1/21, at 1:35 p.m. the following concerns were identified:

Rooms 114 - 116 shared bathroom; radiator rusted.
Rooms 201 - 203 shared bathroom; radiator rusted.
Rooms 202 - 204 shared bathroom; radiator rusted.
Rooms 207 - 209 shared bathroom; radiator rusted.
Rooms 208 - 210 shared bathroom; radiator rusted.
Room 211; radiator rusted.

During an interview and tour of above listed resident rooms on 12/2/21, at 10:30 a.m. the Nursing Home Administrator confirmed the facility failed to maintain a clean, homelike environment for six shared resident bathrooms (Room 114-116, 201-203, 202-204, 207-209, 208-210, and 211) as required.

28 Pa Code: 201.29 (k) Resident rights.

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




 Plan of Correction - To be completed: 12/30/2021

Preparation and/or execution of this plan of correction does not constitute admission or agreement by this provider of the facts alleged, or conclusion set forth in the statement of deficiencies. The plan of correction is prepared and/or executed solely because it is required by the provisions of federal and/or state law. The plan of correction constitutes our credible allegation of compliance.


F-0584 Safe/Clean/Comfortable/Homelike Environment
1. 114-116 shared bathroom
2. 201-203 shared bathroom
3. 202-204 shared bathroom
4. 207-209 shared bathroom
5. 208-210 shared bathroom
6. 211 single bathroom
Rusted radiators have been sanded and painted 12/20/2021
Maintenance Director completed an audit of resident rooms for rusted radiators and repairs were made as needed. 12/3/2021
Preventative maintenance logs have been reviewed and revised to include radiators. Maintenance and housekeeping staff have been educated by Administrator on preventative maintenance and notifying the Maintenance Director of environmental issues.
Administrator, Maintenance Director, housekeeping supervisor and or designee will observe 5 resident bathroom radiators weekly x4 weeks then bi-weekly for 60 days. The results of these audits will be taken to the monthly QAA meeting for review and monitoring

483.25(b)(1)(i)(ii) REQUIREMENT Treatment/Svcs to Prevent/Heal Pressure Ulcer: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.
483.25(b) Skin Integrity
483.25(b)(1) Pressure ulcers.
Based on the comprehensive assessment of a resident, the facility must ensure that-
(i) A resident receives care, consistent with professional standards of practice, to prevent pressure ulcers and does not develop pressure ulcers unless the individual's clinical condition demonstrates that they were unavoidable; and
(ii) A resident with pressure ulcers receives necessary treatment and services, consistent with professional standards of practice, to promote healing, prevent infection and prevent new ulcers from developing.
Observations:
Based on facility policy, observations, and staff interview, it was determined that the facility failed to prevent the potential for cross-contamination of disease, and failed to follow acceptable infection control practice during dressing care for one of one residents (Resident R9).

Findings include:

The facility policy "Wound Management Program" dated 10/4/21 indicated that residents receive necessary treatment and services to promote healing, prevent infection, and prevent new sores from developing.

Review of the Centers for Disease Control (CDC) guidance "Guideline for Prevention of Catheter Associated Urinary Tract Infections" updated 6/6/19, indicated to keep the urine drainage bag off the floor to maintain unobstructed urine flow an prevent infection.

During an observation of a dressing change for Resident R9 on 12/1/21, at 1:37 p.m. Licensed Practical Nurse (LPN) Employee E3 gripped the edge of the garbage can with gloved hands, and moved it. LPN Employee E3 then cleaned Resident R9's wound without removing the soiled gloves, or performing hand hygiene.

During an interview on 12/1/21, at 1:45 p.m. LPN Employee E3 confirmed that she contaminated her hands when moving the garbage can, and confirmed the possibility of contaminating Resident R9's wounds with microorganisms present on the garbage can.

28 Pa. Code: 211.10(d) Resident care policies.
Previously cited: 7/22/21

28 Pa. Code: 211.12(d)(1)(5) Nursing services.
Previously cited: 7/22/21


 Plan of Correction - To be completed: 12/30/2021

F-0686 Treatment/Services to Prevent/Heal Pressure Ulcer
During a dressing change, employee E3 gripped the edge of the garbage can without changing gloves or performing hand hygiene. This practice had the potential to affects multiple residents, however no other residents were affected.
All licensed nursing staff who perform dressing change will be educated by the Director of Nursing/Infection Control Nurse on the proper procedure for completing a dressing change and hand hygiene by 12/22/2021. The DON or Infection Control Nurse and/or designee will also visualize 1 dressing change for 5 residents weekly, monitoring for correct technique and proper hand hygiene with all nurses who perform dressing changes.
DON OR Infection Control Nurse and/or designee will complete audits on 5 residents weekly for 4 weeks, 3 residents weekly for 4 weeks then twice a week for 4 weeks. Results of these audits will be taken to the monthly QAA meeting for review and monitoring



483.25(g)(1)-(3) REQUIREMENT Nutrition/Hydration Status Maintenance: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.
483.25(g) Assisted nutrition and hydration.
(Includes naso-gastric and gastrostomy tubes, both percutaneous endoscopic gastrostomy and percutaneous endoscopic jejunostomy, and enteral fluids). Based on a resident's comprehensive assessment, the facility must ensure that a resident-

483.25(g)(1) Maintains acceptable parameters of nutritional status, such as usual body weight or desirable body weight range and electrolyte balance, unless the resident's clinical condition demonstrates that this is not possible or resident preferences indicate otherwise;

483.25(g)(2) Is offered sufficient fluid intake to maintain proper hydration and health;

483.25(g)(3) Is offered a therapeutic diet when there is a nutritional problem and the health care provider orders a therapeutic diet.
Observations:

Based on review of facility policies and clinical records and staff interviews, it was determined that the facility failed to make certain that a weight loss was identified and addressed in a timely manner for one of four residents (Resident R46).

Findings include:

Review of the facility policy "American Health Foundation Nutrition/Hydration Program" dated 10/4/21, indicated the facility must ensure that a resident maintains acceptable parameters of nutritional status, and stated a weight loss greater that 7.5% in three months and/or greater than 10% in six months is classified as a severe weight loss.

A review of the clinical record indicated that Resident R46 was admitted to the facility on 7/2/21, with diagnoses that included a facial weakness, muscle weakness, and breast cancer.

Review of Resident R46's weight record indicated the following weights:

07/4/21 - 186.4 lbs
12/3/21 - 160.4 lbs , indicating a 13.95 % weight loss in 5 months

A review of the clinical record failed to reveal a nutritional assessment completed after 7/3/21, and failed to reveal a weight loss assessment.

A review of the physician orders revealed Resident R46 was on a regular diet with regular/thin liquids and Ensure nutritional supplement three times a day with meals added 7/6/21. Further review failed to reveal additional nutritional interventions.

A review of the care plan indicated Resident R46 was at risk for weight loss and the registered dietician was to evaluate and make diet changes as needed.

During a telephone interview on 12/3/21, at 11:45 a.m. Registered Dietitian Employee E2 confirmed that facility staff did not inform her of the 13.95% weight loss, and no additional interventions were attempted to address the weight loss.

During an interview on 12/3/21, at 2:00 p.m. the Nursing Home Administrator and Assistant Director of Nursing Employee E1 confirmed that Resident R46 had a significant weight loss, nursing staff failed to notify the Registered Dietitian and the weight loss was not addressed.


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

28 Pa. Code: 211.2 (a) Physician services.

28 Pa. Code: 211.6 (b) Dietary services.

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

28 Pa. Code: 211.10(d) Resident care policies.
Previously cited: 7/22/21

28 Pa. Code: 211.12 (d)(1)(5) Nursing services.
Previously cited: 7/22/21

28 Pa. Code: 211.12 (d)(2)(3) Nursing services.


 Plan of Correction - To be completed: 12/30/2021

This deficient practice had the potential to affect multiple residents, however, no other residents were affected.
Resident R46 was assessed by the RD on 12/03/2021, no negative effects were noted. Resident was re-weighed and added to the nutrition at risk meeting and continues to receive Ensure clear TID with meals. Resident noted to weigh 160.4lbs, Resident continues to eat 0-25% of all meals with alternatives offered. Resident refuses alternative. Resident drinks 50-100% of Ensure clear three times daily. Resident weight stable at this time and will continue current diet and supplements. Will keep MD, RD and /or CRNP notified of any changes
DON or designee will provide education to all licensed staff regarding obtaining daily, weekly and monthly weights. Education will include Consistency of how weights are obtained (Standing, Wheelchair, and Mechanical lift), documentation of weights and notification made to resident, physician, POA, DON and Dietician. Education will be completed by 12/22/2021.
An audit of all residents' charts will be conducted to ensure that tall resident weights are obtained in a consistent manner, and care plans are updated to reflect current dietary recommendations and interventions.
Starting 12/21/2021, a weekly nutrition at risk intradisciplinary team meeting will be held and will include the following: DON, ADON, Dietician and RNAC. An audit tool will be created to track significant weight gains or losses of 5% in 30 days, 7.5% in 60 days and 10% in 180 days along with any new interventions that are implemented. DON or designee will ensure that there is documentation of notification to the resident, POA and MD/CRNP of significant weight gain or loss in the EMAR. Weekly audits will continue for 90 days.
Results of weekly nutrition at risk meetings and chart audits will be taken to QAA meeting for review and monitoring.

483.45(g)(h)(1)(2) REQUIREMENT Label/Store Drugs and Biologicals: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(g) Labeling of Drugs and Biologicals
Drugs and biologicals used in the facility must be labeled in accordance with currently accepted professional principles, and include the appropriate accessory and cautionary instructions, and the expiration date when applicable.

483.45(h) Storage of Drugs and Biologicals

483.45(h)(1) In accordance with State and Federal laws, the facility must store all drugs and biologicals in locked compartments under proper temperature controls, and permit only authorized personnel to have access to the keys.

483.45(h)(2) The facility must provide separately locked, permanently affixed compartments for storage of controlled drugs listed in Schedule II of the Comprehensive Drug Abuse Prevention and Control Act of 1976 and other drugs subject to abuse, except when the facility uses single unit package drug distribution systems in which the quantity stored is minimal and a missing dose can be readily detected.
Observations:
Based on review of observation, interview, and manufacturer guidelines, the facility failed to dispose of an expired medication in one of two (2 C hall) medication rooms.

Findings include:

Manufacturer's recommendations of Tubersol (Tuberculin Purified Protein Derivative) instruct "a vial of Tubersol which has been entered and in use for 30 days should be discarded".

During a medication room observation on 12/1/21, at 12:40 p.m., one vial of Tubersol was noted to be opened and dated 10/28/21.

During an interview at that time, RN Employee E2 confirmed the Tubersol vial was opened and expired and should have been discarded.

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

28 Pa. Code: 211.9(h) Pharmacy services.





 Plan of Correction - To be completed: 12/30/2021

F- 0761 Label/Store Drugs and Biologicals
Facility failed to dispose of expired medication in 1 of 2 medication rooms. Multiple residents had the potential to be affected by this deficient practice, however no residents were affected.
The medications were immediately removed 11/30/2021 from the medication room refrigerator. The DON or designee will provide education to all licensed staff on proper medication storage by 12/22/2021. The DON/designee will conduct an audit of all medication rooms and medication carts to ensure that all medications are stored correctly and are not expired. An audit tool will be utilized to monitor medication storage for the next 90 days.
Audits will be completed by the DON/designee weekly x4 weeks, then every 2 weeks for the next 60 days. Results of the audits will be taken to the monthly QAA meeting for review and monitoring


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