Nursing Investigation Results -

Pennsylvania Department of Health
BLOOMSBURG CARE AND REHABILITATION CENTER
Patient Care Inspection Results

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BLOOMSBURG CARE AND REHABILITATION CENTER
Inspection Results For:

There are  73 surveys for this facility. Please select a date to view the survey results.

Surveys don't appear on this website until at least 41 days have elapsed since the exit date of the survey.
BLOOMSBURG CARE AND REHABILITATION CENTER - Inspection Results Scope of Citation
Number of Residents Affected
By Deficient Practice
Initial comments:

Based on an abbreviated complaint survey completed on December 4, 2019, it was determined that Bloomsburg Care Center and Rehabilitation 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:


483.40(d) REQUIREMENT Provision of Medically Related Social Service: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.
483.40(d) The facility must provide medically-related social services to attain or maintain the highest practicable physical, mental and psychosocial well-being of each resident.
Observations:

Based on a review of clinical records and staff interview, it was revealed that the facility failed to provide medically related social services to assist residents with decisions related to their medical status, adjustment to current life circumstances/situations and to promote the resident's psychosocial well being for two out of five residents reviewed (Resident CR1 and 2.)

Findings include:


A review of Resident 2's clinical record revealed that resident had sustained a fractured left tibia while on a leave of absence from the facility on February 9, 2019. Subsequently, the resident required open reduction surgery and internal fixation to repair the injury during February 2019.

Following the resident's injury, the resident underwent various treatments, procedures and surgeries related to the injury, including wounds and surgical removal of the hardware, which had become infected. A review of the resident's clinical record revealed she had a diagnosis of severe peripheral artery disease and had insertion of a SFA (Superficial Femoral Artery) stent to improve circulation.

The clinical record revealed that on November 21, 2019, a surgeon assessed the resident, after the wound care specialist contacted him with concerns that the resident's stent was occluded. The resident was examined by the surgeon and it was concluded that the resident's left leg wound had significantly worsened during the past month. The surgeon determined that the resident's foot should be amputated.

The surgeon documented that the amputation was discussed with the resident and her daughter. The discussion noted that the resident required an amputation, which would possibly be above the knee. The resident and her daughter were not able to commit to a decision at that time and stated they would make a decision after Thanksgiving.

On December 2, 2019, the resident had a follow-up appointment scheduled, which her daughter cancelled and then rescheduled.

A review of the resident's most recent MDS (minimum data set-standardized assessment tool completed at periodic intervals to plan resident care) dated September 12, 2019, revealed that the resident's cognition was intact (BIMS-brief interview for mental status score 13/15.)

During the survey on December 4, 2019 at 1:20 p.m.,the resident was interviewed. She stated without the surveyor asking, that she had been told that she was going to have to have her foot amputated. She stated that she was worried about the procedure and was "scared."

A review of interdisciplinary progress notes dated November 22, 2019, revealed that the resident had returned from appointments at the vascular surgeon and wound care. The resident was told during these appointments that her leg was not salvageable and she required an amputation. It was noted that the resident stated that she needed to think about proceeding with the surgery. The plan was for a follow-up appointment on December 2, 2019, to discuss/schedule the amputation.

Further review of the resident's clinical record revealed no documented evidence that the facility had provided timely and necessary medically related therapeutic social services, including discussing the recommended amputation with the resident, providing assistance and support with the resident's decision-making and attempting to alleviate her fears to promote the resident's psychosocial well-being.

On December 4, 2019, the Social Worker was interviewed at 2:20 p.m. She stated that she had "heard" that the resident needed an amputation, but thought that the resident hadn't made a decision yet. The Social Worker acknowledged that she had not met with the resident to determine if the required any assistance or emotional support with the decision..

A review of the clinical record of Resident CR1 revealed admission to the facility on September 29, 2018. A friend, was noted to be acting as the resident's financial and medical power of attorney for the resident and had signed all of the resident's admission paperwork, including her rights information. There was no documented evidence that this resident was adjudicated incompetent by the court or assessed as unable to exercise her rights and responsibilities or make decisions.

A review of the resident's MDS Assessment dated October 5, 2018, revealed that the resident's cognition was intact. The resident's BIMS (brief interview for mental status, the cognitive portion of the assessment) was a 15/15.

According to review of the resident's clinical record the resident's friend had instructed the facility not to allow the resident to sign any documents. On October 5, 2018, the resident's friend expressed concerns with the resident's family coming into the facility to attempt to take the resident out on a leave of absence. The friend stated that the resident "acts mean" when she talks to certain family members, but she did not wish to take the resident's cell phone away from her.

On October 16, 2018, the resident's friend stated that she did not want the resident to know that her placement at the facility was to be long term. The resident's friend also expressed concerns with the resident's niece. The friend directed staff that the resident could talk to her niece, but could not leave the facility with her.`

A review of interdisciplinary progress notes dated December 7, 2018, revealed that the resident's nephew came into the facility and attempted to discuss the resident's placement at the facility. During this visit, he expressed concerns with the actions of the resident's friend and implied that the resident's friend was being investigated in community related to this medical and financial decision making. The facility contacted the resident's friend and notified her of these allegations.

A Social Service referral was made on December 14, 2018, because the resident was upset regarding her finances. Social Services staff reminded the resident that her friend was handling her finances. The facility contacted the resident's friend to make her aware of the resident's concerns. The resident's friend responded that this was not a new behavior for the resident.

On January 21, 2019, Social Services staff met with the resident at the request of the resident. The resident stated that she spoke with her nephew regarding transfer to another long term care facility. The Social Service worker again noted that there were complex family dynamics involved and this nephew did not have the ability to participate in decisions for the resident. The resident's friend was contacted and the friend stated she did not want to pursue the resident's discharge.

Social Services completed an MDS/BIMS assessment on the resident on April 11, 2019. The resident's cognition remained intact with a score of 13/15. Subsequent MDS/BIMS assessments completed on July 3, 2019, and September 10, 2019, both revealed that the resident's cognition remained intact with scores of 15/15 at each assessment.

On September 20, 2019, Social service progress notes revealed the resident was "anticipating" discharging to another skilled facility. A review of nursing progress notes revealed that the resident was discharged that same day.

A review of the resident's clinical record, revealed no documented evidence that the facility had written proof that the resident's friend did in fact have power of attorney, to make medical and financial decisions for the resident.

There was no documented evidence that despite the limitations set by the resident's alleged power of attorney on the resident's ability to exercise her rights, along with expressions of concern by the resident and a family member, that Social Services had discussed these concerns with the resident. In each instance, Social Services deferred instead, to this resident's friend. There was no documented evidence that Social Services staff had assured that the resident's right were protected and she was allowed to participate in decisions regarding her health care and personal finances.

When interviewed on December 4, 2019 at 2:45 p.m.,the licensed nursing home administrator was unable to provide documented evidence that the facility had written evidence that this resident's friend had durable power of attorney for the resident.





28 Pa. Code 211.5(f)(g)(h) Clinical Records

28 Pa. Code 211.16 (a) Social Services.

28 Pa. Code 201.29(a)(j)(l)(1)(2) Resident rights



 Plan of Correction - To be completed: 02/02/2020

F0745
1. Resident #1 no longer resides at BCRC.
Resident #2 has met with the social service director to discuss the recommended amputation providing assistance and support with the resident's decision making and attempting to alleviate her fears to promote the resident's psychosocial well-being.
2. Social service/designee will be educated on proper follow up and documentation for residents that are in need of timely and necessary medically related therapeutic social services.
3. The IDT will review the 24-hour report to identify and include any resident requiring timely and necessary medically related therapeutic social services. The social service director/designee will interview each resident identified and document the outcome of the conversation in the resident's medical record. The IDT will review social service director/designee documentation to verify the medically related therapeutic social service intervention has been provided. Social Service director/designee will log residents identified requiring the necessary medically related therapeutic social services.
4. The IDT will review social service director/designee documentation to verify that the timely and necessary medically related therapeutic social service intervention has been provided.
5. Social Service director/designee will log residents identified requiring the necessary medically related therapeutic social services. Social service director/designee will report on it's tracking of residents requiring necessary medically related therapeutic social services to QAPI x 3 months.

483.10(b)(3)-(7)(i)-(iii) REQUIREMENT Rights Exercised by Representative: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.
483.10(b)(3) In the case of a resident who has not been adjudged incompetent by the state court, the resident has the right to designate a representative, in accordance with State law and any legal surrogate so designated may exercise the resident's rights to the extent provided by state law. The same-sex spouse of a resident must be afforded treatment equal to that afforded to an opposite-sex spouse if the marriage was valid in the jurisdiction in which it was celebrated.
(i) The resident representative has the right to exercise the resident's rights to the extent those rights are delegated to the representative.
(ii) The resident retains the right to exercise those rights not delegated to a resident representative, including the right to revoke a delegation of rights, except as limited by State law.

483.10(b)(4) The facility must treat the decisions of a resident representative as the decisions of the resident to the extent required by the court or delegated by the resident, in accordance with applicable law.

483.10(b)(5) The facility shall not extend the resident representative the right to make decisions on behalf of the resident beyond the extent required by the court or delegated by the resident, in accordance with applicable law.

483.10(b)(6) If the facility has reason to believe that a resident representative is making decisions or taking actions that are not in the best interests of a resident, the facility shall report such concerns when and in the manner required under State law.

483.10(b)(7) In the case of a resident adjudged incompetent under the laws of a State by a court of competent jurisdiction, the rights of the resident devolve to and are exercised by the resident representative appointed under State law to act on the resident's behalf. The court-appointed resident representative exercises the resident's rights to the extent judged necessary by a court of competent jurisdiction, in accordance with State law.
(i) In the case of a resident representative whose decision-making authority is limited by State law or court appointment, the resident retains the right to make those decisions outside the representative's authority.
(ii) The resident's wishes and preferences must be considered in the exercise of rights by the representative.
(iii) To the extent practicable, the resident must be provided with opportunities to participate in the care planning process.
Observations:

Based on review of clinical records and staff interview revealed the facility failed to ensure that individuals making medical and financial decisions for residents were legally authorized to do so and to assure that these decisions did not extend beyond the extent allegedly extended by the resident and that the wishes and preferences of the resident were considered to the extent possible (Resident CR1) for one out of five residents reviewed.

Findings include:

A review of the clinical record revealed that Resident CR 1 was admitted to the facility on September 29, 2018. Clinical record review revealed that a friend stated that she was acting as the financial and medical power of attorney for the resident and had signed all of the resident's admission paperwork. However, there was no documented evidence that the resident was adjudicated incompetent by the court or identified to have impairments/limitations, which prevented her from making sound decisions regarding her care and finances at the time of admission.

A review of the resident's MDS (minimum data set - a federally mandated assessment conducted periodically to plan resident care) dated October 5, 2018, revealed that the resident's cognition was intact. The resident's BIMS(brief interview for mental status, the cognitive portion of the assessment) with a score of 15/15.

Further review of the resident's clinical record revealed that this friend had instructed the facility not to allow the resident to sign any documents. On October 5, 2018, the resident's friend expressed concerns with the resident's family attempting to come into the facility to take the resident out on a leave of absence. The friend also stated that the resident "acts mean" when she talks to certain family members, but she did not wish to take the resident's cell phone away from her.

Documentation revealed that on October 16, 2018, the resident's friend stated that she did not want the resident to know that her placement at the facility was to be long term. She also expressed concerns with the resident's niece. She stated she did not want to restrict contact with her, but she did not want her to receive any information about the resident or to allow the resident to go out on a leave of absence with the resident's niece.

A review of the resident's clinical record revealed the resident had completed a Living Will prior to admission, and had made this particular niece her second decision maker if the resident's friend could no longer serve.

On December 7, 2018, the resident's nephew came into the facility and attempted to discuss the resident's placement at the facility. During this visit, he expressed concerns with the actions of the resident's friend. The facility contacted the resident's friend and she stated that she did not want to restrict the resident's contact with this nephew because "she loved him."

A Social Service referral was made on December 14, 2018, because the resident was upset regarding her finances. The resident was reminded that her friend was handling her finances. The facility then contacted the resident's friend to make her aware of the resident's concerns. The resident's friend responded that this was not a new behavior for the resident.

On January 21, 2019, Social Services staff met with the resident at the resident's request. The resident stated that she spoke with her nephew regarding transfer to another long term care facility. The Social worker again noted there were complex family dynamics involved and this nephew did not have the ability to participate in decisions for the resident. The resident's friend was contacted and she stated that she did not want to pursue the resident's discharge.

Social Services completed an MDS/BIMS assessment on the resident on April 11, 2019. The resident's cognition remained intact with a score of 13/15. Subsequent MDS and BIMS assessments dated July 3, 2019, and September 10, 2019, also revealed that the resident's cognition remained intact with scores of 15/15 at each assessment.

On September 20, 2019, Social service progress notes revealed the resident was "anticipating" discharging to another skilled facility. A review of nursing progress notes revealed that the resident was discharged that day.

A review of submitted communication, revealed that the resident's friend did not want the resident to be made aware of her discharge to another facility, until the morning of her discharge. She also requested that her name (the resident's friend) not be mentioned as the organizer of the resident's discharge. The Nursing Home Administrator, who was no longer employed at the facility, instructed the Social Worker that it was the resident's right to know she was leaving and the resident was informed on the afternoon of September 19, 2019, that she would be leaving the facility.

According to review of interdisciplinary progress notes, the resident was discharged from the facility at 12:00 p.m., on September 20, 2019.

A review of the resident's clinical record, revealed no evidence that the facility had documented proof that the resident's friend did in fact have a durable power of attorney, to make medical and financial decisions for the resident.

The facility also failed to determine, if this individual did in fact have this legal authority and had determined that it was effective immediately or when the resident no longer had the capability to exercise her rights.

There was no indication, that despite the resident's intact cognition, that the facility had attempted to determine from the resident, her wishes, preferences or account of her personal history. The facility continually differed to the resident's friend, even when the resident had expressed concerns about her finances.

There was no indication that the facility made attempts, to allow this capable, cognitively intact resident, to participate in any of the decisions regarding her care or with whom she wished to interact.

When interviewed on December 4, 2019 at 2:45 p.m., the licensed nursing home administrator was unable to provide documented evidence that the facility had documented evidence that the resident's friend had health and financial power of attorney for the resident.


28 Pa. Code: 201.18(a)(b)(2)(e)(1) Management

28 Pa. Code: 201.19 (a)(j)(l)(1)(2) Resident Rights.






 Plan of Correction - To be completed: 02/02/2020

F0551
1. Resident no longer resides at Bloomsburg Care and Rehab Center.
2. An audit will be conducted on 30% of current residents to determine that individuals making medical and financial decisions for residents are legally authorized to do so and to verify
that these decisions did not extend beyond the extent allegedly extended by the resident and
that the wishes and preferences of the resident were considered to the extent possible.
3. Upon admission, the admissions coordinator/designee will verify that resident's living will, POA for both medical and financial and POLST are available and communicate to the IDT.
4. Admissions/designee will audit each new admission to verify the facility has been provided accurate information regarding POA, both financial and medical, POLST and living will.
5. Admissions/designee will report findings to QAPI x3 months.

201.14(g) LICENSURE Responsibility of licensee.:State only Deficiency.
(g) A facility owner shall pay in a timely manner bills incurred in the operation of a facility that are not in dispute and that are for services without which the resident's health and safety are jeopardized.
Observations:

Based on review of facility accounts payable and interview with administrative staff it was determined that the facility failed to pay, in a timely manner, bills incurred in the operation of the facility, that are not in dispute, and are for services without which the residents health and safety are jeopardized.

Findings include:

Review of the aging report (financial report which shows unpaid invoices by date ranges) conducted at the time of the survey ending December 4, 2019, revealed outstanding accounts payable balances for resident care, which included pharmacy and therapy services.

According to review of the facility Vendor Aging Report, there was a balance due to the pharmacy consultant for a due date range of 91 through 120 days for $1,350.00; 61 through 90 days for $1,370.25 and for 30 through 60 days for $1,410.25, with a total outstanding balance of $4,130.25.

Interview with the Business Office manager on December 5, 2019 at 3:55 p.m. revealed that the payment terms of agreement for this vendor was 30 days.

A review of the facility Vendor Aging Report revealed that the facility owed $25,953.47 for the due date range of 91 through 120 days for pharmacy services and supplies.

Interview with the Business Office manager on December 5, 2019 at 3:55 p.m. revealed that the payment terms of agreement for this vendor was 90 days.

According to review of the facility Vendor Aging Report, revealed that there was a balance due for Rehabilitation/Therapy Services of $190,609.73, for a due date range in excess of 121 days; $98,205.86 for a due date range from 91 through 120 days; and $95,372.89 for a due date range of 61 through 90 days out, for a total of $381,188.48 outstanding balance.

Interview with the Business Office manager on December 5, 2019 at 3:55 p.m. revealed that the payment terms of agreement for this vendor was 60 days.

The business office manager confirmed that these providers were active vendors for resident care and services provided to the facility.












 Plan of Correction - To be completed: 02/02/2020

P0430
1. All outstanding bills have been paid.
2. All invoices will be paid timely per vendor agreement.
3. A change in staff member responsible for A/P on a corporate level has occurred.
4. Weekly review of A/P by business office manager/designee x3 months and findings provided to QAPI.


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