Pennsylvania Department of Health
MANATAWNY CENTER FOR REHABILITATION AND NURSING
Patient Care Inspection Results

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Severity Designations


Minimal Citation - No Harm	Minimal Harm	Actual Harm	Serious Harm

MANATAWNY CENTER FOR REHABILITATION AND NURSING
Inspection Results For:

There are 117 surveys for this facility. Please select a date to view the survey results.

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MANATAWNY CENTER FOR REHABILITATION AND NURSING - Inspection Results	Scope of Citation Number of Residents Affected By Deficient Practice

Initial comments:

Based on a Medicare/Medicaid Recertification survey, State Licensure survey, Complaint survey, and a Civil Rights Compliance survey completed on January 31, 2025, it was determined that Manatawny Center For Rehabilitation and Nursing, 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 of the Health portion of the survey.

Plan of Correction:

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 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.

§483.25(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 clinical record review, and staff interview, it was determined that the facility failed to ensure that necessary treatments were provided for two of five residents with a pressure ulcer (Residents 71 and 177).

Findings include:

Review of Resident 71's wound consult of January 27, 2025, revealed resident presented with a stage 3 pressure ulcer (full thickness tissue loss) of the left heel. The consult indicated a new order recommendation to cleanse with wound cleanser, apply betadine (antiseptic solution used to disinfect open wounds), and leave open to air daily and prn (as needed). Review of the physician's orders and TAR (treatment administration record) revealed that the order was not implemented.

Interview with the Director of Nursing (DON) on January 31, 2025, at 11:17 a.m. confirmed that the treatment order was changed during wound rounds, but the order was not put into place.

Review of Resident 177's wound consult of January 20, 2025, revealed resident presented with a stage 2 pressure ulcer (shallow wound with partial thickness skin loss) of the sacrum (large, triangular bone at the base of the spine). The consult indicated a new order recommendation to clean with wound cleanser, apply house barrier cream, and leave open to air daily and prn. Review of the physician's orders and TAR revealed that the order was not implemented.

Interview with the DON and Nursing Home Administrator on January 31, 2025, at 1:05 p.m. confirmed that the order to change the treatment was not implemented.

28 Pa. Code 211.5(f) Clinical records
Previously cited 2/15/24

28. Pa. Code 211.12(d)(1)(3)(5) Nursing services
Previously cited 2/15/24

Plan of Correction - To be completed: 02/28/2025

Preparation and/or execution of this plan does not constitute admission or agreement by the provider of the truth of the facts alleged or conclusions set forth on the statement of deficiencies. This plan of correction is prepared and/or executed solely because it is required.

1.Resident R71 and R 177's wounds were reassessed, and physicians were notified that new wound orders implemented on wound rounds were not transcribed to the TAR (treatment administration record) and were not implemented. There were no unfavorable outcomes related to the facilities alleged deficient practice.

2.Audit of current residents with pressure ulcers completed to ensure that recommended treatments are in place as recommended by wound team.

3.DON/Designee will complete training to licensed staff on the components of this regulation, including ensuring treatment orders are transcribed to the TAR in a timely manner.

4.DON/Designee will have complete audits of 5 residents with pressure wounds 2 x a week x4 weeks, then 1 x a week x 4 weeks then, 2x a month then 1x a month x 2 months. The findings of these quality monitoring's to be reported to the Quality Assurance/ Performance Improvement Committee until monthly and/or until substantial compliance is met. Quality Monitoring schedule modified based on findings in QAPI.

5.Date of Compliance will be February 28, 2025.

483.10(i)(1)-(7) REQUIREMENT Safe/Clean/Comfortable/Homelike Environment:

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(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 81°F; 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 a safe and homelike environment for one of the four units observed (Milestone Unit).

Findings include:

An observation on the Milestone unit conducted on January 28, 2025, revealed the following: At 11:51 a.m., room 23's wall by the window was observed with two holes measuring 3.0 x 5.0 inches and the other hole measuring 2.0 x 5.0 inches; 11:58 a.m., room 22's wall by the window was observed with one hole measuring 5.0 x 7.0 inches; and at 12:01 p.m., room 21's wall by the window was observed with two holes one measuring 2.0 x 11 inches and the other was 2.0 x 2.0 inches.

An observation conducted on January 31, 2025, at 11:20 a.m., in the presence of Employee E3 revealed that the above observations on Milestone unit Rooms 21, 22, and 23 were still present.

An interview conducted with Employee E3 on January 31, 2025, at 11:30 a.m. revealed that he/she was not aware nor informed of the holes in the walls in rooms 21, 22, and 23.

The above findings were discussed with the Nursing Home Administrator on January 31, 2025, at 1:00 p.m.

The facility failed to ensure a safe and homelike environment in the Milestone Unit.

28Pa Code 201.14(a) Responsibility of licensee.

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

Plan of Correction - To be completed: 02/28/2025

Preparation and/or execution of this plan does not constitute admission or agreement by the provider of the truth of the facts alleged or conclusions set forth on the statement of deficiencies. This plan of correction is prepared and/or executed solely because it is required.

1.Facility failed to provide a safe and homelike environment in the Milestones unit in rooms 21,22, and 23. Holes were repaired in rooms 21,22, and 23.

2.Audit of all resident rooms in Milestones unit completed to ensure no other areas were observed.

3.Maintenance Director/ Designee will complete training of staff on the components of this regulation to include the need to report all changes in environment to maintenance.

4.The Maintenance Director/Designee will complete audits of 5 rooms 2 x a week x4 weeks, then 1 x a week x 4 weeks then, 2x a month then 1x a month x 2 months to ensure that all rooms have a safe homelike environment. The findings of these quality monitoring's to be reported to the Quality Assurance/ Performance Improvement Committee until monthly and/or until substantial compliance is met. Quality Monitoring schedule modified based on findings in QAPI.

5.Date of compliance will be 2/28/25.

483.21(b)(1)(3) REQUIREMENT Develop/Implement Comprehensive Care Plan:

§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.
§483.21(b)(3) The services provided or arranged by the facility, as outlined by the comprehensive care plan, must-
(iii) Be culturally-competent and trauma-informed.

Observations:

Based on review of clinical records and staff interview, it was determined that the facility failed to develop a comprehensive care plan for two of 25 residents reviewed (Residents 22 and 108).

Findings include:

Review of Resident 22's CRNP's (certified registered nurse practitioner) progress note of January 10, 2025, revealed that the resident was seen and examined for complaints of urinary retention. New order to insert foley catheter (sterile tube inserted into the bladder to drain urine) if needing straight catheterization (intermittent emptying of urine from the bladder using a small tube) for all three shifts. Additional progress note of January 10, 2025, revealed that a foley catheter was inserted for urinary retention.

Review of CRNP progress note of January 21, 2025, revealed an order to remove the resident's catheter and complete a bladder scan (procedure used to assess the amount of urine retained within the bladder) every shift for three days related to a voiding trial. Review of progress note of January 22, 2025, revealed resident continues to retain urine per bladder scan and foley catheter placed as ordered.

Interview with the Nursing Home Administrator and Director of Nursing on January 31, 2025, at 1:13 p.m. confirmed that a care plan had not been developed for urinary retention or a foley catheter.

Review of Resident 108's CRNP progress notes dated January 30, 2025 revealed "Patient seen and examined today to review labs drawn yesterday and to follow up on CHF [congestive heart failure - excessive body/lung fluid caused by a weakened heart muscle]."

Further review of Resident 108's CRNP progress notes dated January 30, 2025 revealed "[resident] has been taking Furosemide [Lasix - diuretic used to reduce fluid] 20 mg [milligrams] daily x 3 days. Given only mild decrease, will increase Furosemide. [Resident] continues with edema to right elbow."

Review of Resident 108's care plan failed to reveal evidence of a care plan for the increase in Lasix and failed to reveal evidence of a care plan for right elbow edema.

Interview with Director of Nursing on January 31, 2025 at 9:45 a.m. confirmed that no care plan existed for Resident 108's right elbow edema and also confirmed there was no care plan for Resident 108's increase in Lasix.

28 Pa. Code 211.5(f) Clinical records
Previously cited 2/15/24

28 Pa. Code 211.12(d)(1)(5) Nursing services
Previously cited 2/15/24

Plan of Correction - To be completed: 02/28/2025

Preparation and/or execution of this plan does not constitute admission or agreement by the provider of the truth of the facts alleged or conclusions set forth on the statement of deficiencies. This plan of correction is prepared and/or executed solely because it is required.

1.Facility failed to develop a comprehensive care plan for R22 for urinary retention with placement of a foley catheter and R108 for increase in Lasix and right elbow edema. Care plans were updated for both residents.

2.Audit of current residents completed to ensure that changes were added to care plans.

3.DON/Designee will complete education to licensed staff on the components of this regulation to include the need for comprehensive care plans for changes.

4.DON/Designee will complete audits of 5 residents 2 x a week x4 weeks, then 1 x a week x 4 weeks then, 2x a month then 1x a month x 2 months. The findings of these quality monitoring's to be reported to the Quality Assurance/ Performance Improvement Committee until monthly and/or until substantial compliance is met. Quality Monitoring schedule modified based on findings in QAPI.

5.Date of compliance will be 2/28/2025

483.21(b)(2)(i)-(iii) REQUIREMENT Care Plan Timing and Revision:

§483.21(b) Comprehensive Care Plans
§483.21(b)(2) A comprehensive care plan must be-
(i) Developed within 7 days after completion of the comprehensive assessment.
(ii) Prepared by an interdisciplinary team, that includes but is not limited to--
(A) The attending physician.
(B) A registered nurse with responsibility for the resident.
(C) A nurse aide with responsibility for the resident.
(D) A member of food and nutrition services staff.
(E) To the extent practicable, the participation of the resident and the resident's representative(s). An explanation must be included in a resident's medical record if the participation of the resident and their resident representative is determined not practicable for the development of the resident's care plan.
(F) Other appropriate staff or professionals in disciplines as determined by the resident's needs or as requested by the resident.
(iii)Reviewed and revised by the interdisciplinary team after each assessment, including both the comprehensive and quarterly review assessments.

Observations:

Based upon clinical record review, it was determined the facility failed to revise a care plan to reflect changes in nutrition for a resident with weight loss for one of 25 residents reviewed (Resident 84).

Findings include:

Review of Resident 84's clinical record revealed between December 14, 2024 and January 6, 2025 Resident 84 had a 5.89 % weight loss.

Further review of the clinical record revealed weight warning note from the dietitian dated January 6, 2025 identifying the weight loss and suggesting adding pudding to lunch and dinner and to also add desert for additional calories.

Review of Resident 84's care plan failed to reveal that the care plan was revised to include the changes in nutrition from the dietitian.

Interview with Director of Nursing on January 31, 2025 at 9:45 a.m. confirmed that the care plan was not revised to include changes from the dietitian.

28 Pa. Code 211.5(f) Clinical records
Previously cited 4/30/24, 3/8/24

28 Pa. Code 211.12(d)(1)(5) Nursing services
Previously cited 6/11/24, 4/30/24, 3/8/24

Plan of Correction - To be completed: 02/28/2025

Preparation and/or execution of this plan does not constitute admission or agreement by the provider of the truth of the facts alleged or conclusions set forth on the statement of deficiencies. This plan of correction is prepared and/or executed solely because it is required.

1.Facility failed to revise a care plan to reflect changes in a R84s weight loss. Care plan updated for this resident.

2.Audit of current residents with weight loss completed to ensure that residents have care plans in place and are updated.

3.DON/ Designee will complete training for licensed staff on the components of this regulation to include the need to update care plans.

4.DON/Designee will complete audits of 5 residents with weight loss weekly 2 x a week x4 weeks, then 1 x a week x 4 weeks then, 2x a month then 1x a month x 2 months. The findings of these quality monitoring's to be reported to the Quality Assurance/ Performance Improvement Committee until monthly and/or until substantial compliance is met. Quality Monitoring schedule modified based on findings in QAPI.

5.Date of compliance will be 2/28/25.

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