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

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Severity Designations


Minimal Citation - No Harm	Minimal Harm	Actual Harm	Serious Harm

PARKHOUSE REHABILITATION AND NURSING CENTER
Inspection Results For:

There are 135 surveys for this facility. Please select a date to view the survey results.

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PARKHOUSE REHABILITATION AND NURSING CENTER - 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 and two complaint investigations completed on June 7, 2024, it was determined that Parkhouse Rehabilitation and Nursing 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 for the Health portion of the survey process.

Plan of Correction:

483.21(b)(3)(i) REQUIREMENT Services Provided Meet Professional Standards:

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.

§483.21(b)(3) Comprehensive Care Plans
The services provided or arranged by the facility, as outlined by the comprehensive care plan, must-
(i) Meet professional standards of quality.

Observations:

Based on review of the Pennsylvania Professional Nursing Practice Act, facility policy and procedure, observations, and staff interviews it was determined the facility failed to ensure that staff met the professional standards for a licensed nurse during medication administration for one of three residents reviewed (Resident 201).

Findings include:

The Professional Code, Title 49, Professional and Vocational Standards (Pennsylvania Professional Nursing Practice Act), Chapter 21.145(a) states that the Licensed Practical Nurse (LPN) is prepared to function as a member of the health-care team by exercising sound nursing judgment based on preparation, knowledge, and experience in nursing competency. The LPN participates in the planning, implementing, and evaluating nursing care, using focused assessment in settings where nursing takes place.

Review of Chapter 21.145 (3) indicates, an LPN shall follow the written, established policies and procedures of the facility that are consistent with the Act.

Review of the facility's policy titled "Administering Medications", dated April 1, 2022, revealed "medication should all be administered in a safe and timely manner, and as prescribed. Residents may self-administer their own medications only if the physician, in conjunction with the Interdisciplinary Care Planning Team, has determined that they have the decision-making capacity to do so safely."

Review of Resident 201's Minimum Data Set (MDS- standardized assessment tool that measures health status in long-term care residents) dated March 17, 2024, revealed resident had severe cognitive impairment.

Observation conducted on June 5, 2024 at 9:15 a.m. of the medication administration with licensed nurse Employee E3 supervised by licensed nurse Employee E4. Employee E3 crushed medications Aspirin 81mg (medication used to treat pain, and inflammation) one tablet, Amlodipine 5 mg (medication used to treat high blood pressure), Olanzapine 7.5 mg (An anti-psychotic medication), and Oxycodone 5mg (medication used to treat severe pain) then poured it into an Ensure drink. Employee E3 stirred the drink with a straw gave the drink to Resident 201 then left the room. Employee E3 marked the medications as administered in the EMR (Electronic Medical Record) and then proceeded to the next resident for medication administration.

Observation conducted on on June 5, 2024, at 9:39 a.m., of Resident 201 sitting in bed, Ensure drink observed on the garbage can. While in the presence of licensed nurses Employee E3 and E4, Ensure drink was observed with 10 cc of liquid left in the container. Employee E4 confirmed that the ordered medications were not administered fully to the resident.

Interview conducted with Licensed Nurse Employee E3 on June 5, 2024, revealed Resident 201 had behaviors of not taking medications. Resident medications were crushed and placed on the Ensure drink, but the resident would not drink the Ensure in their presence, so staff left Ensure with medication for the resident to finish.

Review of Resident 201's clinical record failed to reveal if Resident 201 was previously assessed for safe self-medication administration.

The above information was conveyed to the Nursing Home Administrator and Director of Nursing on June 7, 2024, at 10:00 a.m.

The facility failed to ensure professional standards for medication administration were met.

28 Pa. 211.10(c) Resident care policies

28 Pa. Code 211.12(c)(d)(1)(5) Nursing services

Plan of Correction - To be completed: 06/18/2024

Both staff members E3 and E4 educated on medication administration. All parties notified in relation to resident 201 not fully taking all medications as prescribed. Add in the resident was assessed for self-administration and care plan was updated.
Current licensed nurses will be re-educated on the medication administration policy and self-administration regarding residents taking meds in liquids and ensuring medications are consumed as ordered.
Designee will conduct random medication administration audits with licensed nurses weekly x 4. Results will be reviewed during the facility's monthly QAPI meeting.

483.25(g)(4)(5) REQUIREMENT Tube Feeding Mgmt/Restore Eating Skills:

§483.25(g)(4)-(5) Enteral Nutrition
(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)(4) A resident who has been able to eat enough alone or with assistance is not fed by enteral methods unless the resident's clinical condition demonstrates that enteral feeding was clinically indicated and consented to by the resident; and

§483.25(g)(5) A resident who is fed by enteral means receives the appropriate treatment and services to restore, if possible, oral eating skills and to prevent complications of enteral feeding including but not limited to aspiration pneumonia, diarrhea, vomiting, dehydration, metabolic abnormalities, and nasal-pharyngeal ulcers.

Observations:

Based on review of the facility policies and procedures, observations, and staff interview, it was determined that the facility failed to ensure that a resident receives the appropriate treatment to prevent complications of enteral feeding for one of four residents reviewed (Resident 269).

Findings include:

Review of the facility policy "Enteral Nutrition via Pump, Procedure," (controlled method for providing nutritional needs via tube feeding), revealed the procedure was when using "canned formula the tubing that is connected to a [fed] bag is only good for 24 hours. The bag must be changed every 24 hours."

Review of Resident 269's clinical record revealed the following diagnoses: Hemiplegia and Hemiparesis following non-traumatic intracerebral hemorrhage affecting left non-dominant side (weakness or paralysis on one side of the body due to bleeding within the brain tissue), Diabetes Mellitus Type II with Nephropathy (condition where high blood sugar levels damage the blood vessels in the kidneys, leading to kidney failure1),and Gastroesophageal reflux disease (GERD) without esophagitis (occurs when the acidity of the reflux is weakened, suppressed by medications, or doesn't cause damage to the esophagus).

Review of Resident 269's clinical record revealed the following orders: every shift Nutren 1.0 [with] fiber via feeding pump [at] 80 milliliters/ hour x 22 hours (up at 1PM, down at 12PM) or until total volume infused. Use 7 cartons per day (250 mleach) for a total of 1750ML; Total calories=1750CALS

Observations conducted on June 6, 2024, at 9:22 a.m. revealed a date of June 4, 2024, with a time of "3-11 shift".

Interview conducted with the Nursing Home Administrator on June 6, 2024, at 1:15 P.M. confirmed Resident 269's feed bag should have been changed and that it was a deficient practice.

The facility failed to ensure that Resident 269 received tube feeding appropriately by replacing feed bag and tubbing every 24 hours.

28 Pa. Code 211.12(d)(5) Nursing Services.

Plan of Correction - To be completed: 06/18/2024

Change this to Resident 269's feeding bag was disposed and replaced.
Current residents with tube feed orders were audited to ensure all feeds and tubing were replaced per policy.
Current licensed nurses will be re-educated on the enteral feed policy.
Designee will conduct random audits x 1 week and weekly x 3 week to ensure every resident with tube feed orders have the proper date and tubing per policy.

483.45(f)(1) REQUIREMENT Free of Medication Error Rts 5 Prcnt or More:

§483.45(f) Medication Errors.
The facility must ensure that its-

§483.45(f)(1) Medication error rates are not 5 percent or greater;

Observations:

Based on observation, review of manufacturer's guidelines clinical record review, and staff interviews, it was determined that the facility failed to correctly administer medications to a resident and failed to ensure that residents were free from a medication error rate of five percent or greater for two of three residents reviewed (Resident 122 and 201) resulting in a medication error rate of 17.24% percent.

Findings include:

Review of the facility's policy titled "Administering Medications" dated April 1, 2022, revealed medication should all be administered in a safe and timely manner, and as prescribed.

Review of Morphine Sulfate ER manufacturer's guide revealed the following "Do not break, crush, or chew the medication", it can cause rapid release and absorption of a potentially fatal dose of Morphine.

Observation of the medication administration was conducted with licensed nurse Employee E3 supervised by licensed nurse Employee E4 on June 5, 2024, at 9:15 a.m. Employee E3 crushed medications Aspirin 81 mg (medication used to treat pain, and inflammation) one tablet, Amlodipine 5 mg (A medication used to treat high blood pressure), Olanzapine 7.5 mg (An anti-psychotic medication), and Oxycodone 5mg (A medication used to treat severe pain) then poured it into an Ensure drink. Employee E3 stirred the drink with a straw gave it to Resident 201 then left the room. Employee E3 marked the medications as administered in the EMR (Electronic Medical Record) and then proceeded to the next resident for medication administration.

Observation conducted during a medication administration for Resident 122 with licensed nurse Employee E3 on June 5, 2024, at 9:20 a.m. revealed licensed nurse, Employee E3 crushed medication Morphine ER (Extended Release) (medication to treat severe pain) 15 mg (milligrams) and then administered it to Resident 122.

Interview conducted with licensed nurse, Employee E3 on June 5, 2024, revealed Resident 122 does not take medications whole. Employee E3 confirmed that the physician should have been notified so medication/form could have been changed.

Observation conducted on June 5, 2024, at 9:39 a.m., revealed Resident 201's Ensure drink mixed with the above medications observed sitting on the garbage can. In the presence of licensed nurses Employee E3 and E4, Ensure drink was observed with 10 cc of liquid left in the container. Employee E4 confirmed that the medications ordered were not completely administered to the resident.

The above information was conveyed to the Nursing Home Administrator and Director of Nursing on June 5, 2024, at 10:00 a.m.

The facility failed to ensure Residents 122 and 201 were free from medication errors.

28 Pa. 211.10(c) Resident care policies

28 Pa. Code 211.12(c)(d)(1)(5) Nursing services

Plan of Correction - To be completed: 06/18/2024

Both staff members E3 and E4 were educated on medication administration policy. All parties notified in relation to medication incidents involving R201 and R122.
Current residents that require medication administration in liquids were reviewed to ensure self-administration and care plan was assessed and updated if needed.
All licensed nurses will be re-educated on the medication administration policy and ensuring medications given in liquid are consumed per order and something about medications that cannot be crushed.
Designee will conduct random medication administration audits with licensed nurses weekly x 4. Results will be reviewed during the facility's monthly QAPI meeting.

§ 211.12(f.1)(2) LICENSURE Nursing services. :

(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 review of nursing time schedules, it was determined that the facility administrative staff failed to provide a minimum of one nurse aide per 12 residents during the day and one nurse aide per 12 residents during the evening on two days of staffing reviewed (January 5, 2024, and March 10, 2024).

Findings include:

Review of the staffing for the weeks of December 31, 2023, March 10, 2024, and May 31, 2024, revealed the following dates and shifts did not meet the minimum requirements for nurse aide staffing ratios:

January 5, 2024, on the evening shift
March 10, 2024, on the day and evening shift

Interview with the Nursing Home Administrator on June 7, 2024, at approximately 11:30 a.m. confirmed the above findings.

Plan of Correction - To be completed: 06/18/2024

Daily staffing records reviewed from 6/1/24 to audit compliance with State minimum requirement on staffing levels
Administration and Nursing Management including staffing coordinators will be re-educated regulation for maintaining the staffing ratios and ppd per regulation.
NHA/Designee will complete daily audit to ensure staffing ratios and ppd are met

§ 211.12(i)(1) LICENSURE Nursing services.:

(1) Effective July 1, 2023, the total number of hours of general nursing care provided in each 24-hour period shall, when totaled for the entire facility, be a minimum of 2.87 hours of direct resident care for each resident.

Observations:

Based on review of facility staffing, it was determined that the facility failed to ensure the total number of general nursing care hours provided in each 24-hour period was a minimum of 2.87 hours per patient day (PPD) for three days of staffing reviewed (January 5, 2024, March 10, 2024, and March 16, 2024).

Findings include:

Review of facility staffing revealed the following dates were below 2.87 hours PPD:

January 5, 2024, with a PPD of 2.70
March 10, 2024, with a PPD of 2.63
March 16, 2024, with a PPD of 2.82

The facility staffing PPD being below the state minimum requirements was confirmed by the Nursing Home Administrator on June 7, 2024, at approximately 11:30 a.m.

Plan of Correction - To be completed: 06/18/2024

Daily staffing records reviewed from 6/1/24 to audit compliance with State minimum requirement on staffing levels
Administration and Nursing Management including staffing coordinators will be re-educated regulation for maintaining the staffing ratios and ppd per regulation. Staffing Coordinators to schedule facility staff as well as contracted agency staff to fill shifts.
NHA/Designee will complete daily audit to ensure staffing ratios and ppd are met

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