Pennsylvania Department of Health
MILFORD HEALTHCARE AND REHABILITATION CENTER
Patient Care Inspection Results

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MILFORD HEALTHCARE AND REHABILITATION CENTER
Inspection Results For:

There are  122 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.
MILFORD HEALTHCARE AND REHABILITATION CENTER - Inspection Results Scope of Citation
Number of Residents Affected
By Deficient Practice
Initial comments:

Based on a revisit and abbreviated complaint survey completed on March 26, 2024, it was determined that Milford Healthcare and Rehabilitation Center failed to correct federal deficiencies cited during the survey of March 3, 2024, and continued to be out of compliance with the following requirements of 42 CFR Part 483, Subpart B Requirements for Long term Care Facilities and the 28 PA Code, Commonwealth of Pennsylvania Long Term Care Licensure Regulations.




 Plan of Correction:


483.60(i)(1)(2) REQUIREMENT Food Procurement,Store/Prepare/Serve-Sanitary:This is a less serious (but not lowest level) deficiency but was found to be widespread throughout the facility and/or has the potential to affect a large portion or all the residents.  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.
483.60(i) Food safety requirements.
The facility must -

483.60(i)(1) - Procure food from sources approved or considered satisfactory by federal, state or local authorities.
(i) This may include food items obtained directly from local producers, subject to applicable State and local laws or regulations.
(ii) This provision does not prohibit or prevent facilities from using produce grown in facility gardens, subject to compliance with applicable safe growing and food-handling practices.
(iii) This provision does not preclude residents from consuming foods not procured by the facility.

483.60(i)(2) - Store, prepare, distribute and serve food in accordance with professional standards for food service safety.
Observations:

Based on facility policy review, observations, and staff interviews, it was determined the facility failed to store food items under sanitary conditions in the facility's kitchen and two of two resident pantry areas (first and second floors).

Findings include:

Review of facility policy, titled Food Receiving and Storage, policy and procedure review date of January 29, 2024, included the following but not limited to:

Food items and snacks kept on the nursing units must be maintained as indicated below:
a.All food items to be kept below 41 degrees F must be placed in the refrigerator located at the nurses' station and labeled with a "use by" date.
b.All foods belonging to residents must be labeled with the resident's name, the item and the ''use by'" date.
c.Refrigerators must have working thermometers and be monitored for temperature according to state-specific guidelines.
d.Beverages must be dated when opened and discarded after twenty-four (24) hours.
e.Other opened containers must be dated and sealed or covered during storage.
f.Partially eaten food may not be kept in the refrigerator.

Observations of the facility's kitchen on March 26, 2024, at approximately 8:40 AM revealed a prep cooler with the following items that were not labeled and dated as to when they were opened/received/prepared:

10 containers of mandarin oranges
2 cupcakes
1 bottle of lemon juice
2 ham and cheese sandwiches
1 turkey and cheese sandwich
1 container of turkey base
1 container of liquid egg whites
1 package of sandwich thins
1 bottle of a protein shake
1 container of chopped garlic.

An interview with Employee 4 cook/dietary aide on March 26, 2024, at 8:55 AM confirmed the aboved mentioned food was not labeled or dated in the prep cooler and stated that everything should be labeled or dated when first opened, put into use or received.

Observation of the first floor nurses' station medication room/pantry on March 26, 2024, at 9:00 AM revealed a refrigerator which contained a bag of salad in a shopping bag, with no name or date, that contained a shopping receipt with purchase date of March 16, 2024. The pre-cut salad was wet with slimy wilting lettuce leaves.

A Ready Shake was located on the door shelf of this refrigerator with no thaw date noted. Interview with Employee 3, the Dietary Manager, at that time indicated that Ready shakes should not be stored in the refrigerator and a thaw date should be noted on the carton as the product should be used within 14 days of thawing or within manufacturer guidelines for use.

A package of sliced cheese, wrapped in wax paper, was located in the crisper drawer of the refrigerator with a resident name, Resident A1, noted on the bag but there was no date as to when the cheese was placed in the refrigerator. The wax paper did not cover the entire amount of the cheese slices and the ends of the cheese were visibly dried and hardened to the touch.

A half consumed opened 14 oz container of chocolate ice cream was observed in the freezer. Resident A2's name was on the container, but there was no date to indicate when the ice cream was placed in the freezer. The ice cream was crystallized, hardened and appeared discolored.

A box of Hot Pockets (microwavable turnover containing meat and cheese) was located on the refrigerator door with Resident A2's name. The box contained one hot pocket and the box indicated "keep frozen." This product was not dated and not kept frozen as per manufacturer directions.

Interview with Employee 3, the Dietary Manager, on March 26, 2024, confirmed that food items are to be labeled and dated with resident names and any opened items should be dated when opened or in use.

Following surveyor observations on the first floor pantry, upon entry to the second floor nurses' station medication room/pantry on March 26, 2024, at 9:30 AM dietary staff were present and attempting to date opened items in the refrigerator with a red marking pen.

The refrigerator contained two bottle of 32 ounce Boathouse Farms berry juice both opened and in use, and at that time containing only half the juice in the bottle, dated March 26, 2024, indicated date of opening for use, in red marker. Employee 3 stated this type of juice is not provided by the facility.

A bottle of nectar thick apple juice with approximately three quarters of the juice remaining, had a date of March 26, 2024 in red marking pen, indicating opened for use date on this same date. The manufacturer directions on the thickened juice indicated the juice is to be discarded if not used within ten days of opening. There was no way to determine the actual date of opening since dietary staff dated all the undated items in the pantry as initially opened on March 26, 2024.

The shelf on the door of the refrigerator revealed an opened jar of jam containing with half of the jam. The jar was not labeled with a name or date when opened.

A container of fresh blueberries with Resident A3's name was located on the shelf with no date to indicate when the container was placed on the shelf.

Interview with Employee 3, Dietary Manager, on March 26, 2024, at 11:45 AM, revealed that food and beverage items should be labeled and dated per policy, and discarded once expired, or beyond their use by date, and it was the facility's expectation that expired items are discarded.


28 Pa. Code 211.6(f) Dietary services





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

Step#1=Facility corrected deficient issues during survey when identified.

Step#2=Facility completed a full house audit of the kitchen refrigerators/freezer and the pantry refrigerators on the nursing floors to ensure items were labeled with open dates and or use by dates. items expired were Discarded.

Step#3=NHA/Designee will educate Kitchen manager and Kitchen manager will educate kitchen staff ensuring items in kitchen refrigerators/freezers along in pantries are labeled with dates and if opened have a use by date labeled ,ensuring refrigerators have a thermometer for monitoring refrigerator temperatures and ensuring temperatures are within acceptable ranges, ensuring beverages are dated when opened and discarded by the use by date, items opened are dated and sealed and or covered during storage, ensuring partially eaten food are not kept in the refrigerator. Labels will be available by med room/pantry refrigerators to ensure when food is received for personal resident use it is promptly labeled by staff.

step#4= NHA/Designee will audit kitchen refrigerators and freezers as well as pantries and food storage areas to ensure items are labeled with an open date along with use by date if needed, thermometers are in place and are within range, expired items are Dis guarded, and will audit to ensure items are fully covered if open and stored correctly. Audits will be completed weekly x 4 weeks and than monthly x 2 months. Results will be reviewed in QAPI.
483.25(g)(1)-(3) REQUIREMENT Nutrition/Hydration Status Maintenance: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(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 observation, review of clinical records, and resident and staff interviews it was determined the facility failed to provide physician ordered nutritional supplementation as prescribed to promote adequate nutritional status and paramaters of three out of 11 sampled residents sampled (Residents A4, A5, and A6 ).

Findings include:

A review of Resident A4 clinical record revealed a physician's order dated February 13, 2024 for Ensure, a nutritional supplement, scheduled for administration to the resident at 2:00 PM daily. It was noted that the supplement will be labeled in the medication room and Boost, another nutritional supplement product, was allowed as a substitution.

During an observation of the first floor medication room on March 26, 2024, at 9:15 AM revealed three nutritional supplements, two Boost supplements and one Ensure supplement labeled with Resident A4's name and dated for administration to the resident on March 15, March 16, and March 17, 2024. However, a review of Resident A4's MAR (medication administration record) revealed that staff documented that the resident had received the supplements on March 15, 2024 and March 16, 2024, and refused the supplement on March 17, 2024.

A review of Resident A5 clinical record revealed a physician's order dated March 4, 2024 for Glucerna, scheduled for administration at 2:00 PM, as a nutritional supplement for weight loss. It was noted that the supplement will be labeled in the medication room and Boost Glucose Control can be allowed as a substitution.

An observation first floor medication room on March 26, 2024, at 9:15 AM revealed three Glucerna nutritional shakes with Resident A5's name and dated for scheduled administration to the resident on March 17, March 21, and March 22, 2024. A review of Resident A5's MAR revealed staff documented that the resident received the supplement on each of these dates, March 17, 21, and March 22, 2024.

An interview conducted with Resident A5 at 11:00 AM on March 26, 2024, revealed that the resident stated that the facility does not consistently provide the supplement daily, stating that sometimes staff will give it to her and on other days, they will not.

A review of Resident A6 clinical record revealed a physician's order dated February 15, 2024 for Ensure at 2:00 PM with a straw as nutritional supplement.

An observation of the second floor medication room on March 26, 2024, at 10:00 AM revealed a Boost nutritional supplement with Resident A6's name with a date of March 21. A review of Resident A6's March 2024 MAR revealed that staff documented that the resident was provided the supplement on March 21, 2024, as ordered.

Interview with Employee 3, the Dietary Manager, on March 26, 2024, revealed that the dietitian writes the residents name on the prescribed nutritional supplement with the date they are to be provided to the resident. She stated that the date on the supplement is the date they should be consumed by the resident. When asked why these supplements remained in the medication rooms, she stated that there were not provided to the residents as ordered on those dates.

Interview with the director of nursing (DON) on March 26, 2024 at 3:45 PM confirmed the physician orders for provision of the nutritional supplements were not consistently followed. The DON confirmed that staff had documented that the residents were provided, or had refused the nutritional supplements, which were observed to remain in the medication rooms.


28 Pa. Code 211.12 (d)(3)(5) Nursing services

28 Pa. Code 211.5 (f) Medical records




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

Step#1=Facility can not retroactively correct.

Step#2=Dietician and Kitchen Manager will change the process of providing supplements. Kitchen manager will place supplement on snack trays to ensure resident receives supplements per order. Orders will be audited by nursing and updated to ensure nursing document percentage consumed on MAR.

Step#3-NHA/Designee will educate Kitchen Staff ensuring they push out supplements on snack trays to ensure supplements are pushed out per physician order. DON/Designee will educate Nurses ensuring percentage consumed will be documented as part of supplement order.

Step#4-NHA/Designee will audit residents who are on supplements to ensure residents are getting supplements per physician's order. Audits will be completed weekly x 4 weeks and then monthly x 2 months. Results will be reviewed in QAPI.
483.45(g)(h)(1)(2) REQUIREMENT Label/Store Drugs and Biologicals: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.
483.45(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 observation and staff interview, it was determined that the facility failed to ensure adherence to use by/expiration dates of pharmaceutical products in the facility's central supply room.

Findings include:


Observations of the facility's central supply room on March 26, 2024, at approximately 10:00 AM revealed 35 bottles of Hydrogen Peroxide that expired December 2023.

There were 10 IV starter kits that expired December 31, 2022.

An interview with DON (director of nursing) on March 26, 2024, at the time of the observation confirmed the pharmacy supplies expired and should have been discarded.

During an interview with the Nursing Home Administrator on March 26, 2024 at approximately 3:30 PM confirmed expired pharmacy products should have been removed from the storage room and discarded.



28 Pa. Code 211.12 (d)(3)(5) Nursing services




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

Step#1-Facility immediately fixed the deficient practice when identified during survey.

Step #2-Facility did a full house audit on central supply room ensuring area did not have expired items and expired items found were discarded.

Step#3-DON/Designee will educate central supply employee to ensure supplies are rotated with expiration dates & check to ensure there are no expired medication/biologicals on a weekly basis.

Step#4=The DON/Designee will audit central supply area to ensure there are no expired medication/biologicals and if there are ensuring items are discarded. Audits will be conducted weekly for 4 weeks and then monthly x 2 months. Results will be reviewed in QAPI.
483.25(i) REQUIREMENT Respiratory/Tracheostomy Care and Suctioning: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(i) Respiratory care, including tracheostomy care and tracheal suctioning.
The facility must ensure that a resident who needs respiratory care, including tracheostomy care and tracheal suctioning, is provided such care, consistent with professional standards of practice, the comprehensive person-centered care plan, the residents' goals and preferences, and 483.65 of this subpart.
Observations:

Based on observation, review of select facility policy and staff interview it was determined the facility failed to store and maintain oxygen equipment in a safe, functional and sanitary manner on the second floor nursing unit and in the general storge area.

Findings include:


A review of the undated facility policy, provided during the survey ending March 26, 2024, entitled Oxygen Storage Policy revealed oxygen tanks are to be stored in an area that is well ventilated, dry and away from sources of heat, open flames or flammable materials. Empty tanks can be stored in a secured medication room and or treatment room until maintenance and or designee is notified to collect and take the designated to the storage location.

An observation on March 26, 2024, at 9:30 AM revealed four oxygen cylinders located in the medication/panty area on the second floor. Two of the cylinders had white plastic caps on the valve posts of the metal oxygen cylinder to indicate the cylinder was not used or full. The other two cylinders had regulators (device attached to oxygen tank post used to deliver the oxygen) attached, which indicated they were used or empty.

Interview with Employee 1, an LPN, on March 26, 2024, at the time of the observation, regarding the storage location of full clean and used empty tanks, revealed that the nurse stated that she was "only per diem" and did not know that answer. When asked where the policy regarding oxygen storage could be located, she stated she was not sure.

Interview with Employee 2, RN. at 9:37 AM on March 26, 2024, Employee 2 stated that used oxygen tanks are to be taken outside to the cage where the clean and dirty oxygen cylinders are stored. When asked why used (dirty) and unused (clean) oxygen tanks were stored together in the medication/pantry she stated the used tanks should have been taken off the unit but a few new tanks are stored in a carrier in the medication/pantry for use if needed.

A review of the oxygen storage area on March 26, 2024, at 1:00PM, revealed that the storage area was located outside of the building in a caged in area against the building, that was accessed by exiting through the doorway at the end of the facility hallway near the boiler room and the laundry area. The area was located against the wall to the boiler room. Multiple staff were observed outside this door smoking, while on break. The smoking area was also located near the caged area.

Multiple oxygen tanks, more than 40 tanks, were stored in this caged in area with signs on the left reading "full" and the right side "empty." However, both empty and full tanks were observed mixed together, revealing some used dirty tanks mixed in with the clean tanks that were sealed.

The facility failed to maintain oxygen cylinders in a safe and sanitary manner as evidenced by the storage of unused clean full tanks with the used/dirty empty tanks and ensuring the storage area was away from heat sources such as staff smoking area.


28 Pa Code 211.12 (d)(3)(5) Nursing services

28 Pa. Code 201.18 (e)(2.1) Management







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

Step#1-Facility immediate fixed the deficient practice when identified during survey

Step #2-Facility did a full house audit as well as bought new oxygen organizers to ensure oxygen tanks are stored in an organized way where empty would be with empty and full would be with full with signs labeling location.

Step#3-DON/Designee will educate nursing staff along with central supply employee to ensure oxygen tanks are stored in a safe and proper area (in oxygen storage by employee entrance or in med room oxygen storage bin) ensuring empty is stored with empty and full is stored with full. NHA/Designee will educate regarding employee smoking area away from oxygen storage by the picnic benches.

Step#4=The DON/Designee will audit oxygen storage area to ensure oxygen is stored in a safe/organized/sanitary manor and that no smoking is occurring in this location through an audit that will be conducted 3 times a week for 4 weeks and then monthly x 2 months. Results will be reviewed in QAPI.
483.15(c)(3)-(6)(8) REQUIREMENT Notice Requirements Before Transfer/Discharge:Least serious deficiency but affects more than a limited number of residents, staff, or occurrences. This deficiency has the potential for causing no more than a minor negative impact on the resident but is not found to be throughout this facility.
483.15(c)(3) Notice before transfer.
Before a facility transfers or discharges a resident, the facility must-
(i) Notify the resident and the resident's representative(s) of the transfer or discharge and the reasons for the move in writing and in a language and manner they understand. The facility must send a copy of the notice to a representative of the Office of the State Long-Term Care Ombudsman.
(ii) Record the reasons for the transfer or discharge in the resident's medical record in accordance with paragraph (c)(2) of this section; and
(iii) Include in the notice the items described in paragraph (c)(5) of this section.

483.15(c)(4) Timing of the notice.
(i) Except as specified in paragraphs (c)(4)(ii) and (c)(8) of this section, the notice of transfer or discharge required under this section must be made by the facility at least 30 days before the resident is transferred or discharged.
(ii) Notice must be made as soon as practicable before transfer or discharge when-
(A) The safety of individuals in the facility would be endangered under paragraph (c)(1)(i)(C) of this section;
(B) The health of individuals in the facility would be endangered, under paragraph (c)(1)(i)(D) of this section;
(C) The resident's health improves sufficiently to allow a more immediate transfer or discharge, under paragraph (c)(1)(i)(B) of this section;
(D) An immediate transfer or discharge is required by the resident's urgent medical needs, under paragraph (c)(1)(i)(A) of this section; or
(E) A resident has not resided in the facility for 30 days.

483.15(c)(5) Contents of the notice. The written notice specified in paragraph (c)(3) of this section must include the following:
(i) The reason for transfer or discharge;
(ii) The effective date of transfer or discharge;
(iii) The location to which the resident is transferred or discharged;
(iv) A statement of the resident's appeal rights, including the name, address (mailing and email), and telephone number of the entity which receives such requests; and information on how to obtain an appeal form and assistance in completing the form and submitting the appeal hearing request;
(v) The name, address (mailing and email) and telephone number of the Office of the State Long-Term Care Ombudsman;
(vi) For nursing facility residents with intellectual and developmental disabilities or related disabilities, the mailing and email address and telephone number of the agency responsible for the protection and advocacy of individuals with developmental disabilities established under Part C of the Developmental Disabilities Assistance and Bill of Rights Act of 2000 (Pub. L. 106-402, codified at 42 U.S.C. 15001 et seq.); and
(vii) For nursing facility residents with a mental disorder or related disabilities, the mailing and email address and telephone number of the agency responsible for the protection and advocacy of individuals with a mental disorder established under the Protection and Advocacy for Mentally Ill Individuals Act.

483.15(c)(6) Changes to the notice.
If the information in the notice changes prior to effecting the transfer or discharge, the facility must update the recipients of the notice as soon as practicable once the updated information becomes available.

483.15(c)(8) Notice in advance of facility closure
In the case of facility closure, the individual who is the administrator of the facility must provide written notification prior to the impending closure to the State Survey Agency, the Office of the State Long-Term Care Ombudsman, residents of the facility, and the resident representatives, as well as the plan for the transfer and adequate relocation of the residents, as required at 483.70(l).
Observations:

Based on review of clinical records and transfer notices and staff interview it was determined that the facility failed to provide written notices of facility initiated transfers to the resident and the residents' representative that were written in a language that was easily understood for three out of 11 residents reviewed (Residents CR1, A7, and A8).

Findings include:

A review of the clinical record of Resident CR1 revealed the resident was transferred to the hospital on March 22, 2024, and did not return to the facility.

A review of the resident's "Notice of Transfer or Discharge" letter revealed the resident was transferred to the hospital due to respiratory distress.

A review of the clinical record of Resident A7 revealed the resident was transferred to the hospital on March 25, 2024, and returned to the facility on March 25, 2024.

A review of the resident's "Notice of Transfer or Discharge" letter revealed the resident was transferred to the hospital due to tachycardia and hypotension.

A review of the clinical record of Resident A8 revealed the resident was transferred to the hospital on March 26, 2024, and remained in the hospital.

A review of the resident's "Notice of Transfer or Discharge" letter revealed the resident was transferred to the hospital due to respiratory distress.

The facility failed to provide notices of facility initiated transfers to the hospital that identified the reason for the residents' transfers in a language that was easily understood.

During an interview with the Nursing Home Administrator and Director of Nursing on March 26, 2024, at approximately 3:30 PM, confirmed that the reasons for the residents' transfers were written in medical or diagnosis terms, which may not be easily understood by the residents and their representatives.


28 Pa. Code 201.14(a) Responsibility of Licensee


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

Step#1=Facility can not retroactively correct

step#2=Facility can not retroactively correct

Step#3=NHA/Designee will educate BOM to ensure the reason for the residents transfer noted on the transfer form is in language that is easily understood

Step#4=NHA/Designee will audit Transfer/Discharge forms to ensure the reason for the residents' transfer is in language that is easily understood. Audits will be completed weekly x4 weeks than monthly x 2 months. Results will be reviewed in QAPI.
201.14(a) LICENSURE Responsibility of licensee.:State only Deficiency.
(a) The licensee is responsible for meeting the minimum standards for the operation of a facility as set forth by the Department and by other Federal, State and local agencies responsible for the health and welfare of residents. This includes complying with all applicable Federal and State laws, and rules, regulations and orders issued by the Department and other Federal, State or local agencies.

Observations:

Based on a review of the facility's bed assessment fees it was determined the facility failed to timely submit quarterly assessment fees owed since quarter ending March 31, 2022.

Findings include:

According to the Centers for Medicare and Medicaid Services (CMS) approved the Commonwealth of Pennsylvania's request to implement a Pennsylvania Nursing Facility Assessment Program, which was authorized by the General Assembly in September 2003. The General Assembly authorized the Department of Human Services (DHS) to collect this assessment from all nongovernmental licensed nursing facilities. The revenue from this assessment will be used to maintain Medical Assistance (MA) rates and provide additional reimbursement to MA-participating nursing facilities.

As part of the assessment program, each non-exempt nursing facility must submit a report of specific resident days for each reporting quarter. The reported days will include the following: Pennsylvania MA facility and therapeutic leave days, Pennsylvania MA hospital reserve days, Pennsylvania MA managed care days, Pennsylvania MA hospice days, Long-Term Care Capitated Assistance Program (LTCCAP) days, Pennsylvania MA pending days, other states' MA days, private paydays, and Medicare days.

Nursing facilities should be prepared to provide information regarding the licensed bed size at the end of each quarter and whether the facility participated as a Continuing Care Retirement Community on the last day of the reporting quarter. Nursing facilities submit this information for each quarter using the Pennsylvania Nursing Facility Submission System.

According to a review of the facility resident day assessment the facility's last payment of was submitted on March 7, 2024, for $128,990.61, which was $507,62.52 less than the total amount due for the assessment quarter ending March 31, 2022.

The facility has failed to submit payment for the last eight quarters ending June 30, 2022, until March 31, 2024.

The following amounts are owed for each assessment quarter;

Assessment quarter ending 6/30/2022 $179,753.13
Assessment quarter ending 9/30/2022 $136,229.28
Assessment quarter ending 12/31/2022 $136,229.28
Assessment quarter ending 3/31/2023 $104,105.56
Assessment quarter ending 6/30/2023 $113,794.46
Assessment quarter ending 9/30/2023 $151,146.84
Assessment quarter ending 12/31/2023 $155,256.27
Assessment quarter ending 3/31/2024 $156,058.11

The outstanding facility bed assessment fees owed by the facility were confirmed by interview with the corporate consultant on March 26, 2024 at 4:00 PM.



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

Step#1=Facility can not retroactively correct-Facility reached out to the state and applied for a hardship application and will pay what they can when funds are available.

Step#2=facility can not retroactively correct-Facility reached out to the state and applied for a hardship application and will pay what they can when funds are available.

Step#3=Designee will educate operator on the importance of paying Bills within a timely manner if funds are available

Step#4=Designee will review financials to see if funds are available to make a payment towards facilities bed tax amount owed. Facility reached out to the state and applied for a hardship application and will pay what they can when funds are available. Audits will be conducted monthly -results will be reviewed in QAPI.
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's outstanding accounts payable and interviews with staff, it was determined 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:

Interview with the Nursing Home Administrator (NHA) on March 26, 2024 at 10:00 AM revealed that the facility's bills were conveyed to the facility's corporation for payment. The outstanding bills were not paid at the facility level.

A review of the facility aging report (financial report which shows unpaid invoices by date ranges) conducted at the time of the survey ending March 26, 2024, revealed outstanding accounts payable balances, which required payment of goods and services within 91-120 days.

Vendor #1 (transportation) $23,890.10 (facility has agreement to pay $1500/week) in order to ensure resident transports are not interrupted,

Vendor #2 (plumbing and heating) $8236.54,

Vendor #3 (electric) $1,874.94

Vendor #4 (fire safety) $1,140.00

Vendor #5 (chemistry labs) $1.814.19

Vendor #6 (roofing) $9,900.00

Vendor #7 (water treatment services) $21,388.55

The aging report indicated the facility owed balances of $450,511.00 ranging from 30 days to 91 plus days.






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

Step#1=Facility can not retroactively correct-The resident's health and safety were/are not jeopardized due to deficient practice.
Vendor#1-Facility is currently in payment agreement with vendor. Facility will continue this payment arrangement until outstanding amount is paid current
Vendor#2-Facility is currently in payment agreement with vendor. Facility will continue this payment arrangement until outstanding amount is paid current.
Vendor#3-Payment for this vendor per arrangement is that this vendor would be paid for the full outstanding amount with a check and check mailed on 4/8/2024 per arrangement.
Vendor#4-this vendor balance is currently in dispute. This vendor is an outside vendor who was doing the facilities fire drills only. Facility is currently doing their own fire drills and current dispute is in process.
Vendor#5-this vendor balance is currently in dispute. This vendor is an outside vendor who suppled facility with chemical cleaning agents on only 3 occasions. Facility is currently using their regular vendors for all cleaning supplies.
vendor#6-This vendor is a roofing company and the balance is currently in dispute
Vendor #7-this vendor balance is partially in dispute. Vendor and facility are working towards an agreement for the disputed balance. Vendor is still working with and servicing the facility. Services are not in jeopardy.



Step#2=Facility can not retroactively correct-The resident's health and safety were/are not jeopardized due to deficient practice.
Vendor#1-Facility is currently in payment agreement with vendor. Facility will continue this payment arrangement until outstanding amount is paid current
Vendor#2-Facility is currently in payment agreement with vendor. Facility will continue this payment arrangement until outstanding amount is paid current.
Vendor#3-Payment for this vendor per arrangement is that this vendor would be paid for the full outstanding amount with a check and check mailed on 4/8/2024 per arrangement.
Vendor#4-this vendor balance is currently in dispute. This vendor is an outside vendor who was doing the facilities fire drills only. Facility is currently doing their own fire drills and current dispute is in process.
Vendor#5-this vendor balance is currently in dispute. This vendor is an outside vendor who suppled facility with chemical cleaning agents on only 3 occasions. Facility is currently using their regular vendors for all cleaning supplies.
vendor#6-This vendor is a roofing company and the balance is currently in dispute
Vendor #7-this vendor balance is partially in dispute. Vendor and facility are working towards an agreement for the disputed balance. Vendor is still working with and servicing the facility. Services are not in jeopardy.

Step#3=Designee will educate operator on the importance of paying Bills within a timely manner if funds are available and per payment arrangements. Recent Accounts Payable Company change has corrected issues from recurring as outstanding payments are from prior to AP company change.

Step#4=Designee will review monthly payment arrangements for identified vendors to ensure payments are made to the vendors per arrangement plan. Audits will be conducted monthly -results will be reviewed in QAPI.



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