Nursing Investigation Results -

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:

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MILFORD HEALTHCARE 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 February 19, 2020, it was determined that Milford Healthcare and Rehabilitation 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.



 Plan of Correction:


483.24(a)(2) REQUIREMENT ADL Care Provided for Dependent Residents: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.
483.24(a)(2) A resident who is unable to carry out activities of daily living receives the necessary services to maintain good nutrition, grooming, and personal and oral hygiene;
Observations:

Based on a review of clinical records and staff interview it was determined that the facility failed to provide services necessary to maintain adequate personal hygiene and grooming of residents dependent on staff for assistance with these activities of daily living for seven out of 10 residents reviewed (Residents 19, 22, 40, 45, 48, 58 and 69)

Findings include:

A review of Resident 19's quarterly MDS Assessment (Minimum Data Set-a federally mandated standardized assessment process completed periodically to plan resident care) dated January 31, 2020, revealed that the resident was dependent on staff for assistance for (ADLs) activities of daily living to include bathing.

A review of the unit shower schedule indicated that Resident 19 was to receive a shower two times each week, on Tuesdays and Fridays, during the 7 a.m. to 3 p.m. shift.

A review of Resident 19's shower record for the month of January 2020, conducted during the survey of February 19, 2020, revealed that the resident received a shower on only three days out of the nine scheduled days during the month of January 2020. There was no documented evidence that the resident had refused/declined to be showered as scheduled during the month of January 2020.

A review of Resident 22's quarterly MDS Assessment dated February 1, 2020, revealed that the resident was totally dependent on staff for activities of daily living.

A review of the unit shower schedule indicated that the resident was to receive a shower two times each week on Thursdays and Sundays during the 11 p.m. to 7 a.m. shift.

A review of Resident 22's shower record for the month of January 2020, conducted on February 19, 2020, revealed that the resident was not showered during the month of January 2020. Further review of the shower record revealed that the resident was provided bed baths on 7 of the 10 scheduled days she was to receive a shower. There was no documented evidence that the resident had refused to be showered during the month of January 2020.

A review of Resident 40's annual MDS Assessment dated February 21, 2020, revealed that the resident required assistance of staff for activities of daily living and was totally dependent on staff for bathing.

A review of the unit shower schedule indicated that the resident was to receive a shower two times each week on Mondays and Fridays on the 3 p.m. to 11 p.m. shift.

A review of Resident 40's shower record for the month of January 2020, conducted on February 19, 2020, revealed that the resident was not showered on January 10, 2020, or January 31, 2020 as scheduled.

A review of Resident 45's quarterly MDS assessment dated January 23, 2020, revealed that the resident required extensive assistance of staff members for ADLs and was totally dependent on staff for bathing.

A review of the unit shower schedule indicated that the resident was to receive a shower two times each week on Sundays and Wednesdays on the 11 p.m. to 7 a.m. shift.

A review of Resident 45's shower record for the month of January 2020, conducted on February 19, 2020, revealed that the resident received only one shower out of nine scheduled during the month of January 2020.

A review of documentation in Resident 45's clinical record dated Monday January 6, 2020, at 2:18 p.m. revealed that the resident's family had "expressed concern and asked if their mom can get a shower, staff attempted, and she refused a shower." Further review of the resident's shower record for January 2020 revealed no evidence that the resident refused to be showered on the scheduled days.

A review of Resident 48's quarterly MDS assessment dated February 1, 2020, revealed that the resident required staff assistance with ADLs and was totally dependent on staff for bathing.

A review of the unit shower schedule revealed that Resident 48 was to receive a shower two times each week on Mondays and Fridays on the 11 a.m. to 7 a.m. shift.

A review of Resident 48's shower record for the month of January 2020, conducted on February 19, 2020, revealed that the resident was showered only twice out of the nine scheduled.

A review of Resident 58's quarterly MDS assessment dated November 29, 2019, revealed that the resident was totally dependent on staff for activities of daily living.

A review of the resident's individual care card/ Kardex indicated that the resident was to receive a shower three times each week. Further review of the Kardex revealed that the facility was to provide showers on Mondays and Fridays on the 7 a.m. to 3 p.m. shift and hospice staff was to shower the resident on Wednesdays during the 7 a.m. to 3 p.m. shift during their visit.

A review of Resident 58's shower record for the month of January 2020, conducted on February 19, 2020, revealed that the resident received a shower on 8 out of 14 days scheduled.

Further review of the shower record revealed that the facility staff documented that the resident received a shower or a bed bath on each Wednesday January 1, 8, 15, 22 and 29, 2020, that hospice staff was scheduled to provide the resident's personal care. However, there was no documentation available at the time of the survey ending February 19, 2020, from hospice provider in the resident's clinical record to verify that hospice staff had been in the facility and showered the resident or provided a bed bath on those noted dates.

Interview with the Director of Nursing on February 19, 2020, at approximately 1:30 p.m. confirmed that there was no hospice documentation available in Resident 58's clinical record to confirm the resident had been showered or received a bed bath as scheduled on Wednesdays during the 7 AM to 3 PM shift during the month of January 20202. The Director of Nursing stated that the hospice documentation was "available upon request" and was not maintained in the resident's clinical record. The DON verified that the facility's staff was documenting services they had not provided to the resident, but were scheduled to be provided by Hospice staff.

A review of Resident 69's annual MDS assessment dated January 29, 2020, revealed that the resident required staff assistance with ADLs and was totally dependent on staff for bathing.

A review of the unit shower schedule revealed that Resident 69 was to receive a shower two times each week on Sundays and Wednesdays on the 3 p.m. to 11 p.m. shift.

A review of Resident 69's shower record for the month of January 2020, revealed that the resident received only one shower out of 9 showers scheduled.

Interview with Employee 1, a nurse aide, on February 19, 2020, at approximately 9 a.m. revealed that it is the responsibility of each nurse aide to check the shower schedule daily to see which resident on their assignment is scheduled to have a shower.

During an interview with the Director of Nursing (DON) on February 19, 2020, at approximately 2:00 p.m. confirmed that the nursing staff was not showering the residents at the frequency scheduled, at least twice weekly.



28 Pa Code 211.12 (a)(c)(d)(1)(3)(4)(5) Nursing services




 Plan of Correction - To be completed: 03/17/2020

1.Unable to retroactively correct documentation evidence in Point of Care for Resident 19,22,40,45,48,58,60 that staff provided a shower. Residents 19,22,40,45,48,58 & 60 will be provided shower or bed bath as per resident preference and document as indicated.

2.Director of Nursing/designee will review active residents to ensure shower plans are accurate and will complete initial audit to verify they are being completed as per scheduled.

3.Director of Nursing/designee will educate Nursing staff to ensure Certified Nursing Assistants are providing shower or bed bath as per schedule and accurately documenting in Point of Care.

4.Director of Nursing/designee will complete a random audit weekly times 4 weeks and monthly times 2 months to ensure residents are being showered or given bed bath as per scheduled and is documented. Results of Audits will be reviewed during monthly Quality Assurance Performance Improvement Meeting and changes will be made if necessary.

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