Pennsylvania Department of Health
WECARE AT MURRYSVILLE REHABILITATION AND NURSING CENTER
Patient Care Inspection Results

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Severity Designations


Minimal Citation - No Harm	Minimal Harm	Actual Harm	Serious Harm

WECARE AT MURRYSVILLE REHABILITATION AND NURSING CENTER
Inspection Results For:

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WECARE AT MURRYSVILLE REHABILITATION AND NURSING CENTER - Inspection Results	Scope of Citation Number of Residents Affected By Deficient Practice

Initial comments:

Based on an abbreviated survey in response to an annoymous complaint completed on August 20, 2024, it was determined that Murrysville Rehabilitation and Wellness Center was not in 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 observations and staff interview, it was determined that the facility failed to properly store food and maintain sanitary conditions in the Main Kitchen and the facility failed to properly label and date food products in East nursing unit failed to maintain sanitary conditions which created the potential for cross contamination (1 of 2 units).

Findings include:

During an observation of the main designated kitchen on 8/20/24, at 9:10 a.m. the following was observed:
- Dry Storage: 5 boxes of food products stored on the floor, 6 buckets of dishmachine sanitizer
-Walk in freezer- 25 boxes of food stored on the floor

During an observation of the main designated kitchen on 8/20/24, at 9:20 a.m. the following was observed:

-Juice dispenser nozzles, fuzzy, slimy debris (2)

During an observation on the East Nursing Unit on 8:20/24 at 10:30 a.m. the following was observed:

-5 food items not labeled or dated, kifer milk, green tea, cottage cheese and two plates of leftover food

During an interview on 8/20/24 at 12:00 p.m. Nursing Home Administrator confirmed that the facility failed properly store food and maintain sanitary conditions in the Main Kitchen and properly label and date food products in one nursing unit which created the potential for food borne illness.

28 Pa. Code: 201.18(b)(1) Management.
28 Pa. Code: 211.6(c) Dietary services.
28 Pa. Code: 201.14(a) Responsibility of licensee.

Plan of Correction - To be completed: 09/09/2024

1. The five boxes of food products and 6 buckets of dish machine sanitizer were removed from the dry storage area in the main kitchen area. The 25 boxes of food were removed from the floor of the walk in freezer in the main kitchen area. The juice dispenser was cleaned in the main kitchen area. The 5 food items were from the east nursing unit refrigerator.
2. The facility will maintain proper oversight of the food service department. An audit of the refrigerators on the nursing was completed by the Director of Nursing/designee to ensure food products were properly labeled and dated. The dietician completed an audit of the kitchen to ensure for was properly stored and sanitary conditions were maintained.
3. The dietary staff will be re-educated by the dietician/designee on properly storing and maintaining sanitary conditions in the kitchen. Nursing staff will be re-educated by the Director of Nursing/designee on proper labeling and dating of food in the nursing unit refrigerators.
4. The administrator /designee will receive weekly kitchen updates from the dietician each week until the Full-time food service supervisor has been hired. The Dietician/designee will audit the kitchen weekly for four weeks and monthly for three months to ensure items are properly stored and sanitary conditions are maintained. The dietician/designee will audit the nursing unit refrigerators weekly for four weeks and monthly for three months to ensure food is properly labeled and dated. Audits will be presented to the Quality Assurance Performance Improvement Committee Meeting for tracking and trending.

483.60(a)(1)(2) REQUIREMENT Qualified Dietary Staff:

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.

§483.60(a) Staffing
The facility must employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, taking into consideration resident assessments, individual plans of care and the number, acuity and diagnoses of the facility's resident population in accordance with the facility assessment required at §483.71.

This includes:
§483.60(a)(1) A qualified dietitian or other clinically qualified nutrition professional either full-time, part-time, or on a consultant basis. A qualified dietitian or other clinically qualified nutrition professional is one who-
(i) Holds a bachelor's or higher degree granted by a regionally accredited college or university in the United States (or an equivalent foreign degree) with completion of the academic requirements of a program in nutrition or dietetics accredited by an appropriate national accreditation organization recognized for this purpose.
(ii) Has completed at least 900 hours of supervised dietetics practice under the supervision of a registered dietitian or nutrition professional.
(iii) Is licensed or certified as a dietitian or nutrition professional by the State in which the services are performed. In a State that does not provide for licensure or certification, the individual will be deemed to have met this requirement if he or she is recognized as a "registered dietitian" by the Commission on Dietetic Registration or its successor organization, or meets the requirements of paragraphs (a)(1)(i) and (ii) of this section.
(iv) For dietitians hired or contracted with prior to November 28, 2016, meets these requirements no later than 5 years after November 28, 2016 or as required by state law.

§483.60(a)(2) If a qualified dietitian or other clinically qualified nutrition professional is not employed full-time, the facility must designate a person to serve as the director of food and nutrition services.
(i) The director of food and nutrition services must at a minimum meet one of the following qualifications-
(A) A certified dietary manager; or
(B) A certified food service manager; or
(C) Has similar national certification for food service management and safety from a national certifying body; or
D) Has an associate's or higher degree in food service management or in hospitality, if the course study includes food service or restaurant management, from an accredited institution of higher learning; or
(E) Has 2 or more years of experience in the position of director of food and nutrition services in a nursing facility setting and has completed a course of study in food safety and management, by no later than October 1, 2023, that includes topics integral to managing dietary operations including, but not limited to, foodborne illness, sanitation procedures, and food purchasing/receiving; and
(ii) In States that have established standards for food service managers or dietary managers, meets State requirements for food service managers or dietary managers, and
(iii) Receives frequently scheduled consultations from a qualified dietitian or other clinically qualified nutrition professional.

Observations:

Based on staff interviews it was determined that the facility failed to employ a full-time director of food service for the past six out of 31 days (August 2024).

Findings include:

During a kitchen tour on 8/20/24 at 9:10 a.m. kitchen staff stated "the kitchen currently does not have a manager".

During an interview on 8/20/24 at 12:30 p.m. the Nursing Home Administrator confirmed that the facility has not had a Dietary Manager since 8/15/24 as required, the Registered Dietitian is approximately two days a month and the Consultant Manager one day per week.

28 Pa. Code 201. 18(e)(1)(6)Management
28 Pa. Code 211. 6(c) Dietary services

Plan of Correction - To be completed: 09/09/2024

"The Facility submits this Plan of Correction under procedures established by the Department of Health in order to comply with the Department's directive to change conditions which the Department alleges is deficient under State and/or Federal Long Term Care Regulations. This Plan of Correction should not be construed as either a waiver of the facility's right to appeal or challenge the accuracy or severity of the alleged deficiencies or an admission of past or ongoing violation of State or Federal regulatory requirements."

1. The facility employs a dietician on a full-time basis and will be in the facility at least 5 days a week up to 9/9/24 when the new Dietary manager begins. We Care at Murrysville also has a regional dietary manager who will be overseeing the needs of the kitchen. He will be in the facility at least twice a week.
2. The facility will maintain proper oversight of the food service department.
3. The dietician will report directly to the administrator and send weekly updates on the status of the kitchen.
4. The administrator /designee will receive weekly kitchen updates from the dietician each week until the Full-time food service supervisor is on-boarded. Weekly reviews of the kitchen will be presented to the Quality Assurance Performance Improvement Committee Meeting for tracking and trending.

§ 211.6(c) LICENSURE Dietary Services.:

Observations:

Based on observations and staff interviews, it was determined the facility failed to post menus in the facility or distribute to residents at least two weeks in advance for all units of the facility (2 out of 2).

Findings include:

Tour of the facility on 8/20/24, at 9:20 a.m., revealed no menu's posted, either on the units or resident's rooms.

Interview with the Nursing Home Administrator on 8/20/24, at 12:30 p.m. confirmed menu's were not posted two weeks in advanced as required.

Plan of Correction - To be completed: 09/09/2024

. The facility posted current menus on units and distributed menus to residents.
2. The facility will post meus and distribute to residents at least 2 weeks in advance on units in the facility.
3. The dietary staff will be re-educated by the dietician/designee on posting menus on the units and distributing to residents at least 2 weeks in advance.
4. The dietician/designee will audit weekly on the units to ensure menus are posted and distributed to residents. Audits will be presented to the Quality Assurance Performance Improvement Committee Meeting for tracking and trending.

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