Nursing Investigation Results -

Pennsylvania Department of Health
SNYDER MEMORIAL HEALTH CARE CENTER
Patient Care Inspection Results

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SNYDER MEMORIAL HEALTH CARE CENTER
Inspection Results For:

There are  66 surveys for this facility. Please select a date to view the survey results.

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SNYDER MEMORIAL HEALTH CARE 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 completed on January 30, 2020, it was determined that Snyder Memorial Health Care 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:


483.10(e)(4)-(6) REQUIREMENT Choose/Be Notified of Room/Roommate Change: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(e)(4) The right to share a room with his or her spouse when married residents live in the same facility and both spouses consent to the arrangement.

483.10(e)(5) The right to share a room with his or her roommate of choice when practicable, when both residents live in the same facility and both residents consent to the arrangement.

483.10(e)(6) The right to receive written notice, including the reason for the change, before the resident's room or roommate in the facility is changed.
Observations:

Based on clinical record review and staff interviews, it was determined that the facility failed to ensure that in preparation for a room change, the resident's responsible party received written notice, including the reason for the change, before the resident's room was changed for four of four residents with a room change (Residents R17, R21, R66 and R75).

Findings include:

The facility policy addressing room changes, last updated 10/24/19, indicated that prior to changing residents' rooms the responsible party would be notified of the room change and the reason for the room change would be explained.

During a tour of the facility's locked unit, it was noted that Residents R17, R21, R66 and R75 had been moved to different rooms.

Facility Resident Room Change forms documented that Resident R17 and Resident R75 had been moved to different facility rooms on 1/13/20. Progress notes dated 1/17/20, documented that Residents R21 and R66 had been moved to different facility rooms on 1/17/20.

There was no documentation to indicate that any of the above resident's responsible parties were provided written notification prior to the room change.

During an interview on 1/29/20, at 11:05 a.m., the Director of Nursing confirmed that written notification regarding Resident R17, R21, R66 and R75's room changes were not provided prior to the room changes.

28 PA Code 201.14(a) Responsibility of licensee

28 PA Code 201.29(j) Resident rights




 Plan of Correction - To be completed: 03/20/2020

R17, R21, R66 and R75 responsible party will be notified in writing the reason for room change by our Social service director by 2/13/2020

Director of nursing reviewed all residents, no other room changes identified. Room change policy has been updated by our corporate quality assurance registered nurse on 1/30/2020

Education will be provided by our registered nurse staff developer or designee to our Social Service department which handles room change notification, to ensure we are compliant with prior written notifications by 2/13/2020.

The facility will monitor for continued compliance through audits by the quality assurance registered nurse. The audits will be conducted by reviewing room changes 5 times a week for 4 weeks, then weekly times 4 weeks to assure compliance. These audits will be reviewed with quality assurance process improvement committee monthly times two. The QAPI committee will determine the frequency of audits thereafter.
Corrective plan of action completion date : March 20, 2020

483.80(a)(1)(2)(4)(e)(f) REQUIREMENT Infection Prevention & Control: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.
483.80 Infection Control
The facility must establish and maintain an infection prevention and control program designed to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of communicable diseases and infections.

483.80(a) Infection prevention and control program.
The facility must establish an infection prevention and control program (IPCP) that must include, at a minimum, the following elements:

483.80(a)(1) A system for preventing, identifying, reporting, investigating, and controlling infections and communicable diseases for all residents, staff, volunteers, visitors, and other individuals providing services under a contractual arrangement based upon the facility assessment conducted according to 483.70(e) and following accepted national standards;

483.80(a)(2) Written standards, policies, and procedures for the program, which must include, but are not limited to:
(i) A system of surveillance designed to identify possible communicable diseases or
infections before they can spread to other persons in the facility;
(ii) When and to whom possible incidents of communicable disease or infections should be reported;
(iii) Standard and transmission-based precautions to be followed to prevent spread of infections;
(iv)When and how isolation should be used for a resident; including but not limited to:
(A) The type and duration of the isolation, depending upon the infectious agent or organism involved, and
(B) A requirement that the isolation should be the least restrictive possible for the resident under the circumstances.
(v) The circumstances under which the facility must prohibit employees with a communicable disease or infected skin lesions from direct contact with residents or their food, if direct contact will transmit the disease; and
(vi)The hand hygiene procedures to be followed by staff involved in direct resident contact.

483.80(a)(4) A system for recording incidents identified under the facility's IPCP and the corrective actions taken by the facility.

483.80(e) Linens.
Personnel must handle, store, process, and transport linens so as to prevent the spread of infection.

483.80(f) Annual review.
The facility will conduct an annual review of its IPCP and update their program, as necessary.
Observations:


Based on observations, review of facility policy, and staff interview, it was determined that the facility failed to properly follow hand hygiene procedures during the administration of medications to five of 16 residents (Residents R30, R36, R51, R54 and R63).

Findings include:

The facility policy "Handwashing/Hand Hygiene Policy," dated 6/2016, indicated that "Employees must perform appropriate ten (10) to fifteen (15) second handwashing using antimicrobial or non-antimicrobial soap and water and if hands are not visibly soiled, use of an alcohol-based hand rub containing 60-95% ethanol or isopropanol is acceptable for all the following situations: Before preparing or handling medications."

Observations on 1/27/20, during medication administration revealed the following:

At 3:37 p.m., Licensed Practical Nurse (LPN) Employee E1 administered two oral medications to Resident R54, and did not wash his/her hands and/or use alcohol-based hand rub before or after medication administration.

At 3:43 p.m., LPN Employee E1 administered one oral medication to Resident R30, and did not wash his/her hands and/or use alcohol-based hand rub before or after medication administration.

At 3:47 p.m., LPN Employee E1 administered one oral medications to Resident R63, and did not wash his/her hands and/or use alcohol-based hand rub before or after medication administration.

At 3:50 p.m., LPN Employee E1 administered two oral medications to Resident R36, and did not wash his/her hands and/or use alcohol-based hand rub before or after medication administration.

At 3:57 p.m., LPN Employee E1 administered two oral medications to Resident R51, and did not wash his/her hands and/or use alcohol-based hand rub before or after medication administration.

During an interview on 1/27/20, at 4:00 p.m. LPN Employee E1 confirmed that he/she did not follow proper hand hygiene procedures. During an interview on 1/30/20, at 1:19 p.m. the Director of Nursing confirmed that the facility policy is to provide proper hand hygiene before preparing or handling medications.

28 PA Code 211.12(d)(1)(5) Nursing services
Previously cited 12/11/19 and 2/07/19






 Plan of Correction - To be completed: 03/20/2020

On 1/30/2020 the Medical Director was notified by the director of nursing that R30, R36, R51, R54 and R63 received medications from LPN that did not follow proper hand washing as per policy. Medical Director determined no negative outcome.

On 1/30/2020 the policy was reviewed by Director of Nursing and Quality assurance registered nurse and it was determined no changes needed at this time.On 1/30/2020 Nurse(LPN) E1 was given a copy of policy and reviewed with the director of nursing.

The registered nurse staff developer will review our hand washing policy and do an in service with all licensed nurses to assure proper hand washing between medication passes.

The facility will monitor for continued compliance of proper hand washing during medication passes through audits by the quality assurance registered nurse throughout all shifts.Quality assurance registered nurse and/or designee will do audits on med passes to monitor proper hand hygiene with med passes five times a week for four weeks, then weekly times 4 weeks, then monthly times 2 months. These audits will be reviewed with quality assurance process improvement committee monthly times two. The QAPI committee will determine the frequency of audits thereafter.

Corrective plan of action completion date: March 20, 2020

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 81F; and

483.10(i)(7) For the maintenance of comfortable sound levels.
Observations:

Based on observations, it was determined that the facility failed to provide housekeeping services necessary to maintain clean and sanitary resident care equipment for four of six residents with wheelchairs in the secured unit (Residents R52, R68, R69 and R78).

Findings include:

Observations on 1/27/20, at 1:30 p.m. on the secured unit revealed that Residents R52, R68, R69 and R78 were seated in wheelchairs that were observed to be soiled with accumulations of a
build-up of dust, debris, dried food residue and dried spilled liquids.

During additional observations and subsequent interview on 1/28/20, at 10:30 a.m., the Director of Nursing confirmed that the wheelchairs were dirty and should have been cleaned.

28 PA Code 207.2(a) Administrator's responsibility







 Plan of Correction - To be completed: 03/20/2020

R52, R68, R69, R78 wheel chairs were cleaned the evening of 1/27/2020, by cna supervisor and housekeeping manager.

All wheel chairs throughout facility were checked for cleanliness and cleaned if applicable on 1/28/2020 by cna supervisor and housekeeping manager. A cleaning schedule for wheel chairs was created on 1/28/2020 by our Nursing assistant manager and director of Nursing .

Cna staff was given and reviewed a copy of the wheelchair cleaning schedule on 1/29/2020. The Registered nurse staff developer and/or designee will educate staff on cleaning schedule and address any concerns or questions by 2/21/2020.

The facility will monitor for continued compliance through audits by the quality assurance registered nurse to assure cleanliness of the wheelchairs. Quality assurance registered nurse and/or designee will do audits five times a week(10 wheelchairs a day) for four weeks,, then all wheelchairs monthly times 2 months. These audits will be reviewed with quality assurance process improvement committee monthly times two. The QAPI committee will determine the frequency of audits thereafter.

Corrective plan of action completion date: March 20, 2020

483.20(k)(4) REQUIREMENT MD/ID Significant Change Notification:Least serious deficiency and is isolated to the fewest number of residents, staff, or occurrences. This deficiency has the potential for causing no more than a minor negative impact on the resident.
483.20(k)(4) A nursing facility must notify the state mental health authority or state intellectual disability authority, as applicable, promptly after a significant change in the mental or physical condition of a resident who has mental illness or intellectual disability for resident review.
Observations:

Based on clinical record review and staff interview, it was determined that the facility failed to refer a resident with a diagnosed mental disorder for a Level II review for one of 18 residents reviewed for PASSR (Pre-Admission Screening and Resident Review) compliance (Resident R24).

Findings include:

The PASRR was created in 1987 through language in the Omnibus Budget Reconciliation Act (OBRA) and it has three goals: to identify individuals with mental illness and/or intellectual disability, to ensure they are placed appropriately, whether in the community or in a nursing facility, and to ensure they receive the services they require for their mental illness or intellectual disability.

The PASRR Level 1 must be completed on all persons who are considering admission to a Medicaid certified nursing facility. A Level II PASRR evaluation must be completed if the Level 1 PASRR determined that the person is a targeted person with mental illness or an intellectual disability. The Level II PASRR would determine if placement or continued stay in the requested or current nursing facility is appropriate.

Resident 24's clinical record revealed an admission date of 11/2/17, with diagnoses that included brain injury and unspecified psychosis (mental health disorder with symptoms of loss of reality, delusions and/or hallucinations.)

Resident R24's significant change, Minimum Data Set (MDS- a federally mandated standardized assessment tool completed at specific intervals to determine resident care needs) assessment dated 2/2/19, identified that the resident had a significant change in condition.

There was no evidence that the facility forwarded the initial PA-PASSR form and/or completed the appropriate forms to alert the appropriate agencies regarding Resident 24's serious mental illness and significant change in condition.

During interview on 1/28/20, at 11:20 a.m. Social Worker Employee E3 confirmed that the state mental health authority or the state intellectual disability authority was not promptly notified following Resident R24's significant change in condition for review as required.

28 PA Code 201.8(b)(e)(1) Management
Previously cited 12/11/19 and 2/7/19

28 PA Code 211.16(a) Social services




 Plan of Correction - To be completed: 03/13/2020

I hereby acknowledge the CMS 2567-A, issued to SNYDER MEMORIAL HEALTH CARE CENTER for the survey ending 01/30/2020, AND attest that all deficiencies listed on the form will be corrected in a timely manner.
209.8(a) LICENSURE Fire Drills.:State only Deficiency.
(a) Fire drills shall be held monthly. Fire drills shall be held at least four times per year per shift at unspecified hours of the day and night.
Observations:

Based on review of fire drill records and staff interview, it was determined that the facility failed to conduct fire drills on a monthly basis and at least four times per shift yearly.

Findings include:

The facility fire drill records for February 2019, through December 2019, contained no documentation of a monthly fire drill for April 2019, and documented only two yearly fire drills for second shift.

During an interview on 1/30/20, at 11:15 a.m. the Director of Maintenance confirmed that the facility did not conduct all monthly fire drills for 2019 and did not conduct all the required fire drills for second shift in 2019.




 Plan of Correction - To be completed: 03/13/2020

The maintenance director or designee will hold fire drills on different days of the week, at different times of the day and night, so as to be sure all 3 shifts are covered each quarter of the year.
NHA or designee will verify proper completion of fire drill records.
Audits will be completed monthly and information shared at quarterly QAPI meeting.


Completion date 3/13/2020
209.8(b) LICENSURE Fire Drills.:State only Deficiency.
(b) A written report shall be maintained of each fire drill which includes date, time required for evacuation or relocation, number of residents evacuated or moved to another location and number of personnel participating in a fire drill.
Observations:

Based on review of the facility fire drill records and staff interview, it was determined that the facility failed to maintain written fire drill reports that included the number of residents evacuated or moved to another location for 11 of 11 fire drill records reviewed (February through December 2019).

Findings include:

The fire drill records for February 2019, through December 2019, lacked documentation of the number of residents evacuated/moved to another location during the drill.

During an interview on 1/30/20, at 11:15 a.m. the Director of Maintenance confirmed that the number of residents evacuated/moved to another location during a fire drill was not documented for the 2019 fire drills as required.



 Plan of Correction - To be completed: 03/13/2020

The maintenance director or designee will update fire drills forms to include the number of residents evacuated or moved to another location.
These forms will then be used for all fire drills on all 3 shifts and will be covered each quarter of the year.

Results of fire drills will be audited by Administrator or Designee monthly -and results will be shared at quarterly QAPI meeting.

Completion date 3/13/2020

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