Nursing Investigation Results -

Pennsylvania Department of Health
STERLING HEALTH CARE AND REHAB CENTER
Patient Care Inspection Results

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Severity Designations

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Minimal Citation - No Harm Minimal Harm Actual Harm Serious Harm
STERLING HEALTH CARE AND REHAB CENTER
Inspection Results For:

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STERLING HEALTH CARE AND REHAB CENTER - Inspection Results Scope of Citation
Number of Residents Affected
By Deficient Practice
Initial comments:

Based on a Medicare/Medicaid Recertification Survey and State Licensure, and Civil Rights Compliance Survey and two complaints completed on January 15, 2020, it was determined that Sterling Health Care 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 for the Health portion of the survey process.




















































 Plan of Correction:


483.24(c)(1) REQUIREMENT Activities Meet Interest/Needs Each Resident: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(c) Activities.
483.24(c)(1) The facility must provide, based on the comprehensive assessment and care plan and the preferences of each resident, an ongoing program to support residents in their choice of activities, both facility-sponsored group and individual activities and independent activities, designed to meet the interests of and support the physical, mental, and psychosocial well-being of each resident, encouraging both independence and interaction in the community.
Observations:

Based on observations, staff interview, and facility activity documentation, it was determined that the facility failed to provide an ongoing program of meaningful activities designed to meet the individual interests and the physical, mental and psychosocial well-being for all residents.

Findings include:

Observations conducted on the second floor on Sunday January 12, 2020 revealed there were two activities performed through the day which were both religious services.

Interview conducted with a group of eight residents who regularly attend resident council, conducted on January 13, 2019 at 1:30 p.m. revealed there are no activities on Sundays other than religious services and there are no activities provided during the evening on any day. It was also mentioned that there are a few younger people (5 under the age of 60) in the facility and their needs are not being met for activities.

Review of the facility activities calendar revealed for the months of August 2019 through January 2020 revealed there were no activities scheduled after 2:00 p.m. and no activities other than religious services on Sunday.

Interview with Employee E7 on January 15, 2020 at 10:00 a.m. confirmed there are no activities scheduled after 2:00 p.m. and nothing except religious services on Sundays.

28 PA Code 211.10(d) Resident care policies










 Plan of Correction - To be completed: 03/02/2020

1. Weekend activities are provided after 2pm and are not solely religiously focused. They are provided on each unit and involve discussion groups, trivia, movie time, or other resident choice. Weekday activities are provided in the evening from 6pm to 8pm on Tuesdays and Thursdays and Friday is movie night.

2. The activity calendar has been reformatted to list the full program of daily activities. The calendar committee is now inclusive of all ages of the resident population to ensure proper input of choices. The activities director has also included potential community trips for residents.

3. The Activities Director or designee will conduct monthly resident interviews to determine satisfaction with weekend, evening, and the variety of activities offered for diverse resident groups.

4. The Activities Director will report findings to the QAPI committee until 100% satisfaction is achieved for 6 consecutive months.

483.60(i)(1)(2) REQUIREMENT Food Procurement,Store/Prepare/Serve-Sanitary: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.
483.60(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 review of facility policies, observations and staff interviews, it was determined that the facility failed to store food in accordance with professional standards for food service safety in the main kitchen.

Findings included:

Review of the facility policy titled, "Sanitation and Infection Control Food Storage Policies", undated, indicated, "all foods will be held according to manufacturer's guidelines and expiration dates. All foods not labeled with an expiration date will be discarded according to the following guidelines. All foods will be labeled with a "Use By" date when opened and stored in the appropriate manner".

Observation during the initial tour of the main kitchen on January 12, 2020, at 10:00 a.m., in the presence of the Food Service Director, Employee E6, revealed six tubes of beef inappropriately thawing in a sink full of water, and an undated, wrapped block of cheese in the refrigerator. In another refrigerator there were four single serve yogurts with an expiration date of December 21, 2019. In the walk-in freezer, an open bag of bacon, a bag of sugar cookies and a box of frozen fish with no label and no date when they were opened. Observation of the dry food storage area revealed two opened containers of cereal (rice crispies and raisin bran), a bag of noodles, and a bag of graham cracker crumbs with no label and no date of when they were opened or a use by date.

Interview with Employee E6 during the observation, confirmed that the items should have been labeled and/or dated when they were opened.

The facility failed to ensure safe and sanitary storage of food in the main kitchen.


28 Pa. Code 201.14(a) Responsibility of licensee

28 Pa. Code 201.18(b)(1) Management

28 Pa. Code 201.18(b)(3) Management






 Plan of Correction - To be completed: 03/02/2020

1. The tubes of beef were removed from the sink to thaw properly in the refrigerator. Expired food was discarded at the time it was identified.

2. Residents receiving meals have the potential to be affected. All frozen items will be thawed appropriately before being served, and all refrigerated and dry storage items will be dated when opened and stored according to manufacturer recommendations.

3. The Food Service Director will re-educate all cooks and dietary aides of the proper techniques for thawing frozen items, labeling and dating open refrigerated items, and opening and labeling dry goods according to required manufacturer storage recommendations.

4. The Food service Director will audit food thawing practices and inspect the refrigerators and dry storage areas daily for five days, weekly times two, then monthly to ensure compliance. Results will be reported at the facility QAPI meeting.

483.10(a)(1)(2)(b)(1)(2) REQUIREMENT Resident Rights/Exercise of Rights: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(a) Resident Rights.
The resident has a right to a dignified existence, self-determination, and communication with and access to persons and services inside and outside the facility, including those specified in this section.

483.10(a)(1) A facility must treat each resident with respect and dignity and care for each resident in a manner and in an environment that promotes maintenance or enhancement of his or her quality of life, recognizing each resident's individuality. The facility must protect and promote the rights of the resident.

483.10(a)(2) The facility must provide equal access to quality care regardless of diagnosis, severity of condition, or payment source. A facility must establish and maintain identical policies and practices regarding transfer, discharge, and the provision of services under the State plan for all residents regardless of payment source.

483.10(b) Exercise of Rights.
The resident has the right to exercise his or her rights as a resident of the facility and as a citizen or resident of the United States.

483.10(b)(1) The facility must ensure that the resident can exercise his or her rights without interference, coercion, discrimination, or reprisal from the facility.

483.10(b)(2) The resident has the right to be free of interference, coercion, discrimination, and reprisal from the facility in exercising his or her rights and to be supported by the facility in the exercise of his or her rights as required under this subpart.
Observations:



Based upon observations and interviews, it was determined that the facility failed to ensure residents were served meals in a dignified manner for one of four dining rooms observed (Cambridge).

Findings include:

Observation of dining service on January 12, 2020, at approximately 1:10 p.m, revealed nursing staff Employee E4, standing to feed Resident 113 the lunch meal.

Additional observation of dining service on January 13, 2020 at approximately 1:00 p.m., revealed nursing staff Employee E5, standing to feed Resident 113 the lunch meal.

Interview with the Nursing Home Administrator and Director of Nursing on January 15, 2020 at 2:00 p.m. confirmed staff are to interact with residents during meals and should sit down to assist resident who must be fed their meals.






 Plan of Correction - To be completed: 03/02/2020

1. R113 had no untoward effect from the meals served on January 12, 2020 and January 13, 2020; staff will remain seated while assisting R113 with meals.

2. All residents that are dependent upon staff to be fed have the potential to be effected. Staff will remain seated when assisting them with meals.

3. The Staff Developer will re-educate staff to remain seated while feeding residents.

4. The Director of Nursing or designee will conduct random audits during mealtime to ensure that staff remain seated while feeding residents. Audits will be completed weekly times four and then monthly times three with results reported at the facility QAPI meeting.

483.25(d)(1)(2) REQUIREMENT Free of Accident Hazards/Supervision/Devices: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.
483.25(d) Accidents.
The facility must ensure that -
483.25(d)(1) The resident environment remains as free of accident hazards as is possible; and

483.25(d)(2)Each resident receives adequate supervision and assistance devices to prevent accidents.
Observations:


Based on clinical record review, facility documentation review, resident and staff interviews and observations, it was determined the facility failed to provide adequate care to prevent accidents for one of 24 residents reviewed (Resident 24).

Findings include:

Review of Resident 24's quarterly Minimum Data Set (MDS- periodic assessment of resident needs), dated October 14, 2019, revealed the resident required extensive assistance from two staff members for transfers and is cognitively intact.

Review of Resident 24's care plan revealed a care plan for the preventions of falls, initiated December 21, 2018, with an intervention "I need ASSIST OF 2 FOR TRANSFERS" initiated on August 20, 2019.

Review of Resident 24's Care Card, revealed the resident needs assist of two for transfers.

Review of Resident 24's Progress Notes revealed a Health Status Note on December 31, 2019, at 12:03 p.m. stating "resident lowered to floor by CNA in shower room".

Further review of Resident 24's progress notes revealed a Health Status Note on December 31, 2019, at 7:25 p.m. stating "Resident complained of pain to the left lower leg after the fall, per charge nurse, Tylenol given, doctor notified, per doctor LLE (left lower extremity) X-ray, Lidocaine patch (adhesive patch containing numbing medication attached directly to the skin of affected area) to LLE. Mobile X-Ray negative for fracture.

Review of facility documentation for Resident 24's fall of December 31, 2019, revealed a note stating "CNA transferred resident alone. Care card states resident is an assist x 2. CNA will be given verbal counseling".

Interview with Resident 24 on January 12, 2020, at 1:00 p.m. revealed the resident had a fall while in the shower room while being transferred from the shower chair back to her wheelchair and her left foot rolled underneath her and was twisted causing her pain.

Observations at the time of the interview revealed Resident 24 was lying in bed with a Hoyer sling (cloth sling used to support a resident when using a mechanical device to transfer from one surface to another) underneath her and swelling to both of her ankles but the left ankle about twice the size of the right.

Review of Resident 24's Medication Administration Record revealed an order for Tylenol 650 mg as needed every four hours for mild pain, started on August 9, 2019. Review of the December 2019 MAR, revealed the as needed Tylenol was given only once on December 31, 2019, at 4:47 p.m. for a pain level of 7 which was after the fall on that day. Review of the January 2020 MAR, revealed the resident received the as needed Tylenol 15 times from January 1st to January 14th, 2020. Further review of the January 2020 MAR, revealed the reason documented for the administration of the as needed Tylenol was due to pain in the left lower leg or just one leg 10 out of the 15 administrations.

Review of Resident 24's Occupational Therapy Evaluation and Plan of Treatment, dated January 6, 2019, revealed the resident presents s/p (after) a fall with decreased BUE (both arms) strength decreased performance in functional transfers and decreased activity tolerance impacting the resident's ability to perform bed mobility and ADL (Activities of Daily Living- everyday task such as bathing and dressing).

Another interview conducted with Resident 24 on January 14, 2019, at 1:30 p.m. confirmed the resident was transferred in the shower room with the help from only one aide and since this fall the resident has had an increase in pain to the left ankle and the need for a Hoyer lift for transfers since the fall of December 31, 2019.

Interview with the Director of Nursing on January 15, 2020, at 1:00 p.m. confirmed Resident 24 was transferred with the assistance of one staff member when they had been assessed and care planned as needing the assistance of two staff members for transfers.

Free of Accident Hazards/Supervision/Devices
CFR(s): 483.25(d)(1)(2) - Previously cited 01/24/17, 2/15/19

28 Pa. Code 201.14(a) Responsibility of licensee
Previously cited 11/07/18, 2/15/19

28 Pa. Code 201.18(b)(1) Management
Previously cited 11/07/18, 2/15/19

28 Pa. Code 201.18(b)(3) Management
Previously cited 2/15/19

28 Pa. Code 201.18(e)(1) Management
Previously cited 12/11/17, 2/15/19

28 Pa. Code 201.29(c) Resident rights

28 Pa. Code 211.5(f) Clinical records
Previously cited 04/10/18, 2/15/19

28 Pa. Code 211.11(d) Resident care plan
Previously cited 2/15/19

28 Pa. Code 211.12(c) Nursing services
Previously cited 11/07/18, 2/15/19

28 Pa. Code 211.12 (d)(1)(5) Nursing services
Previously cited 11/07/18, 04/10/18, 2/15/19

























 Plan of Correction - To be completed: 03/02/2020

1. R24 did not sustain any injuries from the transfer. R24 continues to be a Hoyer lift.

2. Any resident that requires an assist of more than one person may be affected.

3. The Staff Developer or designee will re-educate staff on proper transfer techniques. The facility has also arranged for Directed In-service training per DOH mandate.

4. The Staff Developer or designee will identify residents that require two person assist and/or Hoyer transfers to ensure proper technique weekly times four then monthly times three. Results will be reported at the facility QAPI meeting.

483.10(g)(10)(11) REQUIREMENT Right to Survey Results/Advocate Agency Info: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.
483.10(g)(10) The resident has the right to-
(i) Examine the results of the most recent survey of the facility conducted by Federal or State surveyors and any plan of correction in effect with respect to the facility; and
(ii) Receive information from agencies acting as client advocates, and be afforded the opportunity to contact these agencies.

483.10(g)(11) The facility must--
(i) Post in a place readily accessible to residents, and family members and legal representatives of residents, the results of the most recent survey of the facility.
(ii) Have reports with respect to any surveys, certifications, and complaint investigations made respecting the facility during the 3 preceding years, and any plan of correction in effect with respect to the facility, available for any individual to review upon request; and
(iii) Post notice of the availability of such reports in areas of the facility that are prominent and accessible to the public.
(iv) The facility shall not make available identifying information about complainants or residents.
Observations:


Based on observations and resident and staff interviews, it was determined that the facility failed to have signage to direct the residents to the location of the State Agency survey results and failed to have the results readily accessible for review.

Findings include:

During a resident group interview conducted on January 13, 2020, at 1:30 p.m. where 8 residents attended it was revealed that the residents had no knowledge of where the State survey results were located or if there was signage stating where they were located.

Observations conducted on January 13, 2020, at 2:00 p.m. revealed that there was no signage posted advising the residents of the location of the State Agency survey results. Further investigation revealed that the signage was at the receptionist desk, but the folder was not available.

An interview with the Receptionist on January 13, 2020, at 2:00 p.m. revealed that the folder was behind the desk and the residents would have to ask for the folder.

An interview with the Assistant Administrator on January 14, 2020, at 8:45 a.m. revealed that there was not signage on the floors indicating where the State Agency survey results were available.

The facility failed to ensure that the residents were aware of the location of the State Agency survey results for their review and that the results were readily accessible for review.

28 Pa. Code 201.18(a)(e)(1) Management

28 Pa. Code 201.18(b)(1) Management
Previously cited: 02/15/2019

28 Pa. Code 201.29(a) Resident rights






 Plan of Correction - To be completed: 03/01/2020

1. The survey results were removed from behind the front desk and placed in the common lobby area so that individuals do not have to ask for the binder. Survey results were also placed in the common dining/activity areas on each floor for ease of resident access.
2. Notification of the locations of survey results were posted at the front desk, in the display information board near the exit to the front lobby and on each floor below the Ombudsman contact posters.
3. The activities director/designee will remind residents of the locations of each manual during the monthly resident council meetings to ensure residents are informed of the availability and location of the reports.
4. The administrator/designee will audit for proper locations of the survey results daily for 14 days, then weekly times 2, then monthly until 100% compliance is achieved for three consecutive months. Results will be reviewed at the Quality Assurance Performance Improvement meeting.


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