Nursing Investigation Results -

Pennsylvania Department of Health
RESTORE HEALTH AT UNIVERSITY CITY
Patient Care Inspection Results

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RESTORE HEALTH AT UNIVERSITY CITY
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.
RESTORE HEALTH AT UNIVERSITY CITY - Inspection Results Scope of Citation
Number of Residents Affected
By Deficient Practice
Initial comments:

Based on an Abbreviated Survey in response to two complaints completed on October 4, 2019, it was determined that Restore Health at University City 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 related to the health portion of the survey process.


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 Plan of Correction:


483.21(b)(1) REQUIREMENT Develop/Implement Comprehensive Care Plan: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.
483.21(b) Comprehensive Care Plans
483.21(b)(1) The facility must develop and implement a comprehensive person-centered care plan for each resident, consistent with the resident rights set forth at 483.10(c)(2) and 483.10(c)(3), that includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment. The comprehensive care plan must describe the following -
(i) The services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being as required under 483.24, 483.25 or 483.40; and
(ii) Any services that would otherwise be required under 483.24, 483.25 or 483.40 but are not provided due to the resident's exercise of rights under 483.10, including the right to refuse treatment under 483.10(c)(6).
(iii) Any specialized services or specialized rehabilitative services the nursing facility will provide as a result of PASARR recommendations. If a facility disagrees with the findings of the PASARR, it must indicate its rationale in the resident's medical record.
(iv)In consultation with the resident and the resident's representative(s)-
(A) The resident's goals for admission and desired outcomes.
(B) The resident's preference and potential for future discharge. Facilities must document whether the resident's desire to return to the community was assessed and any referrals to local contact agencies and/or other appropriate entities, for this purpose.
(C) Discharge plans in the comprehensive care plan, as appropriate, in accordance with the requirements set forth in paragraph (c) of this section.
Observations:

Based on observation, staff interview, review of facility policy, review of nursing assistant job description and a review of clinical records, it was determined that the facility failed to follow a comprehensive resident centered care plan related to incontinence care for two out of three residents observed (Residents R2 and R3).

Findings include:

Review of an undated facility policy titled "Bowel Program" revealed that residents who are incontinent of bowel are checked every two hours for fecal incontinence.

Review of an undated generic Nursing Assistant (NA) job description for the facility revealed that NAs promptly assist residents to the bathroom according to their toileting schedule. They must be "punctual and timely in meeting all requirements of performance".

Review of Resident R3 clinical record revealed the resident was admitted to the facility on October 10, 2008, with a diagnosis of dementia (a broad category of brain diseases most notable for a decline in memory and other mental abilities). Review of the annual comprehensive assessment dated August 22, 2019, revealed the resident was always incontinent of bladder and bowel. The facility developed a care plan initiated on January 29, 2019 and revised on July 7, 2019, for the resident having the potential for impairment to skin integrity related to fragile skin. The care plan included an intervention to provide incontinence care and preventative skin care measures per the facility policy, to keep skin clean and dry and to perform an incontinence check every two hours and as needed.

Observation of Resident R3 on October 3, 2019, at 7:30 a.m. revealed the resident received incontinence care from Employee 6, Nursing Assistant (NA). Employee E6 then pushed the resident to the hallway outside the dining room ready for breakfast.

Review of Resident R2's clinical record revealed the resident was admitted to the facility on September 7, 2018, the diagnosis of having a mass and lump. Review of the annual comprehensive assessment dated August 2, 2019, revealed the resident was always incontinent of bladder and bowel. The facility developed a care plan dated March 24, 2019 and revised June 21, 2019, for the resident having the potential for impairment to skin integrity related to fragile skin and incontinence of bowel and bladder. The care plan included a goal to monitor the resident every two hours and as needed for incontinence episodes.

Observation of Resident R2 on October 3, 2019, at 7:48 a.m. revealed the resident received incontinence care from nursing assistant, Employee E4. Employee E4 then pushed the resident to the dining room where the resident remained until after lunch.

Observation of Residents R2 and R3 on October 3, 2019, from 8:00 a.m. until 12:37 p.m. revealed both residents did not receive incontinence care during this period.

Observation of a skin check for Resident R3 on October 3, 2019, at 12:37 p.m. with nursing assistant, Employee E6, revealed the resident's incontinence brief was soaked with urine. The resident's buttocks and upper thigh skin was wet with urine and red.

Interview with nursing assistant, Employee E6, on October 3, 2019, at 12:37 p.m. revealed confirmation the resident had a wet incontinence brief with urine on her skin.

Observation of a skin check for Resident R2 on October 3, 2019, at 12:45 p.m. with Employee E10, Registered Nurse (RN), revealed the resident's incontinence brief was soaked with urine.

Interview with Registered Nurse, Employee E10, on October 3, 2019, at 12:45 p.m. revealed confirmation the resident had a wet incontinence brief. Employee E10 stated that "we change residents every couple of hours and as needed. If a resident has a bowel movement then we change them every hour."

Interview with the Nursing Home Administrator and the Director of Nursing (DON) on October 3, 2019, at 2:26 p.m. revealed confirmation from the DON that incontinence care had not been provided on a two-hourly basis to Residents R2 and R3, as had been observed on the unit. The NHA stated that he expects staff to follow care plans including that residents with incontinence receive incontinence care per their care plans.

The facility failed to follow comprehensive resident centered care plans related to incontinence care.

42 CFR 483.21(b) Comprehensive Care Plans
Previously cited 05/29/19

28 Pa. Code 211.10(d) Resident care policies
Previously cited 05/29/19

28 Pa. Code 211.11(d) Resident care plan
Previously cited 05/29/19

28 Pa. Code 211.12(c) Nursing services

28 Pa. Code 211.12(d)(1) Nursing services
Previously cited 05/29/19

28 Pa. Code 211.12(d)(3) Nursing services
Previously cited 05/29/19

28 Pa. Code 211.12(d)(5) Nursing services
Previously cited 05/29/19


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 Plan of Correction - To be completed: 11/08/2019

Incontinence care was provided for resident R2 and R3 on October 3, 2019 as per the facility policy after being notified by the surveyor.

Education was given to all nursing staff on the importance of following the facility policy for Residents specific care plans according to their incontinence need.

DON or Designee will randomly audit 5 times a week for 3 weeks to ensure NA's are following the facility policy for Residents specific care plans according to their incontinence need.

POC will be taken to QAPPI to monitor clinical findings and IDT will make recommendations as needed


35 P. S. 448.809b LICENSURE Photo Id Reg:State only Deficiency.
(1) The photo identification tag shall include a recent photograph of the employee, the employee's name, the employee's title and the name of the health care facility or employment agency.

(2) The title of the employee shall be as large as possible in block type and shall occupy a one-half inch tall strip as close as practicable to the bottom edge of the badge.

(3) Titles shall be as follows:
(i) A Medical Doctor shall have the title " Physician. "
(ii) A Doctor of Osteopathy shall have the title " Physician. "
(iii) A Registered Nurse shall have the title " Registered Nurse. "
(iv) A Licensed Practical Nurse shall have the title " Licensed Practical Nurse. "
(v) Abbreviated titles may be used when the title indicates licensure or certification by a Commonwealth agency.


Observations:

Based on observation and staff interview, it was determined that the facility failed to ensure all employees wore photo identification tags that included a recent photograph of the employee, the employee's name, the employee's title and the name of the health care facility or employment agency for 4 of 13 staff observed (Employees E3, E4, E5 and E13).

Findings include:

Observation of Employee E3, Nursing Assistant (NA), on October 3, 2019, at 7:07 a.m. revealed the employee was not wearing any form of identification.

Interview with Employee E3, NA, on October 3, 2019, at 7:07 a.m. revealed confirmation that he did not have an identification badge and he stated he was not issued one by the facility.

Observation of Employee E4, NA, on October 3, 2019, at 7:08 a.m. revealed the employee was wearing a piece of tape with her handwritten name, job title and organization on it.

Interview with Employee E4, NA, on October 3, 2019, at 7:08 a.m. revealed confirmation that the employee did not have an identification badge with her at work.

Observation of Employee E5, Registered Nurse (RN), on October 3, 2019, at 7:10 a.m. revealed the employee was wearing an identification badge for a hospital that was not affiliated with the nursing care facility.

Interview with Employee E5, RN, on October 3, 2019, at 7:10 a.m. revealed the employee did not have her facility issued identification badge with her.

Observation of Employee E13, Licensed Practical Nurse (LPN), on October 3, 2019, at 7:44 a.m. revealed the employee was wearing a piece of tape with her handwritten name and job on it.

Interview with Employee E13, LPN, on October 3, 2019, at 7:44 a.m. revealed the employee did not have her facility issued identification badge with her.

Interview with the Nursing Home Administrator (NHA) on October 3, 2019, at 3:00 p.m. revealed that employees should wear appropriate identification in the facility.

The facility failed to ensure all employees wore photo identification tags that included a recent photograph of the employee, the employee's name, the employee's title and the name of the health care facility or employment agency.


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 Plan of Correction - To be completed: 11/08/2019

On 10/18/19, facility printed out badges for all staff.

Education/in-servicing has begun to ensure all staff are wearing name badges to identify department and name accordingly.

DON/designee will audit randomly 5x/week x 3 weeks to ensure compliance.




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