Nursing Investigation Results -

Pennsylvania Department of Health
ROSEMONT CENTER
Patient Care Inspection Results

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Minimal Citation - No Harm Minimal Harm Actual Harm Serious Harm
ROSEMONT CENTER
Inspection Results For:

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ROSEMONT CENTER - Inspection Results Scope of Citation
Number of Residents Affected
By Deficient Practice
Initial comments:

Based on an Abbreviated Survey in response to a complaint completed on November 6, 2019, it was determined that Rosemont 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 related to the health portion of the survey process.



 Plan of Correction:


483.60(i)(4) REQUIREMENT Dispose Garbage and Refuse Properly: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)(4)- Dispose of garbage and refuse properly.
Observations:

The facility failed to dispose of garbage and refuse properly related to trash on the ground around the dumpsters and an open trash dumpster.

Findings include:

Observation of garbage disposal on November 6, 2019, at 9:15 a.m. in the dumpster area revealed nine gloves mixed with leaves on the ground around the two dumpsters. There were plastic bags, food waste, food wrappers, cardboard boxes and a dirty shower chair also mixed among the leaves around the dumpsters. The right dumpster door was open to the air and contained trash.

Repeat observation of garbage disposal on November 6, 2019, at 4:00 p.m. with the Director of Nursing (DON) revealed confirmation of gloves mixed with leaves on the ground around the two dumpsters. The DON also confirmed the other observations of different waste types mixed into leaves on the ground around the dumpster and confirmed the right dumpster was open to the air.

Interview with the DON on November 6, 2019, at 4:00 p.m. revealed as stated that the disposal of clinical waste including gloves into dumpsters was the responsibility of housekeeping services and that the ground around the dumpsters should be free of waste and leaves to avoid attracting pests to the area.

The facility failed to dispose of garbage and refuse properly.

28 Pa. Code 201.14(a) Responsibility of licensee
Previously cited 05/24/19

28 Pa. Code 201.18(a) Management

28 Pa. Code 201.18(b)(1)(3) Management
Previously cited 05/24/19

28 Pa. Code 207.2(a) Administrator's responsibility


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 Plan of Correction - To be completed: 12/20/2019

No residents were harmed as a result of this deficient practice.

All residents have the potential to be harmed as a result of this deficient practice.

Dietary and housekeeping staff will be educated on refuse not being on the ground and the dumpster doors being closed.

An audit will be conducted 5 times a week, for a period of 4 weeks, then 3 times a week, for a period of 8 weeks. Results of the audits will be taken to the quality assurance performance improvement committee for review and recommendations.

The administrator or designee will be responsible for this audit.
483.20(f)(5), 483.70(i)(1)-(5) REQUIREMENT Resident Records - Identifiable Information: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.
483.20(f)(5) Resident-identifiable information.
(i) A facility may not release information that is resident-identifiable to the public.
(ii) The facility may release information that is resident-identifiable to an agent only in accordance with a contract under which the agent agrees not to use or disclose the information except to the extent the facility itself is permitted to do so.

483.70(i) Medical records.
483.70(i)(1) In accordance with accepted professional standards and practices, the facility must maintain medical records on each resident that are-
(i) Complete;
(ii) Accurately documented;
(iii) Readily accessible; and
(iv) Systematically organized

483.70(i)(2) The facility must keep confidential all information contained in the resident's records,
regardless of the form or storage method of the records, except when release is-
(i) To the individual, or their resident representative where permitted by applicable law;
(ii) Required by Law;
(iii) For treatment, payment, or health care operations, as permitted by and in compliance with 45 CFR 164.506;
(iv) For public health activities, reporting of abuse, neglect, or domestic violence, health oversight activities, judicial and administrative proceedings, law enforcement purposes, organ donation purposes, research purposes, or to coroners, medical examiners, funeral directors, and to avert a serious threat to health or safety as permitted by and in compliance with 45 CFR 164.512.

483.70(i)(3) The facility must safeguard medical record information against loss, destruction, or unauthorized use.

483.70(i)(4) Medical records must be retained for-
(i) The period of time required by State law; or
(ii) Five years from the date of discharge when there is no requirement in State law; or
(iii) For a minor, 3 years after a resident reaches legal age under State law.

483.70(i)(5) The medical record must contain-
(i) Sufficient information to identify the resident;
(ii) A record of the resident's assessments;
(iii) The comprehensive plan of care and services provided;
(iv) The results of any preadmission screening and resident review evaluations and determinations conducted by the State;
(v) Physician's, nurse's, and other licensed professional's progress notes; and
(vi) Laboratory, radiology and other diagnostic services reports as required under 483.50.
Observations:

Based on clinical record review and staff interview, it was determined that the facility failed to maintain clinical records on each resident that were complete and accurately documented for four of five residents reviewed (Residents R1, R3, R4 and R5).

Findings include:

Review of physician's orders for Resident R1 revealed orders for Baclofen Tablet 20 milligrams (mg), give one tablet by mouth four times a day, scheduled for midnight; Oxycodone Tablet 20 mg, give one tablet by mouth every three hours for pain, scheduled for midnight and 3:00 a.m.; Tizanidine Tablet 2 mg, give one tablet by mouth every six hours for spasticity, scheduled for midnight; and Ipratropium-Albuterol Solution 0.5-2.5 mg per 3 ml every six hours for difficulty breathing, scheduled for midnight.

Review of the medication administration audit report and medication administration record (MARs) for Resident R1 revealed that on September 26, 2019, at 12:00 a.m. the resident was scheduled to receive four medications (Baclofen, Oxycodone, Tizanidine and Ipratropium-Albuterol Solution), but they were not signed out as administered until 2:58 a.m. by Employee E5, licensed nurse. One of the four medications was Oxycodone tablet 20 mg to be administered every three hours for pain. Review of the resident's progress notes did not reveal why there was a delay in signing out medications.

Interview with the Director of Nursing (DON) on November 5, 2019, at 3:55 p.m. revealed that Employee E5, licensed nurse, had administered the medications for Resident R1 at the correct time but did not sign them out as given for 2 hours and 58 minutes. The DON stated that all nurses are expected to sign out medication at the time they were administered.

Review of physician's orders for October 27, 2019, for Resident R3 revealed orders for Buspirone Tablet 10 mg, give one tablet by mouth three times a day for anxiety, scheduled for 8:00 a.m. and Risperdal Tablet 1 mg, give one tablet by mouth once daily for psychosis (a mental disorder characterized by disconnection from reality which results in strange behavior often accompanied by perception of stimuli such as voices, images and sensations, and other hallucinations), scheduled for 9:00 a.m.

Review of the medication administration audit report and MAR for Resident R3 revealed that on October 27, 2019, the resident's 8:00 a.m. Buspirone and 9:00 a.m. Risperdal were not signed out as administered by Employee E6, licensed nurse, until 10:44 a.m.

Interview with the DON on November 5, 2019, at 1:29 p.m. revealed that Employee E6, licensed nurse, had administered Resident R3's medications on time on October 27, 2019, but did not sign them out as administered until later. The DON stated this was not an acceptable documentation practice at the facility.

Review of physician's orders for September 27, 2019, for Resident R4 revealed orders for Folic Acid Tablet 1 mg, give one tablet by mouth once daily for anemia, scheduled for 1:00 p.m.; Multi-Day Tablet (multivitamin), give one tablet by mouth once daily for supplement, scheduled for 1:00 p.m.; Keppra Tablet 750 mg, give one tablet by mouth two times a day for seizures, scheduled for 1:00 p.m.; Lasix Tablet 20 mg, give one tablet by mouth one time a day for edema, scheduled for 1:00 p.m.; Gabapentin Capsule 100 mg, give two time a day for bilateral peripheral neuropathy (pain in the extremities), scheduled for 1:00 p.m.; Aspirin Tablet 325 mg, give one tablet by mouth once daily to thin blood, scheduled for 1:00 p.m.; Systane Solution 0.4-0.3 eye drops, give one drop in each eye two times a day for dry eyes, scheduled for 1:00 p.m.; and Zoloft Tablet 25 mg, give one tablet by mouth one time a day for major depression (a mental health disorder of having episodes of psychological depression that is caused by genetic, environmental and psychological factors with symptoms including feelings of sadness, low esteem, hopelessness), scheduled for 1:00 p.m.

Review of the medication administration audit report and MAR for Resident R4 revealed that on September 27, 2019, at 1:00 p.m. the resident was scheduled to receive eight medications (Folic Acid, Multivitamin, Keppra Tablet, Lasix, Gabapentin, Aspirin, Systane Solution, Zoloft Tablet), but they were not signed out as administered until 3:44 p.m. by Employee E6, licensed nurse. Review of the resident's progress notes did not reveal why there was a delay in signing out medications.

Further review of physician's orders for Resident R4 for October 27, 2019, revealed the same orders as on September 27, 2019, with the addition of Phenytoin Sodium Extended Capsule 100 mg, to give two capsules by mouth two times a day for seizures, scheduled for 1:00 p.m.

Review of the medication administration audit report and MAR for Resident R4 revealed that on October 27, 2019, at 1:00 p.m. the resident was scheduled to receive eight medications (Folic Acid, Lasix, Phenytoin Sodium Extended Tablet, Multivitamin, Keppra Tablet, Systane Solution, Aspirin, Gabapentin), but they were not signed out as administered until 2:46 p.m. by Employee E6, licensed nurse. Review of the resident's progress notes did not reveal why there was a delay in signing out medications.

Further review of physician's orders for Resident R4 for November 4, 2019, revealed the same orders as on October 27, 2019, with the addition of Debrox Solution 6.5%, instill two drops in both ears two times a day for wax, scheduled for 9:00 a.m.

Review of the medication administration audit report and MAR for Resident R4 revealed that on November 4, 2019, the resident did not receive the 9:00 a.m. dose of Debrox Solution ear wax drops until 2:54 p.m. The resident was scheduled to receive eight other medications (Aspirin, Systane Solution, Gabapentin, Folic Acid, Lasix, Keppra, Multivitamin, Phenytoin Sodium Extended Tablet) at 1:00 p.m. but did not receive them until 2:54 p.m. Review of the resident's progress notes did not reveal why there was a delay in signing out medications.

Interview with the DON on November 5, 2019, at 1:28 p.m. revealed that employees must administer all medications between one hour before and one hour after the administration time ordered by the physician. The DON stated that Employee E6, licensed nurse, "must have administered the meds for [Resident R4] on time but signed them out late which is not acceptable".

Review of physician's orders for November 1, 2019, for Resident R5 revealed orders for Ipratropium-Albuterol Solution, give every 6 hours for difficulty breathing, scheduled for 12:00 p.m.; Furosemide Tablet 20 mg, give two times daily for edema, scheduled for 2:00 p.m.; and Gabapentin Capsule 100 mg, give by mouth three times a day for peripheral neuropathy, scheduled for 2:00 p.m.

Review of the MAR for Resident R5 revealed that on November 1, 2019, the resident did not receive the 12:00 p.m. Ipratropium-Albuterol and the 2:00 p.m. Furosemide and Gabapentin medications. Review of progress notes did not reveal why all three medications were omitted.

Interview with the DON on November 5, 2019, at 3:54 p.m. revealed confirmation that medications for Resident R5 were not signed out as administered on November 1, 2019, at 12:00 p.m. and 2:00 p.m. The DON stated the medications were administered but the employee who was assigned to the resident failed to sign out the medications.

Interview with the Nursing Home Administrator on November 5, 2019, at 4:15 p.m. revealed confirmation that licensed nurses had not documented medication administration according to accepted standards of documentation.

The facility failed to maintain medical records on each resident that were complete and accurately documented.

28 Pa. Code 211.5(f) Clinical records
Previously cited 05/24/19

28 Pa. Code 211.12(d)(1)(5) Nursing services
Previously cited 08/17/19, 05/24/19


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 Plan of Correction - To be completed: 12/20/2019

Physicians have been made aware of the deficient practice for residents 1, 3, 4, 5. No new orders received.

An audit is being conducted for all residents, and physicians notified as necessary, to determine if other residents have been affected by this deficient practice.

A daily audit will be conducted of all medication administration records, for the next four weeks, to ensure documentation is accurate and medications are administered timely. An audit will then be conducted three times a week, for eight weeks, to ensure compliance. The administrator or designee will be responsible for this audit.
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 on observation, facility policy review and staff interview, it was determined that the facility failed to ensure residents were treated with dignity on one of two nursing units (Second-Floor Unit).

Findings include:

Review of a facility policy titled Conduct and Behavior and dated as revised August 2010 revealed an example of conduct and behavior that is considered inappropriate and is prohibited by the facility includes failure to treat all residents, visitors and fellow employees with kindness, respect and dignity, failure to perform assigned tasks efficiently and in accordance with established procedures, and any behavior that is deemed offensive or unsafe.

Observation of a resident lounge area on November 5, 2019, at approximately 2:40 p.m. revealed Employee E4, Nursing Assistant (NA), grooming Employee E3, NA. Both employees were assigned to work the 7:00 a.m. to 3:00 p.m. shift and were on duty. Employee E4 was providing hair care to Employee E3. Both employees had their backs turned to three residents in the lounge area. The employees were not engaging with the residents during their hair care session.

Interview with the Nursing Home Administrator (NHA) on November 5, 2019, at 3:07 p.m. revealed that employees were not permitted to perform hair care on each other during their shift and employees on lounge duty were expected to engage residents in activities and conversation.

The facility failed to ensure residents were treated with dignity.

28 Pa. Code 201.18(e)(1) Management
Previously cited 05/24/19

28 Pa. Code 201.29(j) Resident rights
Previously cited 05/24/19

28 Pa. Code 207.2(a) Administrator's responsibility

28 Pa. Code 211.12(d)(1)(3)(5) Nursing services
Previously cited 08/17/19, 05/24/19


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 Plan of Correction - To be completed: 12/20/2019

No residents were harmed as a result of this deficient practice.

All residents have the potential to be harmed as a result of this deficient practice.

Certified Nursing Assistants will receive education related to personal grooming in common areas, as well as education regarding interacting with residents.

An audit will be completed five times per week, for a period of 4 weeks; followed by an audit three times a week for a period of 8 weeks. The audit will consist of a visual observation that staff in the common room (dining room) are interacting with residents.

Results of this audit will be taken to the quality assurance performance improvement committee for review and recommendations.

The administrator will be responsible for this audit.

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