Nursing Investigation Results -

Pennsylvania Department of Health
Patient Care Inspection Results

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Inspection Results For:

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Number of Residents Affected
By Deficient Practice
Initial comments:

Based on an abbreviated survey in response to a complaint completed on November 29, 2021, it was determined that Rydal Park of Philadelphia 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:

483.21(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.

Based on clinical record review, interviews with staff, review of facility policies and procedures and hospital record review, it was determined that the facility failed to developed care plan related to bowel disorder and antibiotic therapy for one of six residents reviewed. (Resident Cl2)

Finding include:

The facility's policy entitled Bowel Disorders dated September 2017, indicated that as part of each residents' initial assessment the staff and physician would identify individuals with previously identified lower gastrointestinal tract conditions and symptoms. The policy indicated that the staff and physician would include a review of gastrointestinal problems during any recent hospitalizations, results of barium studies and endoscopies. The policies also indicated that the staff and physician would identify risk factors related to bowel dysfunction; severe anxiety, recent antibiotic use or taking medications that are used to treat or that may cause or contribute to dysmotility.

Review of Resident C12's hospital records revealed that Resident Cl2 was admitted to the hospital on September 25, 2021 for left hip pain after a mechanical fall. A hospital x-ray showed a left hip fracture and a CT scan (an x-ray using tomography) showed a possible coccyx fracture and fracture hematoma as well as stool burden. Resident Cl2 was given a diagnosis of constipation (a condition in which there is difficulty in emptying the bowels, usually associated with hardened feces) during the hospital visit.

Clinical record review for Resident Cl2 indicated that this resident was admitted to the facility on October 4, 2021. Nursing note dated October 4, 2021 indicated that Resident Cl2 was alert and oriented. Nursing assessment on October 5, 2021 revealed Resident Cl2 was admitted post left cephalomedullary nail for a fracture of the femur (a bone situated between the pelvis and the knee). On October 6, 2021 the nursing staff documented that Resident Cl2 was receiving an antibiotic for a urinary tract infection and pain medication for the left hip.

Review of Resident Cl2's October, 2021 physician' orders revealed an order the narcotic medication Oxycodone 5 milligrams every 4 hours as needed for moderate or severe pain and the antibiotic Keflex 500 milligrams three times a day for 8 days.

Review of October, 2021 Medication Administration Record for Resident Cl2 revealed that Resident C12 was administered Oxycodone 5 milligrams from October 4 through October 18, 2021. The Medication Administration Record also indicated that Resident Cl2 was noted receiving antibiotic therapy three times a days.

Interviews with the Nursing Home Administrator and Licensed nursing staff, Employees E2 and E4 on November 3, 2021 at 2:00 p.m. confirmed that there was no documentation to indicate that a care plan was developed for a bowel disorder for Resident C12 with a diagnosis of constipation and receiving a narcotic medication. Further it was confirmed that there was care paln developed for antibiotic therapy.

Review of nursing note dated October 18, 2021 indicated that Resident Cl2 was complaining of increasing abdominal pain. The physician was notified and the resident was transfer to the sent Resident Cl2 to the hospital.
Review of hospital records dated October 19, 2021 revealed that Resident Cl2 was diagnosed with acute sepsis (infection in the blood stream) likely due to urinary tract infection with indwelling urinary catheter. The physician also indicated that a CT scan (computed tomography scan is a medical imaging technique used in radiology to get detailed images of the body) showed fecal impaction with ileus that was decidedly treated with rectal disimpaction and regular enemas and bowel regimen.

28 Pa. Code: 211.11(a) Resident care plan

28 Pa. Code: 211.11(b) Resident care plan

28 Pa. Code: 211.11(c)Resident care plan

28 Pa. Code: 211.11(d) Resident care plan

28 Pa. Code: 211.12(d)(1) Nursing services

28 Pa. Code: 211.12(d)(5) Nursing services

 Plan of Correction - To be completed: 12/21/2021

Preparation and execution of this Response and Plan of Correction does not constitute an admission or agreement by HumanGood /Rydal Park Health Facility of the truth of the facts alleged or conclusions set forth in the Statement of Deficiencies and Plan of Correction. The Plan of Correction is being prepared and/or executed solely because it is required by State and Federal Law. For the purposes of any allegation that the facility is not in substantial compliance with Federal requirements of participation, this Response and Plan of Correction constitutes the facility's allegation of compliance in accordance with section 7305 of the State Operations Manual.

Resident was discharged to the hospital on 10/18/21 and did not return.

All active care plans as of 11/9/21 have been reviewed to ensure a plan of care has been identified for residents with a diagnosis of bowel disorder as well as current use of Antibiotic Therapy.

Staff Educator has begun to educate licensed nurses on initiating and/or updating plan of care to reflect identified diagnosis of bowel disorder as well as current use of Antibiotic Therapy. Education will be completed by 12-21-2021.

Director of Nursing and/or designee will conduct weekly audits x 3 months for residents with identified diagnosis of bowel disorder and current use of Antibiotic Therapy to ensure plan of care is accurate.

Outcomes of audits will be discussed during monthly QAPI x 3 months.

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