Nursing Investigation Results -

Pennsylvania Department of Health
ANN'S CHOICE
Patient Care Inspection Results

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Severity Designations

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Minimal Citation - No Harm Minimal Harm Actual Harm Serious Harm
ANN'S CHOICE
Inspection Results For:

There are  35 surveys for this facility. Please select a date to view the survey results.

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ANN'S CHOICE - 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 August 16, 2019, it was determined that Ann's Choice, 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:


483.10(c)(1)(4)(5) REQUIREMENT Right to be Informed/Make Treatment Decisions: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(c) Planning and Implementing Care.
The resident has the right to be informed of, and participate in, his or her treatment, including:

483.10(c)(1) The right to be fully informed in language that he or she can understand of his or her total health status, including but not limited to, his or her medical condition.

483.10(c)(4) The right to be informed, in advance, of the care to be furnished and the type of care giver or professional that will furnish care.

483.10(c)(5) The right to be informed in advance, by the physician or other practitioner or professional, of the risks and benefits of proposed care, of treatment and treatment alternatives or treatment options and to choose the alternative or option he or she prefers.
Observations:







Based on clinical record review and interviews with staff, it was determined that the facility failed to inform a resident's family member when a medication was prescribed for one of five residents reviewed (Resident R4).

Findings include:

Clinical record review for Resident R4 revealed an Admission MDS (Minimum Data Set - a mandatory periodic resident assessment tool), dated July 10, 2019, which indicated that the resident was admitted to the facility July 3, 2019, and was severly cognitively impaired. Diagnoses included: Alzheimer's Disease (a progressive disease that destroys memory and other important mental functions), unspecified pain, rotator cuff tear and lower back pain related to a pinched nerve.

Review of physician's notes for Resident R4 revealed a note, dated July 11, 2019, which indicated that the resident's daughter was concerned that Tramadol (a pain relieving medication) was making the resident's dementia worse and requested that the medication be held.

Review of the July 2019 Medication Administration Records (MARs) revealed that the medication was stopped on July 11, 2019.

Continued review of physician's notes for Resident R4 revealed an evaluation note, completed on July 18, 2019, for an evaluation of pain. The note indicated that the resident came to the facility due to being unable to care for himself due to severe pain, that the resident had Alzheimers, did not know what medications he was taking, and had nonsensical speech. The resident was observed by the physician to have pain to touch and appears uncomfortable. The physician noted that the resident's family member requested to discontinue Tramadol due to concerns of increasing confusion. The physician also noted to restart the Tramadol due to the resident being in pain.

Review of the July 2019 MARs revealed that the medication was restarted on July 18, 2019.

Review of nurses notes revealed a note, dated July 18, 2019, at 11:11 p.m. which indicated that the physician restarted Tramadol that evening and that Resident R4 reported relief from back pain.

Continued record review revealed that there was no documentation available in the record to indicate that the resident's family member had been notified of the physician's order to restart the Tramadol.

Further record review revealed a nurses note, dated July 24, 2019, at 1:00 p.m. which indicated that Resident R4's family member observed the nurse administering the Tramadol to the resident. The nurse noted that the resident was restarted on Tramadol due to complaints of back pain. The family member requested that the medication be discontinued again at that time.

Review of the July 2019 MARs revealed that the medication was discontinued again on July 24, 2019.

Interview on August 16, 2019, at 12:15 p.m., the Director of Nursing and the Assistant Director of Nursing confirmed that Resident R4's family member should have been notified when the resident was restarted on Tramadol.

The facility failed to inform a resident's family member when a medication was prescribed.

28 Pa Code 201.29(j) Resident rights

Previously cited 7/31/18


 Plan of Correction - To be completed: 10/07/2019

What corrective action will be accomplished for those residents found to have been affected by the deficient practice:

Resident's current physician's orders have been reviewed with the family.

How will you identify other residents affected by the same deficient practice

An audit of new orders written since 8/26/19 will be completed by Assistant Director of Nursing/ designee to ensure
resident/ health care agent has been notified of changes to medication regimen.


What measures will be put in place or what systemic changes you will make to ensure the deficient practice does not recur:
Current Nurses will be re-educated on the process/ requirement related to the notification and documentation of resident and or healthcare agent when there is a change in the residents proposed care and treatment.


How the corrective actions will be monitored to ensure the deficient practice will not recur. Ie, what quality assurance program will be put in place:

The following audits will be completed by the ADON/designee and reported monthly to the facility Quality Assurance committee.
1. 24 hour report of new orders run daily x 2 weeks with comparison to note of resident or family notification x 2 weeks
2. 24 hour report of new orders run 3x per week with comparison to note of resident or family notification x 2 weeks
3. 24 hour report of new orders run weekly with comparison to note of resident or family notification x 2 weeks.




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