|§483.80 (h) COVID-19 Testing. The LTC facility must test residents and facility staff, including|
individuals providing services under arrangement and volunteers, for COVID-19. At a minimum,
for all residents and facility staff, including individuals providing services under arrangement
and volunteers, the LTC facility must:
§483.80 (h)((1) Conduct testing based on parameters set forth by the Secretary, including but not
(i) Testing frequency;
(ii) The identification of any individual specified in this paragraph diagnosed with
COVID-19 in the facility;
(iii) The identification of any individual specified in this paragraph with symptoms
consistent with COVID-19 or with known or suspected exposure to COVID-19;
(iv) The criteria for conducting testing of asymptomatic individuals specified in this
paragraph, such as the positivity rate of COVID-19 in a county;
(v) The response time for test results; and
(vi) Other factors specified by the Secretary that help identify and prevent the
transmission of COVID-19.
§483.80 (h)((2) Conduct testing in a manner that is consistent with current standards of practice for
conducting COVID-19 tests;
§483.80 (h)((3) For each instance of testing:
(i) Document that testing was completed and the results of each staff test; and
(ii) Document in the resident records that testing was offered, completed (as appropriate
to the resident’s testing status), and the results of each test.
§483.80 (h)((4) Upon the identification of an individual specified in this paragraph with symptoms
consistent with COVID-19, or who tests positive for COVID-19, take actions to prevent the
transmission of COVID-19.
§483.80 (h)((5) Have procedures for addressing residents and staff, including individuals providing
services under arrangement and volunteers, who refuse testing or are unable to be tested.
§483.80 (h)((6) When necessary, such as in emergencies due to testing supply shortages, contact state
and local health departments to assist in testing efforts, such as obtaining testing supplies or
processing test results.
Based on a review of clinical records, the facility's COVID-19 testing policy, and standards established by the Centers for Medicare & Medicaid Services, and staff interview, it was determined the facility failed to timely conduct testing of four residents exhibiting signs and symptoms of COVID-19 out of 19 sampled residents (Resident 18, Resident 33, Resident 71, and Resident 82).
According to the Centers for Medicare and Medicaid Services, Center for Clinical Standards and Quality/Survey & Certification Group QSO-Memo - 20-38-NH initially dated August 26, 2020 and revised on September 10, 2021, indicated that residents either vaccinated or unvaccinated who exhibit signs and symptoms of COVID-19 must be tested for COVID-19.
Review of a facility policy entitled "COVID-19 Testing and Vaccination of Residents and HCP (Health Care Personnel) that was revised on October 7, 2021, indicated that anyone with even mild symptoms of COVID-19, regardless of vaccination status, should receive a viral test as soon as possible and/or immediately test any resident or HCP (health care provider) who subsequently develops fevers or symptoms consistent with COVID-19.
A review of Resident 18's clinical record revealed nursing documentation dated August 25, 2021, at 9:36 PM that Resident 18 refused her shower and stated, "I have a cold and I'm hoarse and I don't want to get sicker." Staff noted that the resident's vital signs were all within normal limits.
Nursing Progress Notes dated September 6, 2021, at 10:05 PM, revealed that Resident 18 had a dry, forceful cough without expectoration and noted that it was similar to "hacking" that occurs with choking. Nursing noted that after coughing, the resident holds her chest and takes deep breaths. Resident stated that she does not feel well at all. The resident was noted to be afebrile and appeared to be fatigued per the RN's documentation. A rapid COVID-19 swab was obtained, and results were negative.
On September 22, 2021, nursing noted that the resident continued with a harsh cough and a new order was noted for Robitussin (cough med).
Further review of Resident 18's clinical record failed to reveal she was timely tested for COVID-19 when initially presenting with possible symptoms on August 25, 2021, as stated in the facility's policy and guidelines.
Review of Resident 33's clinical record revealed nursing documentation on December 3, 2021, that the resident had presented with a cough, congestion, postnasal drip, and sore throat with NON (new orders noted) for Robitussin Peak Cold DM Syrup (cough medicine) 10 ml by mouth every 6 hours for cough/congestion for 7 days and orders were obtained for Azithromycin (an antibiotic) 250 mg (milligram) one tablet by mouth for cough for five days.
Further review of Resident 33's clinical record failed to reveal she was tested for COVID-19 when presenting with potential symptoms, as stated in the facility's policy and guidelines.
Review of Resident 71's clinical record revealed nursing documentation on November 27, 2021, that the resident presented with head congestion and a dry cough with NON (new orders noted) for Mucinex DM Tablet Extended Release 12 Hour 30-600, give 1 tablet by mouth every 12 hours as needed for cough or congestion for ten days.
Review of Resident 71's clinical record failed to reveal she was tested for COVID-19 when presenting with potential symptoms, as stated in the facility's policy and guidelines.
Resident 82's clinical record revealed nursing documentation dated June 20, 2021, that the resident had a temperature of 101.4 degrees and was medicated with Tylenol as ordered.
Resident 82's clinical record failed to reveal she was tested for COVID-19 when presenting with a potential symptom, as stated in the facility's policy and guidelines.
During interview with the Director of Nursing (DON) conducted on December 7, 2021, at 11:24 AM, indicated that a COVID-19 PCR test [Polymerase chain reaction (PCR) is a laboratory technique that use primers that match a segment of the virus's genetic material] should be performed anytime a resident has complaints of symptoms or presents with COVID-19 symptoms such as cough, congestion (cold-like symptoms), and fatigue. Additionally, the DON confirmed that residents who present with signs and symptoms of COVID-19 should be tested for COVID-19 immediately.
Interview with the facility's Infection Preventionist, a RN (registered nurse), that was conducted on December 8, 2021, at 10:30 AM, indicated that it was up to the doctor to determine if a resident warranted COVID-19 testing, despite the facility's policy and current COVID test guidelines as per Centers for Medicare and Medicaid Services, Center for Clinical Standards and Quality/Survey & Certification Group.
Interview with Nursing Home Administrator (NHA) on December 8, 2021, at approximately 1:30 PM, confirmed these residents should have been tested for COVID-19 when their symptoms presented.
28 Pa. Code: 201.14(a) Responsibility of licensee.
28 Pa. Code: 201.18(b)(1)(e)(1) Management.
28 Pa. Code: 211.12 (c) Nursing services.
28 Pa. Code 211.10(a)(d) Resident care policies
| ||Plan of Correction - To be completed: 01/25/2022|
Resident 18, 33, 71, and 82 have been tested for Covid-19.
Current residents that are exhibiting symptoms have been tested for Covid-19.
Appropriate staff will be re-educated on the importance of testing residents who are exhibiting Covid-19 symptoms. Staff have been assigned to monitor daily documentation to ensure those that have exhibited symptoms have been tested.
DON/Designee will audit documentation, and speak with resident, to ensure all symptomatic residents have been tested.