Pennsylvania Department of Health
LIBERTY CENTER FOR REHABILITATION AND NURSING
Patient Care Inspection Results

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LIBERTY CENTER FOR REHABILITATION AND NURSING
Inspection Results For:

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LIBERTY CENTER FOR REHABILITATION AND NURSING - 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 March 26, 2024, it was determined that Liberty Center For Rehabilitation and Nursing was not in compliance with the following requirements of 42 CFR Part 483, Subpart B, Requirements for Long Term Care 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:


483.21(b)(1)(3) 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.
483.21(b)(3) The services provided or arranged by the facility, as outlined by the comprehensive care plan, must-
(iii) Be culturally-competent and trauma-informed.
Observations:

Based on clinical record review, reviews of policies and procedures and interviews with staff, it was determined that the facility failed to develop and implement a comprehensive person-centered care plan for skin alterations and skin disorders for one of three residents reviewed. (Resident Cl1)

Findings include:

A review of the facility policy titled comprehensive person-centered care plans, dated March 2022 revealed that the interdisciplinary care team was responsible for development of a care plan for each resident with measurable objectives and timetables to meet the resident's physical, psychosocial and functional needs. The resident and his/her family or legal representative was to participate in the care planning process. The care plan was to describe the services that are to be furnished to attain or maintain the resident's highest practicable physical, mental and psychosocial well-being. Care plan interventions were required to address the underlying source of the problem areas not just the symptoms or triggers.

Clinical record review revealed that Resident Cl1 was admitted to the facility on May 1, 2019. The residents diagnoses included seizure disorder, obesity, hypertension (high blood pressure), diabetes mellitus, lymphedema (swelling of the limbs and arms caused by a compromised lymphatic system) of the lower extremities and fungal dermatitis (a red, itchy scaly rash of the skin).

Clinical record review revealed a physician's order dated July 13, 2023 through March 26, 2024, for a topical cream (clotrimazole betamethasone) to be applied to the gluteus (buttocks) twice a day for Resident Cl1,. The physician also gave instructions for the care giver to apply this topical cream to the skin, after the skin was washed with soap and water and dried.

Clinical record review for Resident Cl1 revealed that the interdisciplinary care team failed to develop a care plan for Resident Cl1 with a diagnosis of fungal dermatitis.

Clinical record review for Resident Cl1 revealed that the interdisciplinary care team failed to develop a care plan for Resident Cl1 with a diagnosis of lymphedema of the extremities, to include measurable goals for the care of this skin disorder.

Interview with the Director of Nursing, Employee E2 and interview with Licensed nurse, Employee E3 at 1:00 p.m., on March 26, 2024 confirmed that the interdisciplinary care team had failed to develop and implement a comprehensive care plan for the care and treatment of a skin disorder, lymphedema for Resident Cl1.

28 Pa. Code 211.10(a)(c)(d) Resident care policies

28 Pa. Code 211.12(d)(1)(3)(5) Nursing services

28 Pa. Code 201.14(a) Responsibility of licensee







 Plan of Correction - To be completed: 05/12/2024

1. Resident C11 was in the hospital at the time of visit and is not returning back to the facility.

2. The Director of Nursing/Designee will audit the care plan of current residents to ensure that the care plan is person centered and individualized based on their medical diagnosis.

3. Staff responsible for Care plans will be educated on the components of this regulation with an emphasis on ensuring that resident care plans are person centered and individualized with diagnosis present.

4. The DON/Designee will audit 5 random residents' care plans 1x a week x4 weeks, 2x monthly x2 months, then monthly x2 months to ensure that care plans are person centered and individualized with diagnosis present. The findings of these quality monitoring's to be reported to the Quality Assurance/Performance Improvement Committee until monthly and/or until substantial compliance is met. Quality Monitoring schedule modified based on findings.

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