§483.10(i) Safe Environment.
The resident has a right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
The facility must provide-
§483.10(i)(1) A safe, clean, comfortable, and homelike environment, allowing the resident to use his or her personal belongings to the extent possible.
(i) This includes ensuring that the resident can receive care and services safely and that the physical layout of the facility maximizes resident independence and does not pose a safety risk.
(ii) The facility shall exercise reasonable care for the protection of the resident's property from loss or theft.
§483.10(i)(2) Housekeeping and maintenance services necessary to maintain a sanitary, orderly, and comfortable interior;
§483.10(i)(3) Clean bed and bath linens that are in good condition;
§483.10(i)(4) Private closet space in each resident room, as specified in §483.90 (e)(2)(iv);
§483.10(i)(5) Adequate and comfortable lighting levels in all areas;
§483.10(i)(6) Comfortable and safe temperature levels. Facilities initially certified after October 1, 1990 must maintain a temperature range of 71 to 81°F; and
§483.10(i)(7) For the maintenance of comfortable sound levels.
|
Observations:
Based on observation, interview with resident and staff, review of facility documentation and review of CDC recommendations, it was determined that the facility failed to ensure comfortable air temperatures between 71 degrees Fahrenheit and 81 degrees. This failure resulted in an Immediate Jeopardy situation with air temperatures ranging between 82.4 degrees Fahrenheit and 90.6 degrees Fahrenheit in two of two nursing units (Second and Third Floor).
Findings include:
Review of The Center for Disease Control and Prevention recommendation titled "Extreme Heat" date June 21, 2024, revealed Heat-related illnesses, like heat exhaustion or heat stroke, happen when the body is not able to properly cool itself. While the body normally cools itself by sweating, during extreme heat, this might not be enough. In these cases, a person's body temperature rises faster than it can cool itself down. This can cause damage to the brain and other vital organs.
Review of The Center for Disease Control and Prevention (CDC) recommendation titled "Extreme Heat" dated February 13, 2024, revealed that people aged 65 years or older are more prone to heat-related health problems. Older adults do not adjust as well as young people to sudden changes in temperature. They are more likely to have a chronic medical condition that changes normal body responses to heat. They are more likely to take prescription medicines that affect the body's ability to control its temperature or sweat.
Observation of the First floor on July 9, 2024, at 9:07 a.m. revealed water covering the floor. The Assistant Director of Maintenance, Employee E3 was mopping up the First floor corridor.
Interview with the Assistant Director of Maintenance, Employee E3 at time of observation revealed that the facility central air conditioning was not functioning and the administrator had temporary portable water-cooled spot cooling air conditioners installed on all the nursing units. The air-conditioner that was placed on the Second-floor- Room 223 malfunctioned causing a leak onto the first floor.
Tour of the facility nursing units, floors two and three, accompanied with Director of Nursing, Employee 4 on July 9, 2024 at 9:25 a.m. revealed the Second-floor portable malfunctioned air conditioner. The inspection of Room 223 revealed that the portable water-cooled spot cooling air conditioner became dislodged forcing water to drain on the floor.
2nd Floor nursing unit:
Room 225 temped at 84.2 degrees Fahrenheit
Room 226 temped at 82.4 degrees Fahrenheit
Room 230 temped at 83.1 degrees Fahrenheit
Room 238 temped at 83.4 degrees Fahrenheit
3rd Floor Nursing unit:
Room 305 temped at 82.5 degrees Fahrenheit
Room 306 temped at 83.4 degrees Fahrenheit
Room 308 temped at 86.1 degrees Fahrenheit
Room 310 temped at 85.5 degrees Fahrenheit
Room 310 temped at 85.5 degrees Fahrenheit
Room 311 temped at 84.9 degrees Fahrenheit
Room 312 temped at 84.2 degrees Fahrenheit
Room 313 temped at 83.6 degrees Fahrenheit
Room 323 temped at 90.6 degrees Fahrenheit
Room 325 temped at 87.9 degrees Fahrenheit
Room 326 temped at 88.3 degrees Fahrenheit
Room 328 temped at 84.2 degrees Fahrenheit
Interview with Nursing Home Administrator, Employee 2, on July 9, 2024, at 11:17 a.m. revealed Employee E2 believed that there was a functioning air conditioning at the facility. Employee E2 stated that it was noticed that the temperatures were approaching a dangerous zone and an air condition rental company was contacted and water-cooled portable air conditioners for each unit (three on each floor) were rented. Employee E2 had a HVAC
(heating, ventilation and air conditioning) service company come to the facility earlier during the day on July 9, 2024, to clean the air condition tower and tubing. Employee E2 stated that "the air condition is fully working".
Review of portable air conditioners manufacturer's documentation revealed that the "protable air conditioners offer an extremely efficient and effective way to control the climate in any sized room. Because water cooled air conditioners do not discharge large amounts of heat, they do not require exhaust ducting and are used to great effect in enclosed areas. Portable air conditioner units that are water cooled simply require access to an appropriate power source, a source of water, and a drain. Our units ship with hoses as an accessory. They will connect to any standard sink but can also be used in janitor and utility sinks or used with any other type of wastewater outlet".
Review of the facility tempeture logs for July 8, 2024, revealed temperatures above 81 degrees Fahrenheit and as high 87.6 degrees Fahrenheit. Further review of temperature logs revealed that there were missing temps on June 29, 2024, and June 30, 2024, July 4, 2024 and July 5, 2024.
-Interview with Resident R1 on July 9, 2024, at 9:40 a.m. revealed that the room has had no air condition for five days, and it has been really very hot, and difficult to breath.
-Interview with Resident R2 on July 9, 2024, at 9:51a.m. revealed that the temperature has been too hot, with no relief.
-Interview with Resident R3 on July 9, 2024, 9:59 a.m. revealed that the temperature has been so hot, Resident R3 has not been able to sleep.
-Interview with Resident R4 on July 9, 2024, 10:05 a.m. revealed that it has been really very hot the last few days. Resident R4 was observed with no fan in the room and requested a fan at the time of the interview.
-Interview with Resident R5 on July 9, 2024, 10:11 a.m. revealed that his room tempeture is too hot, has been for a week.
-Interview with Resident R6 on July 9, 2024, 10:18 a.m. revealed that it has been a little hot. Resident R6 observed with no fan in the room and the resident stated that he would like a fan.
-Interview with Resident R7 on July 9, 2024, 10:34 a.m. revealed the he would like it to be cooler.
-Interview with Resident R8 on July 9, 2024, 10:41 a.m. revealed this resident cannot get out of bed and stated it has been hot and that it is hard to breath.
-Interview with Resident R9 on July 9, 2024, 10:45 am stated it has been very uncomfortable.
-Interview with Resident 10, on July 9, 2024, 10:15 a.m. observed in the Third-floor hall sitting in front of the portable air conditioner, states that it's so hot and this is the only way she can get relief.
-Interview with Facility County Ombudsman on July 9, 2024, at 11:05 a.m. revealed he was at the facility to investigate twenty-three complaints of resident with no air condition.
Interview with Nursing Home Administrator, Employee E2 on July 9, 2024, at 2:20 p.m. revealed that the facility's plan to alleviate the heat was to make sure every resident has a working fan and try tabletop portable air cooler that works with ice cubes, and possible cooling blankets. Employee E2 believed that the central air would begin to cool the building.
Tour of the facility nursing units Second and Third floors with Nursing Home Administrator, Employee E2 and Maintenance Assistant Director, Employee E3 on July 10, 2024, at 9:05 a.m. of the Third-floor nursing unit revealed two portable air conditioners on each wing (three total). One portable air conditioner was not functioning properly.
Observation and test of air temperatures with the facility's thermometer revealed the following air temperatures:
Room 225 temped at 84.2 degrees Fahrenheit
Room 308 temped at 86.3 degrees Fahrenheit
Room 310 temped at 86.1 degrees Fahrenheit
Room 313 temped at 85.6 degrees Fahrenheit
Room 321 temped at 87.9 degrees Fahrenheit
Room 323 temped at 86.9 degrees Fahrenheit
Room 325 temped at 84.7 degrees Fahrenheit
Room 326 temped at 86.9 degrees Fahrenheit
Interview with Regional owner, Employee E1 and Nursing Home Administrator, Employee E2 on July 10, 2024, at 2:00 p.m. confirmed the above air temperatures in resident rooms and that the portable air conditioners in the halls, fans, air chillers, and the facility central air condition has not improved the air temperatures.
Interviews conducted with 10 residents revealed that it was difficult to breath, the room temperature was too hot, they were unable to sleep due to the hot temperatures in their room and they felt uncomfortable. The facility received 23 complaints from residents with no air conditioning in their rooms. In accordance with https://www.timeanddate.com/weather/usa/philadelphia the temperatures in the Philadelphia region from July 6-11, 2024 range from 91 degrees Fahrenheit to 97 degrees Fahrenheit. "The increased age and comorbidities of the residents in the facility make them more susceptible to serious adverse outcomes related to reduced cardiovascular physiological reserves, an impaired sense of thirst, and compromised regulatory systems due to senile degeneration. In addition to medications that the residents' are receiving.
Based on the above findings Immediate Jeopardy to the safety of the residents was identified to the Nursing Home Administrator on July 10, 2024, at 1:04 p.m. for failure to maintain comfortable air temperatures between 71 degrees Fahrenheit and 81 degrees Fahrenheit in two of two nursing floors. The Nursing Home Administrator was provided with the Immediate Jeopardy template on July 10, 2024, at 1:04 p.m. and an immediate action plan was requested.
The following action plan was received and accepted on July 10, 2024, at 7:37 p.m.
-On July 10, 2024, the facility initiated a comprehensive Quality assurance, performance Improvement Plan to ensure that the facility's central air conditioning systems is maintained in operational conditions.
-Residents that resided in affected rooms were offered a room move and declined. The were informed that if they were uncomfortable and would like to move rooms at any time to inform facility staff.
-Plumbing company on sight July 10, 2024, at approximately 09:00 a.m. to address concerns relating to the cooling unit.
-Portable cooling units provided by industrial rental company were placed in the affected areas to assist with maintaining temperatures.
-Hydration Stations were placed in the resident's common areas by the culinary staff on July 9, 2024.
-Additional portable cooling systems were installed appropriately in the affected resident rooms on July 10, 2024.
-The maintenance director re-tested affected rooms after proper installation of portable cooling systems and rooms were confirmed to be within appropriate range.
-Facility temperatures will be checked every shift to ensure that they are within appropriate range along with resident interviews to ensure that they are comfortable with the current temperatures.
-If the facility room affected does not meet and maintain the appropriate temperatures the facility will initiate the emergency plan to include closure of the affected rooms and mandated movement of residents to functioning rooms.
-A contract was entered into with HVAC company to ensure continuous operation of the central cooling system on July 10, 2024.
-A part for the non-operational chillers required for repair was ordered on July 9, 2024, and is scheduled to be installed on Friday, July 12, 2024. Once installed and operational, the second chiller requiring repair/ cleaning will be taken out of service and repaired as well as cleaned.
-An Ad Hoc QAPI meeting was held on July 10, 2024 to discuss the events surrounding the facility's failure to ensure that the temperatures in the facility were maintained between 71-81 degrees Fahrenheit, to identify the root cause, and to initiate improvements to the facility's processes and procedures regarding ensuring that temperatures are appropriately maintained in the facility, the facility has a plan in place when temperatures are not maintained and to ensure that the central cooling system has a routine maintenance plan in place to address cleaning of the system and routine maintenance and repairs to ensure that the system remain in operational status.
-The Southeastern Pennsylvania Healthcare Coalition was notified via phone on July 10, 2024.
A review of air temperature audits was completed on July 11, 2024, revealed that air temperatures on the Second and Third floor were maintained below 81 degrees.
Observation on July 11, 2024, between 2:30-3:30 p.m. revealed that portable air conditioners units were placed at each resident room.
It was confirmed that a signed contract was secured by the facility with an HVAC company for the extended of 3 years.
Following verification of the implementation of the immediate action plan, review the Immediate Jeopardy was lifted on July 11, 2024, at 3:37 p.m.
Refer to F908
28 Pa. Code 201.14(a) Responsibility of licensee
28 Pa. Code 201.18(b)(1) Management
28 Pa. Code 201.18(b)(3) Management
| | Plan of Correction - To be completed: 08/14/2024
1. Resident 1, Resident 2, Resident 3, Resident #4, Resident #5, Resident #6, Resident #7, Resident #8, Resident #9, Resident #10 were provided with portable air conditioners.
2. Other resident's rooms with a temperature of 81 degrees or above were provided with portable air conditioners.
3. The service contract with Carrier was signed by the Director of Operations on 07.10.2024. Service will be scheduled with the manufacturer as per their recommendations and contract. Plumbing vendor restored the air conditioning flow to resident rooms and hallways on 07.10.2024. Staff will be educated to report quickly to NHA/designee that any resident area or room is hot, and if residents complain that their room is hot
4. Temperatures will be monitored at 3 times per day x4 weeks, 2x per day for x 4 weeks, 1 x per day for two months to ensure temperatures remain at the required 71-81 degrees. Results of temperature logs will be reported QAPI monthly x 4 months for review and further recommendations.
|
|
