Nursing Investigation Results -

Pennsylvania Department of Health
Patient Care Inspection Results

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Inspection Results For:

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GARDENS AT ORANGEVILLE, THE - Inspection Results Scope of Citation
Number of Residents Affected
By Deficient Practice
Initial comments:

Based on an Abbreviated Complaint survey completed on June 30, 2022, it was determined that the Gardens at Orangeville was not in compliance with the following requirements of 42 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:

483.24(c)(1) REQUIREMENT Activities Meet Interest/Needs Each Resident:This is a less serious (but not lowest level) deficiency and affects more than a limited 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. This deficiency was not found to be throughout this facility.
483.24(c) Activities.
483.24(c)(1) The facility must provide, based on the comprehensive assessment and care plan and the preferences of each resident, an ongoing program to support residents in their choice of activities, both facility-sponsored group and individual activities and independent activities, designed to meet the interests of and support the physical, mental, and psychosocial well-being of each resident, encouraging both independence and interaction in the community.

Based on a review of clinical records, grievances lodged with the facility and the calendar of resident activities and resident and staff interviews, it was determined that the facility failed to provide an ongoing program of activities on the weekends designed to meet the interests, preferences, physical and functional abilities of eight of 8 sampled residents (Residents 28, 39, 48, 64, 69, 76, 79, and 82).

Findings include:

Review of the facility's activity calendar for May 2022 indicated that the weekend activities were planned for Saturday May 7, 2022, Sunday May 15, 2022, Saturday May 28, 2022, and Sunday May 29, 2022.

A review of activity participation logs for Residents 28, 39, 48, 64, 69, 76, 79, and 82 revealed no documentation of resident participation in the above weekend activities. However, a review of activities personnel staffing hours revealed that there was no activity staff available working in the activities department in the facility on those dates and as a result the weekend activities that had been scheduled were not conducted as initially planned on the calendar.

Interview with Employee 1, the activity aide, who is also a nurse aide, conducted on June 30, 2022, revealed that she was scheduled to work as an activities aide on the above dates and conduct the planned activities, but since she is also a nurse aide, the facility had "pulled" her to work as a nurse aide on those dates to meet nursing hours. As a result of the facility reassigning Employee 1 to work as a nurse aide on the weekend dates noted, the planned activities were not conducted as scheduled.

Review of the activity calendars for June 2022 and July 2022 revealed that on the weekends of June 11 and June 12, June 25 and June 26, 2022 and July 9 and July 10, and July 23 and July 24, 2022, only independent resident activities were scheduled and recreation supplies made available in the activity lounge were the planned activities for the residents. No activities were noted Saturday on June 4, 2022.

Interview with the activity director on June 30, 2022 at 10:00 a.m. revealed that scheduling independent activities and noting the availability of recreation supplies in the activity lounge means that there would be no activity staff in the building on the days to conduct activities programming or group activities. The activity director stated that at present there is only one staff member in the facility's activity department.

Review of facility grievances for May 2022 and June 2022 revealed that Resident 79 filed a grievance on June 26, 2022, relaying that he approached the nurses station and inquired where Activity staff were this weekend (June 25 and June 26, 2022). The nurse told the resident that there were no activity staff in the building for the weekend.

During interview with Resident 79 on June 30, 2022 at 11:30 a.m. he stated that he doesn't like many of the activities programming provided by the facility, but his preference was to go outside and sit out there and enjoy the sunshine and air when weather permits. Resident 79 stated that he was unable to go outside as preferred during that weekend, as well as, a few in May 2022, because there was no activity staff available to assist the resident with his preferred outdoor activities.

During interview with Residents 28, 39, 64, 69, 76, and 82 on June 30, 2022, each resident stated that they did not go to the activity room for independent activities on the weekends or get supplies on the weekends. The residents stated that they mostly watched TV on the weekend and one resident (who wanted to remain annoymous) stated that she "just stared out the window."

Interview with the Administrator on June 30, 2022 at 1:15 p.m. confirmed that no activities programming was provided on May 7, 2022, May 15, 2022, May 28, 2022, and May 29, 2022 due to lack of activities staff. The Administrator also confirmed that only independent activities and access to supplies were planned on the weekends during June 2022 and July 2022. The NHA also verified that the facility reassigned the one activity aide to work as a nurse aide and therefore group and/or structured activities programming were not conducted.

28 Pa. Code 201.18(e)(6) Management

28 Pa. Code 201.29 (i)(j) Resident rights

 Plan of Correction - To be completed: 07/26/2022

The facility cannot retroactively address the concerns identified.
The last two weekend activity calendar and participation logs will be reviewed to determine the activities calendar were provided as offered.
Residents will be offered and provided with weekend activities to attend as they desire. Activity calendar will be posted on the units and in each residents room.
Weekend supervisors will ensure the activity programs as scheduled are being provided. In the event the activities cannot be provided, education will be provided to the nursing supervisors to notify the on call administration.
Activity calendar for the weekend schedule and the activity participation logs will be reviewed weekly x4, then monthly x2.
Results to QA for review and recommendations.

211.12(i) LICENSURE Nursing services.:State only Deficiency.
(i) A minimum number of general nursing care hours shall be provided for each 24-hour period. The total number of hours of general nursing care provided in each 24-hour period shall, when totaled for the entire facility, be a minimum of 2.7 hours of direct resident care for each resident.

Based on review of facility nurse staffing data, it was determined that the facility failed to maintain a minimum of 2.7 hours of direct resident care for each resident.

Findings include:

A review of facility nurse staffing data, including deployment sheets from June 13, 2022, through June 29, 2022, revealed that the facility's 24 hour daily nurse staffing nurse staffing was below 2.7 hrs per resident on the following day:

June 26, 2022 - general nursing hours of direct resident care for each resident was 2.65

Interview with the Administrator on June 30, 2022 at 1:30 p.m. confirmed the lack of minimum nursing hours on the above date.

 Plan of Correction - To be completed: 07/26/2022

Nursing hours for June 26, 2022 cannot be corrected as this is a past event.
Calculation of daily PPD will be completed and reviewed daily for accuracy by scheduler and back up scheduler. The facility has developed internal incentives to retain and attract new staff. Agency contracts opened in an effort to reach daily PPD. Monitoring projections to enable more time to replenish PPD as needed.
Daily PPD will be audited weekly x4, then monthly x2.
Results to QA for review and recommendations.

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