Nursing Investigation Results -

Pennsylvania Department of Health
MANORCARE HEALTH SERVICES-POTTSTOWN
Patient Care Inspection Results

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MANORCARE HEALTH SERVICES-POTTSTOWN
Inspection Results For:

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MANORCARE HEALTH SERVICES-POTTSTOWN - Inspection Results Scope of Citation
Number of Residents Affected
By Deficient Practice
Initial comments:
Based on a Medicare/Medicaid Recertification survey, State Licensure survey, and Civil Rights Compliance survey completed January 31, 2020, it was determined that Manorcare Health Services-Pottstown, 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.


 Plan of Correction:


483.24(a)(2) REQUIREMENT ADL Care Provided for Dependent Residents: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.
483.24(a)(2) A resident who is unable to carry out activities of daily living receives the necessary services to maintain good nutrition, grooming, and personal and oral hygiene;
Observations:

Based on clinical record review, observation, and resident interview, it was determined that the facility failed to ensure that personal hygiene was provided to two of 24 sampled residents. ( Residents 44, 203)

Findings include:

Clinical record review revealed that Resident 44 had a diagnoses that included dementia. Review of the Minimum Data Set Assessment dated November 29, 2019, revealed that the resident had memory impairment and required extensive assistance from staff for personal hygiene. On January 28, 2020, at 11:39 a.m., January 29, 2020, at 11:00 a.m., and on January 30, 2020 at 11:55 a.m., Resident 44 was observed in the dining room with long dirty fingernails.

Clinical record review revealed that Resident 203 was admitted to the facility on January 17, 2020, and had a diagnoses that included muscle weakness and heart failure. Review of the care plan revealed the resident required assistance from staff for personal hygiene and bathing. In an interview on January 28, 2020, at 10:05 a.m., the resident stated, "I have not taken a bath and my private area stinks down there". The resident then removed her socks and stated, "Look at my toenails, they're long and jagged". Further clinical review revealed the resident was not provided a bath since admission.

In an interview on January 30, 2019 at 1:30 p.m., the Director of Nursing confirmed Resident 44 nails were not cut, and Resident 203 was not assisted with personal hygiene for bathing and toenail care.

28 Pa. Code 211.12(d)(5) Nursing Services











 Plan of Correction - To be completed: 03/03/2020

1) Resident #44 nails were cut and Resident #203 is being offered showers and is being followed but the podiatrist.
2) Utilizing the ADL QAPI tool residents were reviewed for nail care needs and shower schedules.
3) The facility will take educate Nursing staff utilizing the focus on F tag 677 ADL care provided to dependent residents.
4) Random audits will be conducted weekly time 4 weeks and monthly times two thereafter. Results will be submitted to QA&A for review and recommendations.
5) March 3

483.24(c)(1) REQUIREMENT Activities Meet Interest/Needs Each Resident: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.
483.24(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.
Observations:

Based on observations and clinical record review, it was determined that the facility failed to implement an activity program designed to meet resident needs and preferences for one of 24 sampled residents. (Resident 15)

Findings include:

Clinical record review revealed that Resident 15 had diagnoses that included left above the amputation. The admission Minimum Data Set assessment dated November 6, 2019, revealed that the resident had cognitive impairment and activities of interest included reading, listening to music, being with animals, keeping up with the news, and religious activities.

Observation on January 28, 2020 from 10:30 a.m. through 1:45 p.m., Janaury 29, 2020 from 9:45 a.m. through 2:10 p.m. and January 31, 2020 at 10:34 a.m. revealed Resident 15 was in bed.

A review of Resident 15's individual activity participation record from November 2019, through January 2020, revealed limited activity participation. There was no indication that the facility provided the resident with sensory stimulation and resources such as current events, intellectual/cognitive programs, books, newspapers, pet visits, or spiritual/ religious activities to allow the resident to pursue independent preferred activities.

In interview on January 30, 2020 at 1:45 p.m., the Activities Director confirmed there was no plan of care developed and implemented for an individualized program of activities for Resident 15.







 Plan of Correction - To be completed: 03/03/2020

1) Care plan for resident #15 was created to ensure that he is receiving activities based on preferences and needs.
2) A comprehensive review of all resident's care plans will be conducted to ensure that an individualized program of activities is being provided.
3) The facility will educate activity staff on Focus on F tag 679 activities
4) Random audits will be conducted to ensure they are receiving activities that meet their needs and preferences. Audits will be conducted weekly times 4 and monthly times two. Results will be submitted to QA&A for review and recommendations.
5)March 3

483.10(i)(1)-(7) REQUIREMENT Safe/Clean/Comfortable/Homelike Environment:Least serious deficiency but affects more than a limited number of residents, staff, or occurrences. This deficiency has the potential for causing no more than a minor negative impact on the resident but is not found to be throughout this facility.
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 81F; and

483.10(i)(7) For the maintenance of comfortable sound levels.
Observations:


Based on observation, it was determined that the facility failed to provide a safe, clean, and comfortable environment on one of four nursing units (Third Floor).

Findings include:

Observations of the third floor nursing unit on January 28, 2020, at 10:51 a.m., revealed the following.

Heating units had a build up of dirt and dust in the hallway and rooms 313, 315, 317, 326, 327, 328, 329.

The window sills had chipped paint and dirt in hallways and rooms 313, 315, 317, 326, 327, 328, 329 and resident hallway.

In room 315 the bathroom floor was diry and had a dried liquid substance on it.

In room 329 there was paint coming loose from ceiling.

In the Hallway ceiling lights had bugs.

The central bath entrance had tile missing from the floor.

In the Hallway there was wall paper coming loose from the walls.

28 Pa. code 211.12 (d)(1) Nursing Services
Previously cited 3/30/2018, 10/26/2017
















 Plan of Correction - To be completed: 03/03/2020

1)The heating units have been cleaned and the window sills have been repainted in rooms 313,315,317,326,327,328, and 329. Room 315's bathroom was cleaned. The ceiling in room 329 was repainted. The bugs were removed from the hallway ceiling lights. The tile by the central bath entrance, and the wall paper in the hallway was replaced.

2) Utilizing the Environmental QAPI tool rounds will be completed with the Admin/ housekeeping director and the maintenance directory to identify chipped paint, stained heating unit, wallpaper pealing, and insects in light fixtures.

3) The facility will take further steps to make sure that the issue is maintained by conducting weekly rounds times 4 weeks and monthly thereafter with the admin, housekeeping director and maintenance director. Results will be submitted to QA&A for review and recommendations.

4)March 3

483.10(g)(17)(18)(i)-(v) REQUIREMENT Medicaid/Medicare Coverage/Liability Notice:Least serious deficiency and is isolated to the fewest number of residents, staff, or occurrences. This deficiency has the potential for causing no more than a minor negative impact on the resident.
483.10(g)(17) The facility must--
(i) Inform each Medicaid-eligible resident, in writing, at the time of admission to the nursing facility and when the resident becomes eligible for Medicaid of-
(A) The items and services that are included in nursing facility services under the State plan and for which the resident may not be charged;
(B) Those other items and services that the facility offers and for which the resident may be charged, and the amount of charges for those services; and
(ii) Inform each Medicaid-eligible resident when changes are made to the items and services specified in 483.10(g)(17)(i)(A) and (B) of this section.

483.10(g)(18) The facility must inform each resident before, or at the time of admission, and periodically during the resident's stay, of services available in the facility and of charges for those services, including any charges for services not covered under Medicare/ Medicaid or by the facility's per diem rate.
(i) Where changes in coverage are made to items and services covered by Medicare and/or by the Medicaid State plan, the facility must provide notice to residents of the change as soon as is reasonably possible.
(ii) Where changes are made to charges for other items and services that the facility offers, the facility must inform the resident in writing at least 60 days prior to implementation of the change.
(iii) If a resident dies or is hospitalized or is transferred and does not return to the facility, the facility must refund to the resident, resident representative, or estate, as applicable, any deposit or charges already paid, less the facility's per diem rate, for the days the resident actually resided or reserved or retained a bed in the facility, regardless of any minimum stay or discharge notice requirements.
(iv) The facility must refund to the resident or resident representative any and all refunds due the resident within 30 days from the resident's date of discharge from the facility.
(v) The terms of an admission contract by or on behalf of an individual seeking admission to the facility must not conflict with the requirements of these regulations.
Observations:

Based on clinical record review, review of facility documentation, and staff interview, it was determined that the facility failed to provide a Notice of Medicare Non-Coverage (NOMNC) to the resident or the resident's representative following the end of their Medicare coverage for one of three sampled residents who were discontinued from Medicare Part A with benefit days remaining (Resident 255)

Findings include:

Clinical record review revealed that Resident 255 received Medicare Part A services from July 10, 2019, through July 20, 2019. According to the documentation provided by the facility, Resident 255 discontinued from Medicare Part A with benefit days remaining when she elected to discharge and the physician agreed to the discharge. There was no documented evidence that the resident or representative was provided the required NOMNC form (a notice given to Medicare beneficiaries to convey that Medicare is not likely to provide coverage for services in a specific case).







 Plan of Correction - To be completed: 03/03/2020

I hereby acknowledge the CMS 2567-A, issued to MANORCARE HEALTH SERVICES-POTTSTOWN for the survey ending 01/31/2020, AND attest that all deficiencies listed on the form will be corrected in a timely manner.

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