Nursing Investigation Results -

Pennsylvania Department of Health
LAURELWOOD CARE CENTER
Patient Care Inspection Results

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LAURELWOOD CARE CENTER
Inspection Results For:

There are  111 surveys for this facility. Please select a date to view the survey results.

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LAURELWOOD CARE CENTER - Inspection Results Scope of Citation
Number of Residents Affected
By Deficient Practice
Initial comments:


Based on a complaint survey completed on February 5, 2020, it was determined that Laurelwood Care Center was not in compliance with the following requirements of 42 CFR 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(a)(1)(b)(1)-(5)(i)-(iii) REQUIREMENT Activities Daily Living (ADLs)/Mntn Abilities: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(a) Based on the comprehensive assessment of a resident and consistent with the resident's needs and choices, the facility must provide the necessary care and services to ensure that a resident's abilities in activities of daily living do not diminish unless circumstances of the individual's clinical condition demonstrate that such diminution was unavoidable. This includes the facility ensuring that:

483.24(a)(1) A resident is given the appropriate treatment and services to maintain or improve his or her ability to carry out the activities of daily living, including those specified in paragraph (b) of this section ...

483.24(b) Activities of daily living.
The facility must provide care and services in accordance with paragraph (a) for the following activities of daily living:

483.24(b)(1) Hygiene -bathing, dressing, grooming, and oral care,

483.24(b)(2) Mobility-transfer and ambulation, including walking,

483.24(b)(3) Elimination-toileting,

483.24(b)(4) Dining-eating, including meals and snacks,

483.24(b)(5) Communication, including
(i) Speech,
(ii) Language,
(iii) Other functional communication systems.
Observations:


Based on review of facility policies, shower schedules, and clinical records, as well as resident and staff interviews, it was determined that the facility failed to provide care and services to maintain personal hygiene by failing to provide scheduled showers for five of eight residents reviewed (Residents 1, 2, 3, 4, 6).

Findings include:

The facility's policy regarding showers/bathing, dated December 16, 2019, indicated that all residents would be offered/provided a shower at least one time weekly.

A quarterly Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) for Resident 1, dated January 17, 2020, indicated that the resident was cognitively intact and dependent on staff for bathing. The facility's current (undated) shower schedule for the East Hall indicated that Resident 1 was to receive a shower during the day shift (7:00 a.m. to 3:00 p.m.) on Sundays. The resident's shower records for January 4 through February 2, 2020, revealed that the resident did not receive a shower on Sundays, January 5 and 19, 2020, and there was no documented evidence that the showers were offered and refused by the resident.

Interview with Resident 1 on February 2, 2020, at 8:30 a.m. confirmed that she did not receive her showers as scheduled, and that staff told her that they were "too busy" and she would get a shower the next day. The resident stated that she did not receive any showers during the following days and that she really wanted to have showers. She also stated that even one shower a week was not sufficient.

A comprehensive MDS assessment for Resident 2, dated January 8, 2020, indicated that the resident was cognitively impaired and dependent on staff for bathing. The facility's current shower schedule (undated) for the East Hall indicated that Resident 2 was to receive a shower during the evening shift (3:00 p.m. to 11:00 p.m.) on Saturdays. The resident's shower records for January 4 through February 2, 2020, revealed that the resident did not receive a shower on Saturdays, January 11, 18 and 25, and February 1, 2020, and there was no documented evidence that the showers were offered and refused by the resident.

Interview with Resident 2 on February 2, 2020, at 9:35 a.m. revealed that she did not always receive her showers, and she did not know why.

A quarterly MDS assessment for Resident 3, dated January 7, 2020, indicated that the resident was cognitively impaired, not able to respond to questions, and was dependent on staff for bathing. The facility's current shower schedule (undated) for the South Hall indicated that Resident 3 was to receive a shower during the evening shift on Wednesdays. The resident' shower records for January 4 through February 2, 2020, revealed that the resident did not receive a shower on Wednesdays, January 22 and 29, 2020, and there was no documented evidence that the shower was offered and refused by the resident.

A comprehensive MDS assessment for Resident 4, dated December 24, 2019, indicated that the resident was cognitively intact and dependent on staff for bathing. The facility's current shower schedule (undated) for the South Hall indicated that Resident 4 was to receive a shower during the day shift on Thursdays. The resident's shower records for January 4 through February 2, 2020, revealed that the resident did not receive a shower on Thursday, January 9, 2020, and there was no documented evidence that the shower was offered and refused by the resident.

Interview with the Resident 4 on February 2, 2020, at 9:45 a.m. revealed that she did not refuse the shower on January 9, 2020, and that staff told her that they were too busy to shower her. She stated she was scheduled to have a shower once a week and she wants to be showered as scheduled.

A comprehensive MDS assessment for Resident 6, dated January 17, 2020, indicated that the resident was cognitively intact and required extensive assistance from staff for bathing. The facility's current shower schedule (undated) for the West Hall indicated that Resident 6 was to receive a shower during the day shift on Tuesdays. The resident's shower records for January 4 through February 2, 2020, revealed that the resident did not receive a shower on Tuesday, January 28, 2020, and there was no documented evidence that the shower was offered and refused by the resident.

Interview with Resident 6 on February 2, 2020, at 1:05 p.m. revealed that she did not refuse the shower on January 28, 2020, that she did not know why she was not showered, and that she wanted to be showered as scheduled.

Interview with Licensed Practical Nurse 1 on February 2, 2020, at 2:55 p.m. revealed that she was told by nurse aides that they have not given scheduled showers due to not having enough time related to not having enough staff on the unit.

Interviews with Nurse Aides 2 and 3 on February 2, 2020, at 3:00 p.m. and with Nurse Aide 4 on February 2, 2020, at 3:04 p.m. confirmed that there were times when residents did not receive scheduled showers due to not having sufficient staff on the unit.

Interviews with Nurse Aide 5 on February 2, 2020, at 3:08 p.m. and with Nurse Aide 6 on February 2, 2020, at 3:20 p.m. confirmed that there were times when residents did not receive scheduled showers due to not having sufficient staff.

Interview with Licensed Practical Nurse 7 on February 2, 2020, at 3:24 p.m. confirmed that staff did not always provide scheduled showers due to not having sufficient staff on the unit.

Interview with Nurse Aide 8 on February 2, 2020, at 3:28 p.m. confirmed that there were times when residents did not receive scheduled showers due to not having sufficient staff on the unit. She indicated that at times there was only one nurse aide on the unit and it was not possible to take residents to the other unit to shower them, as there was no one else on the unit to answer call bells and provide care to the residents.

Interview with the Director of Nursing on February 2, 2020, at 10:00 a.m. confirmed that there was no documented evidence that the above residents received showers as scheduled, and that the residents should receive their showers as scheduled.

28 Pa. Code 211.12(d)(5) Nursing services.
Previously cited 10/30/19, 7/12/19.



 Plan of Correction - To be completed: 03/17/2020

This Plan of Correction constitutes our written allegation of compliance for the deficiencies cited. However, submission of this Plan of Correction is not an admission that a deficiency exists or that one was cited correctly. This Plan of Correction is submitted to meet requirements established by state and federal law.

1. R1, R2, R3, R4 have received their showers on their preferred shower date. R6 no longer resides in the facility.
2. Each resident's shower preference has been established and noted in their plan of care. Resident shower schedules/preferences have been added to the tasks in Point of Care tracking system which is an electronic nursing task system utilized to assign, track and record activities of daily living such as bathing for individual residents.
3. Education with nursing staff of F676 with a focus on resident received showers per preference/scheduled. Education will also be provided to any new nursing staff and/or temporary staff the facility may contract for.
4. Audits will be completed by the Director of Nursing/Designee weekly X4; monthly X2 and then randomly. Results of monitoring will be reported to the Quality Assurance Performance Improvement Committee.
5. Date of compliance is March 17, 2020.

483.45(f)(2) REQUIREMENT Residents are Free of Significant Med Errors: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.
The facility must ensure that its-
483.45(f)(2) Residents are free of any significant medication errors.
Observations:


Based on clinical record reviews and staff interviews, it was determined that the facility failed to ensure that it was free from significant medication errors for one of eight residents reviewed (Resident 3).

Findings include:

A quarterly Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) for Resident 3, dated January 7, 2020, revealed that the resident had diagnoses that included diabetes (a disease that interferes with blood sugar control) and received insulin (medication that lowers blood sugar levels).

Physician's orders for Resident 3, dated October 29, 2019, included an order for the resident to receive 10 units of Novolin R insulin (short-acting insulin used to lower blood sugar levels) subcutaneously (injected just under the skin) before meals, which included a scheduled administration time of 4:30 p.m. Orders dated October 29, 2019, included that the resident was to receive 5 units of Novolin R insulin subcutaneously in the morning, which was scheduled for 8:00 a.m. The orders indicated that the insulin was to be held (not given) if the resident's blood sugar reading was below 150 milligrams per deciliter (mg/dL).

Resident 3's Medication Administration Record (MAR) for January 2020 revealed that Novolin R insulin was not held as ordered by the physician and 5 units was administered at 8:00 a.m. for blood sugar levels that were below 150 mg/dL as follows:
January 2 - 144 mg/dL
January 3 - 131 mg/dL
January 7 - 120 mg/dL
January 10 - 115 mg/dL
January 16 - 134 mg/dL
January 24 - 128 mg/dL

Resident 3's MAR for January 2020 revealed that Novolin R insulin was not held as ordered by the physician and 5 units was administered at 4:30 p.m. for blood sugar levels that were below 150 mg/dL as follows:
January 3 - 119 mg/dL
January 10 - 123 mg/dL
January 13 - 103 mg/dL
January 18 - 142 mg/dL
January 23 - 111 mg/dL
January 24 - 117 mg/dL

Interviews with Registered Nurse 12 and the Director of Nursing on February 3, 2020, at 8:57 a.m. and 10:00 a.m., respectively, confirmed that staff should not have administered Novolin R insulin to Resident 3 on the above dates/times because the resident's blood sugar level was below 150 mg/dL.

42 CFR 483.45(f)(2) Residents Are Free of Significant Med Errors.
Previously cited 7/12/19.

28 Pa. Code 211.12(d)(1) Nursing services.
Previously cited 10/30/19, 7/12/19.

28 Pa. Code 211.12(d)(5) Nursing services.
Previously cited 10/30/19, 7/12/19.




 Plan of Correction - To be completed: 03/17/2020

1. R3's insulin has been administered as per order.
2. Residents that receive Regular insulin (medication used to control diabetes) with sliding scales with parameters (used to approximate daily insulin requirements) have been reviewed to ensure that the proper dose is being administered. Residents with sliding scale insulin (used to approximate daily insulin requirements) medication administration records will be reviewed to ensure orders are being followed.
3. Education on F760 with a focus on medications with parameters. Education will also be provided to any new nursing staff and/or temporary staff the facility may contract for. Individual performance and compliance with F760 will be monitored and include additional re-training and/or corrective action as indicated.
4. Audits will be completed by the Director of Nursing/Designee weekly X4; monthly X2 and then random following. The Director of Education/Designee will review competency records of training for licensed staff to ensure completion/status of training. Results of monitoring will be reported to the Quality Assurance Performa

483.35(a)(1)(2) REQUIREMENT Sufficient Nursing Staff: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.
483.35(a) Sufficient Staff.
The facility must have sufficient nursing staff with the appropriate competencies and skills sets to provide nursing and related services to assure resident safety and attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident, as determined by resident assessments and individual plans of care and considering the number, acuity and diagnoses of the facility's resident population in accordance with the facility assessment required at 483.70(e).

483.35(a)(1) The facility must provide services by sufficient numbers of each of the following types of personnel on a 24-hour basis to provide nursing care to all residents in accordance with resident care plans:
(i) Except when waived under paragraph (e) of this section, licensed nurses; and
(ii) Other nursing personnel, including but not limited to nurse aides.

483.35(a)(2) Except when waived under paragraph (e) of this section, the facility must designate a licensed nurse to serve as a charge nurse on each tour of duty.
Observations:


Based on review of facility policies, shower schedules, and clinical records, as well as resident and staff interviews, it was determined that the facility failed to have sufficient nursing staff to provide showers as scheduled for five of eight residents reviewed (Residents 1, 2, 3, 4, 6).

Findings include:

The facility's policy regarding showers/bathing, dated December 16, 2019, indicated that all residents would be offered/provided a shower at least one time weekly.

A quarterly Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) for Resident 1, dated January 17, 2020, indicated that the resident was cognitively intact and dependent on staff for bathing. The facility's current (undated) shower schedule for the East Hall indicated that Resident 1 was to receive a shower during the day shift (7:00 a.m. to 3:00 p.m.) on Sundays. The resident's shower records for January 4 through February 2, 2020, revealed that the resident did not receive a shower on Sundays, January 5 and 19, 2020, and there was no documented evidence that the showers were offered and refused by the resident.

Interview with Resident 1 on February 2, 2020, at 8:30 a.m. confirmed that she did not receive her showers as scheduled, and that staff told her that they were "too busy" and she would get a shower the next day. The resident stated that she did not receive any showers during the following days, and that she really wanted to have showers. She also stated that even one shower a week was not sufficient.

A comprehensive MDS assessment for Resident 2, dated January 8, 2020, indicated that the resident was cognitively impaired and dependent on staff for bathing. The facility's current shower schedule (undated) for the East Hall indicated that Resident 2 was to receive a shower during the evening shift (3:00 p.m. to 11:00 p.m.) on Saturdays. The resident's shower records for January 4 through February 2, 2020, revealed that the resident did not receive a shower on Saturdays, January 11, 18 and 25, and February 1, 2020, and there was no documented evidence that the showers were offered and refused by the resident.

Interview with Resident 2 on February 2, 2020, at 9:35 a.m. revealed that she did not always receive her showers, and she did not know why.

A quarterly MDS assessment for Resident 3, dated January 7, 2020, indicated that the resident was cognitively impaired, not able to respond to questions, and was dependent on staff for bathing. The facility's current shower schedule (undated) for the South Hall indicated that Resident 3 was to receive a shower during the evening shift on Wednesdays. The resident' shower records for January 4 through February 2, 2020, revealed that the resident did not receive a shower on Wednesdays, January 22 and 29, 2020, and there was no documented evidence that the shower was offered and refused by the resident.

A comprehensive MDS assessment for Resident 4, dated December 24, 2019, indicated that the resident was cognitively intact and dependent on staff for bathing. The facility's current shower schedule (undated) for the South Hall indicated that Resident 4 was to receive a shower during the day shift on Thursdays. The resident's shower records for January 4 through February 2, 2020, revealed that the resident did not receive a shower on Thursday, January 9, 2020, and there was no documented evidence that the shower was offered and refused by the resident.

Interview with the Resident 4 on February 2, 2020, at 9:45 a.m. revealed that she did not refuse the shower on January 9, 2020, and that staff told her that they were too busy to shower her. She stated that she was scheduled to have a shower once a week and she wants to be showered as scheduled.

A comprehensive MDS assessment for Resident 6, dated January 17, 2020, indicated that the resident was cognitively intact and required extensive assistance from staff for bathing. The facility's current shower schedule (undated) for the West Hall indicated that Resident 6 was to receive a shower during the day shift on Tuesdays. The resident's shower records for January 4 through February 2, 2020, revealed that the resident did not receive a shower on Tuesday, January 28, 2020, and there was no documented evidence that the shower was offered and refused by the resident.

Interview with the Resident 6 on February 2, 2020, at 1:05 p.m. revealed that she did not refuse the shower on January 28, 2020, that she did not know why she was not showered, and that she wanted to be showered as scheduled.

Interview with Licensed Practical Nurse 1 on February 2, 2020, at 2:55 p.m. revealed that she was told by nurse aides that they have not given scheduled showers due to not having enough time related to not having enough staff on the unit.

Interviews with Nurse Aides 2 and 3 on February 2, 2020, at 3:00 p.m. and with Nurse Aide 4 on February 2, 2020, at 3:04 p.m. confirmed that there were times when residents did not receive scheduled showers due to not having sufficient staff on the unit.

Interview with Nurse Aide 5 on February 2, 2020, at 3:08 p.m. confirmed that there were times when residents did not receive scheduled showers due to not having sufficient staff. She also stated that when she was assigned to be one-on-one (one staff member assigned to one specific resident on a continuous basis) with a resident, there were times that she had to take the resident into the restroom with her when she needed to use the toilet because there were not staff available to monitor the resident while she took a break.

Interview with Nurse Aide 6 on February 2, 2020, at 3:20 p.m. confirmed that there were times when residents did not receive scheduled showers due to not having sufficient staff.

Interview with Licensed Practical Nurse 7 on February 2, 2020, at 3:24 p.m. confirmed that staff did not always provide scheduled showers due to not having sufficient staff on the unit.

Interview with Nurse Aide 8 on February 2, 2020, at 3:28 p.m. confirmed that there were times when residents did not receive scheduled showers due to not having sufficient staff on the unit. She indicated that at times there was only one nurse aide on the unit and it was not possible to take residents to the other unit to shower them, as there was no one else on the unit to answer call bells and provide care to the residents.

Interview with the Director of Nursing on February 2, 2020, at 10:00 a.m. confirmed that there was no documented evidence that the above residents received showers as scheduled, and that the residents should receive their showers as scheduled.

28 Pa. Code 201.18(e)(1) Management.
Previously cited 10/30/19, 7/12/19.

28 Pa. Code 211.12(d)(5) Nursing services.
Previously cited 10/30/19, 7/12/19.



 Plan of Correction - To be completed: 03/17/2020

1. R1, R2, R3 and R4 have received bathing according to resident plan of care. R6 no longer resides in the facility.
2. The facility will evaluate census, acuity and diagnosis of resident population daily and as needed in order to assign staff. Resident care plans have been reviewed to confirm residents request regarding bathing.
3. Nursing staff will be re-educated on resident rights, preferences, care plan and facility policy and procedure regarding documentation (including refusal of care). Education will also be provided to any new nursing staff and/or temporary staff the facility may contract for.
4. Audits will be completed by the Director of Nursing/Designee weekly X4; monthly X2 and then random following. Results of monitoring will be reported to the Quality Assurance Performance Improvement Committee.
5. Date of compliance is March 17, 2020.

483.25 REQUIREMENT Quality of Care: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.
483.25 Quality of care
Quality of care is a fundamental principle that applies to all treatment and care provided to facility residents. Based on the comprehensive assessment of a resident, the facility must ensure that residents receive treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the residents' choices.
Observations:


Based on clinical record reviews and staff interviews, it was determined that the facility failed to ensure that medications were administered in accordance with physician's orders for two of eight residents reviewed (Residents 1, 3).

Findings include:

Physician's orders for Resident 1, dated September 23, October 7 and 24, and December 12, 2019, included orders for the resident to receive 300 milligrams (mg) of gabapentin (medication used to treat nerve pain) three times a day (including at bedtime), 5 mg of Melatonin (used to promote sleep) at bedtime for insomnia, 60 mg of duloxetine hydrochloride (medication used to treat nerve pain) two times daily (including at bedtime), 50 mg of trazodone hydrochloride (medication used to treat insomnia) at bedtime, and 50 mg of metoprolol (treats high blood pressure) two times daily (including at bedtime).

Review of Resident 1's Medication Administration Record (MAR) for January 2020 revealed that there was no documented evidence that the above medications were administered as ordered at bedtime on January 1, 11 and 25, 2020.

Physician's orders for Resident 3, dated October 29, 2019, included an order for the resident to receive 10 units of Novolin R insulin (short-acting insulin used to lower blood sugar levels) subcutaneously (injected just under the skin) before meals, which was scheduled for 4:30 p.m. The order indicated that the inulin was to be held if the resident's blood sugar reading was below 150 milligrams/deciliter (mg/dl).

Resident 3's MAR for January 2020 revealed that there was no documented evidence that the resident's blood sugar level was checked at 4:30 p.m. on January 16, 2020, or that the insulin was either administered or held based on the blood sugar level.

Interview with the Director of Nursing on February 2, 2020, at 10:00 a.m. confirmed that there was no documented evidence that the above medications were administered as ordered for Residents 1 and 3.

42 CFR 483.25 Quality of Care.
Previously cited 7/12/19.

28 Pa. Code 211.12(d)(1) Nursing services.
Previously cited 10/30/19, 7/12/19.

28 Pa. Code 211.12(d)(5) Nursing services.
Previously cited 10/30/19, 7/12/19.




 Plan of Correction - To be completed: 03/17/2020

1. R1 and R3 have received their medications as ordered.
2. Medication Administration Records have been reviewed for the previous 2 week period on all residents and proper follow up completed as needed. The daily clinical start-up meeting to include the review of missed medication entries.
3. Education with licensed staff on F684 with focus on medication administration. Education will also be provided to any new nursing staff and/or temporary staff the facility may contract for. Individual performance and compliance with F684 will be monitored and include additional re-training and/or corrective action as indicated.
4. Audits will be completed by the Director of Nursing/Designee weekly X4; monthly X2 and then random following. Results of monitoring will be reported to the Quality Assurance Performance Improvement Committee.
5. Date of compliance is March 17, 2020.

483.45(a)(b)(1)-(3) REQUIREMENT Pharmacy Srvcs/Procedures/Pharmacist/Records: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.
483.45 Pharmacy Services
The facility must provide routine and emergency drugs and biologicals to its residents, or obtain them under an agreement described in 483.70(g). The facility may permit unlicensed personnel to administer drugs if State law permits, but only under the general supervision of a licensed nurse.

483.45(a) Procedures. A facility must provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of each resident.

483.45(b) Service Consultation. The facility must employ or obtain the services of a licensed pharmacist who-

483.45(b)(1) Provides consultation on all aspects of the provision of pharmacy services in the facility.

483.45(b)(2) Establishes a system of records of receipt and disposition of all controlled drugs in sufficient detail to enable an accurate reconciliation; and

483.45(b)(3) Determines that drug records are in order and that an account of all controlled drugs is maintained and periodically reconciled.
Observations:


Based on review of policies and clinical records, as well as staff interviews, it was determined that the facility failed to obtain medications from the pharmacy or the facility's emergency medication supply in a timely manner for two of eight residents reviewed (Residents 6, 7).

Findings include:

The facility's policy regarding pharmacy hours and delivery schedules, and the policy for arrangement with non-contract pharmacy, dated December 16, 2019, indicated that the facility would receive deliveries from the contracted pharmacy (main pharmacy used by the facility to routinely obtain medications) at least once a day Monday through Saturday, excluding holidays. Emergency deliveries for medications that needed to be administered immediately may be arranged through the contracted pharmacy or a non-contract pharmacy (a local pharmacy used to obtain medications in a timely manner), if necessary. The non-contract pharmacy was to provide routine and timely pharmacy services. If a medication delivery was delayed and/or arrival was uncertain, the facility was to be notified and the contracted pharmacy may then be requested by the facility to fill an emergency order.

A nursing note for Resident 6, dated January 10, 2020, at 5:59 p.m. revealed that the resident was admitted to the facility with diagnoses that included epilepsy (disease that causes seizures). Physician's orders, dated January 10, 2020, included an order for the resident to receive 10 milligrams (mg) of clobazam (medication used to treat epilepsy) and 20 mg at bedtime. The resident's Medication Administration Record (MAR) for January 2020 revealed that the resident did not receive clobazam at bedtime on January 10, 2020, or in the morning of January 11, 2020. There was no documented evidence that the contracted pharmacy or the non-contract pharmacy were contacted to attempt to obtain the medication in a timely manner, and there was no documented evidence that the physician was notified that the medication was not administered as ordered.

A nursing note for Resident 7, dated January 14, 2020, indicated that the resident arrived at the facility at 6:22 p.m. Physician's orders dated January 14, 2020, included an order for the resident to receive 80 mg of atorvastatin calcium (medication used to lower cholesterol) at bedtime. The resident's MAR for January 2020 revealed that atorvastatin calcium was not given at bedtime on January 14, 2020.

A current inventory sheet for the facility's emergency medication kit (undated), provided by the facility on February 3, 2020, revealed that atorvastatin was available in 10 mg tablets.

There was no documented evidence of any attempts to obtain atorvastatin for Resident 7 in a timely manner from the contracted pharmacy, from the non-contract pharmacy, or from the facility's emergency medication supply, and no documented evidence that the physician was notified that the medication was not administered as ordered.

Interview with Registered Nurse 13 on February 3, 2020, at 8:57 a.m. revealed that the cut off time for the facility to call the contracted pharmacy and request that they call the non-contract pharmacy to obtain a medication was 5:00 p.m. Staff could also request a STAT medication (emergency delivery of medication) from the contract pharmacy if necessary.

Interview with the Director of Nursing on February 3, 2020, at 12:05 p.m. confirmed that there was no documented evidence that nursing staff attempted to obtain necessary medications from the contracted pharmacy, the non-contract pharmacy, and/or the facility's emergency medication kit in a timely manner. She indicated that there was a non-contract pharmacy in the local area, but she could provide no documented evidence that any attempts were made to obtain the residents' medications from the non-contract pharmacy.

42 CFR 483.45(a)(b)(1)-(3) Pharmacy Services/Procedures/Pharmacist/Records.
Previously cited 7/12/19

28 Pa. Code 211.9(a)(1) Pharmacy services.
Previously cited 7/12/19.

28 Pa. Code 211.12(d)(3) Nursing services.
Previously cited 7/12/19, 10/20/19.

28 Pa. Code 211.12(d)(5) Nursing services.
Previously cited 7/12/19, 10/20/19.






 Plan of Correction - To be completed: 03/17/2020

1. R6 no longer resides in the facility. R7 has received his medication as per order.
2. Medications that are not available in the facility or the Omincell, staff will call the back-up pharmacy and physician if necessary.
3. Education of F755 with a focus on receiving medications as per order. Education will also be provided to any new nursing staff and/or temporary staff the facility may contract for.
4. Audits will be completed by the Director of Nursing/Designee weekly X4; monthly X2 and then random following. Results of monitoring will be reported to the Quality Assurance Performance Improvement Committee.
5. Date of compliance is March 17, 2020.

205.9(c) LICENSURE Corridors.:State only Deficiency.
(c) Areas used for corridor traffic may not be considered as areas for dining, storage, diversional or social activities.
Observations:


Based on observations and staff interviews, it was determined that the facility failed to ensure that corridors were not used for storage.

Findings include:

Observations in the South hallway on February 2, 2020, at 4:35 a.m. and February 3, 2020, at 11:45 a.m. revealed that one treatment cart was stored in the corridor adjacent to residents' rooms. Observations in the East hallway on February 2, 2020, at 4:45 a.m. and February 3, 2020, at 11:42 a.m. revealed that a treatment cart was stored in the corridor adjacent to residents' rooms. The observations revealed that the carts were not being used at those times.

Interview with Registered Nurse 9 on February 3, 2020, at 11:42 a.m. and Licensed Practical Nurses 10 and 11 on February 3, 2020, at 11:45 a.m. and 11:47 a.m., respectively, confirmed that the treatment carts were stored in the corridors when they were not in use.

Interview with the Director of Nursing on February 3, 2020, at 12:05 p.m. revealed that she was not aware that the treatment carts could not be stored in the corridor.




 Plan of Correction - To be completed: 03/17/2020

1. No residents were impacted by the storage of the treatment carts.
2. Treatment carts will be stored in a location other than the corridors when not in use.
3. Education with licensed staff on P910 with focus on proper storage of treatment carts. Education will also be provided to any new nursing staff and/or temporary staff the facility may contract for.
4. Audits will be completed by the Director of Nursing/Designee weekly X4; monthly X2 and then random following. Results of monitoring will be reported to the Quality Assurance Performance Improvement Committee.
5. Date of compliance is March 17, 2020.

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.
Observations:


Based on review of nursing staffing schedules and payroll records, it was determined that the facility failed to provide the required minimum number of nursing care hours of 2.7 hours of direct resident care for each resident during one of 21 days reviewed.

Findings include:

The facility's nursing schedules and payroll records for January 8 through 28, 2020, revealed that the facility provided only 2.64 hours of direct nursing care per resident on January 17, 2020.






 Plan of Correction - To be completed: 03/17/2020

1. Staffing is monitored and adjusted daily if needed to maintain appropriate levels.
2. The facility retains a recruiting service to advertise and fill open positions. Additionally, contracts with three staffing agencies are in effect to alleviate any short term staffing needs.
3. The Director of Nursing and the nursing scheduler have been trained on the facility requirements for staffing and meet with the Administrator daily to review and adjust as needed. On weekends, the Registered Nurse Supervisor will monitor schedules and address any needs or adjustments. The scheduled weekly staffing meeting will review all vacant positions, recruiting and staffing needs.
4. The staffing report will be completed daily by the nursing scheduler/designee with review to include the Administrator/Director of Nursing. Results of monitoring will be reported to the Quality Assurance Performance Improvement Committee.
5. Date of compliance is March 17, 2020.


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