Pennsylvania Department of Health
GREENTREE SKILLED NURSING AND REHABILITATION CENTER
Patient Care Inspection Results

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GREENTREE SKILLED NURSING AND REHABILITATION CENTER
Inspection Results For:

There are  168 surveys for this facility. Please select a date to view the survey results.

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GREENTREE SKILLED NURSING AND REHABILITATION CENTER - Inspection Results Scope of Citation
Number of Residents Affected
By Deficient Practice
Initial comments:
Based on an Abbreviated Survey in response to a complaint, completed on April 8, 24, it was determined that Greentree Skilled Nursing and Rehabilitation 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:


483.25(d)(1)(2) REQUIREMENT Free of Accident Hazards/Supervision/Devices: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(d) Accidents.
The facility must ensure that -
483.25(d)(1) The resident environment remains as free of accident hazards as is possible; and

483.25(d)(2)Each resident receives adequate supervision and assistance devices to prevent accidents.
Observations:
Based on clinical and facility record review, facility submitted documents, and staff interviews, it was determined that the facility failed to provide adequate supervision to be aware of resident's departure from the facility for one of seven residents (Resident R1).

Review of the clinical record revealed Resident R1 was admitted to the facility on 11/9/23.

Review of the Minimum Data Set (MDS - periodic assessment of resident care needs) dated 2/11/24, included diagnoses of high blood pressure and obesity.

Review of an "Elopement Risk Assessment" completed on 11/10/23, indicated Resident R1 was not risk for elopement.

Review of Resident R1's plan of care for "Potential for Discharge" initiated 11/9/23, indicated that Resident R1 will be discharged home when clinical and rehabilitation goals are met.

Review of a progress note written by the Director of Nursing, dated 3/31/24, at 1:16 p.m., written on 4/1/24, at 11:20 a.m., indicated "Resident returned from LOA (leave of absence) with son around 10:30 pm on Easter (3/21/24), Son packed up all belongings and cleared her room out. Did not sign AMA papers, nor took medications. MD notified, Police asked to do a wellness check. Resident alert and oriented x3."

Review of a progress note written by Registered Nurse (RN) Employee E1 dated 4/1/24, at 9:00 a.m. indicated "Resident not in room. Per roommate resident packed her belongings and left with her son at approximately 1 AM. Unit Manager notified."

During an interview with Resident R2 (roommate of Resident R1) on 4/4/24, at approximately 11:30 a.m., that she was still awake Resident R1 left, at what she thought was about 1:00 a.m. Resident R2 stated "She left with her boy, her son. She didn't even say good-bye."

During an interview on 4/4/24, at approximately 1:30 p.m. Unit Manager Employee E2 stated that she was notified during morning meeting, by RN Employee E1 that while completing her morning medication pass, Resident R1 was not on the floor. Unit Manager Employee E2 stated she was told by both RN Employee E1 and Nurse Aide (NA) Employee E3 that neither were informed during the report provided by night shift working from 3/31/24, into 4/1/24, that Resident R1 had left the building. Unit Manager Employee E2 further confirmed she called NA Employee E4, who had Resident R1 as part of her assignment on the night shift from 3/31/24, into 4/1/24, and NA Employee E4 stated to her that she was not aware that Resident R1 had left the building.

During an interview on 4/4/24, at approximately 3:30. the Nursing Home Administrator was made aware that the facility's failure to provide adequate supervision to be aware of a resident's departure from the facility for one of seven residents.

28 Pa. Code 201.14(a) Responsibility of licensee.

28 Pa. Code 201.18(b)(e)(1) Management.

28 Pa. Code 201.20(b)(1) Staff Development.

28 Pa. Code 201.29(a) Resident rights.

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

28 Pa. Code 211.11(d) Resident care plan.

28 Pa Code 211.12(d)(1)(2)(5) Nursing services.


 Plan of Correction - To be completed: 05/09/2024

vent involving R1 was filed in the event reporting system (ERS).

The Director of Nursing and/or designee will complete an audit of facility risk reports and discharges for the past 30 days to identify any missed reportable incidents or conditions. Missed events that meet the reportable incidents and conditions guidelines will be submitted through the event reporting system.

Administrator and Director of Nursing will receive education on Elopement Policy, Program and Definitions and Event Reporting Requirements by Market Representatives. Staff will receive education on Elopement Policy, Program and Definitions, in addition to supervision expectations by the Nurse Practice Educator.

Director of Nursing and/or designee will complete audits of facility risk reports reporting requirement: and supervision observation audits 3x a week x 2 weeks; weekly x 2 weeks; then monthly thereafter, monitored by the Administrator, with reporting through Quality Assurance and Process Improvement Committee for review and/or recommendation ongoing.

51.3 (g)(1-14) LICENSURE NOTIFICATION:State only Deficiency.
51.3 Notification

(g) For purposes of subsections (e)
and (f), events which seriously
compromise quality assurance and
patient safety include, but not
limited to the following:
(1) Deaths due to injuries, suicide
or unusual circumstances.
(2) Deaths due to malnutrition,
dehydration or sepsis.
(3) Deaths or serious injuries due
to a medication error.
(4) Elopements.
(5) Transfers to a hospital as a
result of injuries or accidents.
(6) Complaints of patient abuse,
whether or not confirmed by the
facility.
(7) Rape.
(8) Surgery performed on the wrong
patient or on the wrong body part.
(9) Hemolytic transfusion reaction.
(10) Infant abduction or infant
discharged to the wrong family.
(11) Significant disruption of
services due to disaster such as fire,
storm, flood or other occurrence.
(12) Notification of termination of
any services vital to continued safe
operation of the facility or the
health and safety of its patients and
personnel, including, but not limited
to, the anticipated or actual
termination of electric, gas, steam
heat, water, sewer and local exchange
of telephone service.
(13) Unlicensed practice of a
regulated profession.
(14) Receipt of a strike notice.

Observations:
Based on review of clinical record and facility documents, it was determined that the facility failed to notify the State Survey Agency of a reportable event within 24 hours for one of one resident (Residents R1).

Findings include:

Review of the clinical record revealed Resident R1 was admitted to the facility on 11/9/23.

Review of the Minimum Data Set (MDS - periodic assessment of resident care needs) dated 2/11/24, included diagnoses of high blood pressure and obesity.

Review of an "Elopement Risk Assessment" completed on 11/10/23, indicated Resident R1 was not risk for elopement.

Review of a progress note written by the Director of Nursing, dated 3/31/24, at 1:16 p.m., written on 4/1/24, at 11:20 a.m., indicated "Resident returned from LOA (leave of absence) with son around 10:30 pm on Easter (3/21/24), Son packed up all belongings and cleared her room out. Did not sign AMA papers, nor took medications. MD notified, Police asked to do a wellness check. Resident alert and oriented x3."

Review of a progress note written by Registered Nurse (RN) Employee E1 dated 4/1/24, at 9:00 a.m. indicated "Resident not in room. Per roommate resident packed her belongings and left with her son at approximately 1 AM. Unit Manager notified."

During an interview with Resident R2 (roommate of Resident R1) on 4/4/24, at approximately 11:30 a.m., that she was still awake Resident R1 left, at what she thought was about 1:00 a.m. Resident R2 stated "She left with her boy, her son. She didn't even say good-bye."

During an interview on 4/4/24, at approximately 1:30 p.m. Unit Manager Employee E2 stated that she was notified during morning meeting, by RN Employee E1 that while completing her morning medication pass, Resident R1 was not on the floor. Unit Manager Employee E2 stated she was told by both RN Employee E1 and Nurse Aide (NA) Employee E3 that neither were informed during the report provided by night shift working from 3/31/24, into 4/1/24, that Resident R1 had left the building. Unit Manager Employee E2 further confirmed she called NA Employee E4, who had Resident R1 as part of her assignment on the night shift from 3/31/24, into 4/1/24, and NA Employee E4 stated to her that she was not aware that Resident R1 had left the building.

During an interview on 4/4/24, at approximately 3:30 p.m. the Nursing Home Administrator was made aware of the facility's failure to notify the appropriate State Survey Agency as required.


 Plan of Correction - To be completed: 05/09/2024

Event involving R1 was filed in the event reporting system (ERS).

The Director of Nursing and/or designee will complete an audit of facility risk reports and discharges for the past 30 days to identify any missed reportable incidents or conditions. Missed events that meet the reportable incidents and conditions guidelines will be submitted through the event reporting system.

Administrator and Director of Nursing will receive education on Elopement Policy, Program and Definitions and Event Reporting Requirements by Market Representatives. Staff will receive education on Elopement Policy, Program and Definitions, in addition to supervision expectations by the Nurse Practice Educator.

Director of Nursing and/or designee will complete audits of facility risk reports reporting requirements 3x a week x 2 weeks; weekly x 2 weeks; then monthly thereafter, monitored by the Administrator, with reporting through Quality Assurance and Process Improvement Committee for review and/or recommendation ongoing.

211.12(f.1)(2) LICENSURE Nursing services. :State only Deficiency.
(2) Effective July 1, 2023, a minimum of 1 nurse aide per 12 residents during the day, 1 nurse aide per 12 residents during the evening, and 1 nurse aide per 20 residents overnight.

Observations:
Based on review of nursing time schedules and staff interviews, it was determined that the facility administrative staff failed to provide a minimum of one nurse aide per 12 residents during the day and/or evening shifts, and one nurse aide per 20 residents during the night shift on three of thirteen days (3/29/24 - 3/31/24).

Findings include:

Review of the nursing schedules and census information for 3/23/24, through 4/4/24, revealed that the facility failed to meet the following:

3/29/24: Night shift required 61.13 hours of nurse aide care, facility provided 47.11.
3/30/24: Day shift required 100.63 hours of nurse aide care, facility provided 98.30.
3/31/24: Day shift required 100.00 hours of nurse aide care, facility provided 92.43; Evening shift required 100.00 hours of nurse aide care, facility provided 94.45; Night shift required 60.00 hours of nurse aide care, facility provided 52.87.

On 4/4/24, at approximately 3:30 p.m., the Nursing Home Administrator was made aware that the facility administrative staff failed to provide a minimum of one nurse aide per 12 residents during the day and/or evening shifts, and one nurse aide per 20 residents during the night shift on three of thirteen days.


 Plan of Correction - To be completed: 05/09/2024

Unable to correct past occurrence(s). There were no adverse effects to the residents of the facility.

To prevent future occurrence, the Administrator, Director of Nursing and Human Resources Coordinator will receive education on staffing requirements on nurse aide ratio and minimum per patient per day staffing hours requirements, by a Regional Clinical Support Representative.

Staffing meetings will be held 5 days weekly to review ratios from the prior day(s) and the projected staffing for the upcoming week, to ensure appropriate staffing levels are planned. Identified staffing needs will be offered to existing staff, and local staffing agencies, as needed, to enlist and meet the requirements, by the Administrator, Director of Nursing and Human Resource Coordinator. The facility will recruit staff through use of company platforms and recruiter representatives.

Audits of staffing ratios will be completed, by the NHA/designee to ensure that the facility meets daily hours requirements and Nurse Aide staffing ratio requirements. Audits will be completed 4 x weekly, for 2 weeks, 2 x weekly for 2 weeks, 1 x weekly thereafter, with reporting through Quality Assurance and Process Improvement for review and or recommendations.

211.12(f.1)(4) LICENSURE Nursing services. :State only Deficiency.
(4) Effective July 1, 2023, a minimum of 1 LPN per 25 residents during the day, 1 LPN per 30 residents during the evening, and 1 LPN per 40 residents overnight.
Observations:
Based on review of nursing time schedules and staff interviews, it was determined that the facility administrative staff failed to provide a minimum of one licensed practical nurse (LPN) per 40 residents during the night shift on two of thirteen days (3/29/24, and 4/1/24).

Findings include:

Review of the nursing schedules and census information for 3/12/24, through 3/16/24, revealed that the facility failed to meet the following:

3/29/24: Night shift required 32.60 hours of LPN care, facility provided 29.33.
4/01/24: Night shift required 32.00 hours of LPN care, facility provided 26.55.

On 4/4/24, at approximately 3:30 p.m., the Nursing Home Administrator was made aware that the facility administrative staff failed to provide a minimum of one LPN per 40 residents during the night shift on two of thirteen days.


 Plan of Correction - To be completed: 05/09/2024

Unable to correct past occurrence(s). There were no adverse effects to the residents of the facility.

To prevent future occurrence, the Administrator, Director of Nursing and Human Resources Coordinator will receive education on staffing requirements on Licensed Practical Nurse (LPN) ratios by a Regional Clinical Support Representative.

Staffing meetings will be held 5 days weekly to review LPN ratios from the prior day(s) and the projected ratios for the upcoming week, to ensure appropriate staffing levels are planned. Identified staffing needs will be offered to existing staff, and local staffing agencies, as needed, to enlist and meet the requirements, by the Administrator, Director of Nursing and Human Resource Coordinator. The facility will recruit staff through use of company platforms and recruiter representatives.

Audits of LPN ratios will be completed by the NHA/designee to ensure that the facility meets daily hours LPN staffing ratio requirements. Audits will be completed 4 x weekly, for 2 weeks, 2 x weekly for 2 weeks, 1 x weekly thereafter, with reporting through Quality Assurance and Process Improvement for review and or recommendations, effective 01/31/2024 and ongoing.

211.12(i)(1) LICENSURE Nursing services.:State only Deficiency.
(1) Effective July 1, 2023, 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 2.87 hours of direct resident care for each resident.

Observations:

Based on review of nursing time schedules and staff interviews it was determined that the facility administrative staff failed to provide the minimum number of general nursing hours to each resident in a 24 hour period on 13 of 13 days (3/23/24 - 4/4/24).

Findings include:

Review of the nursing schedules and census information for 3/23/24, through 4/4/24, revealed that the facility failed to maintain 2.87 hours of general nursing care to each resident in a 24-hour period on the following dates:

-3/23/24, Census 160. PPD 2.69.
-3/24/24, Census 158. PPD 2.77.
-3/25/24, Census 158. PPD 2.66.
-3/26/24, Census 158. PPD 2.78.
-3/27/24, Census 163. PPD 2.73.
-3/28/24, Census 163. PPD 2.70.
-3/29/24, Census 163. PPD 2.50.
-3/30/24, Census 161. PPD 2.66.
-3/31/24, Census 160. PPD 2.50.
-4/01/24, Census 160. PPD 2.63.
-4/02/24, Census 165. PPD 2.77.
-4/03/24, Census 166. PPD 2.69.
-4/04/24, Census 166. PPD 2.85.

On 4/4/24, at approximately 3:30 p.m., the Nursing Home Administrator was made aware that the facility failed to provide the minimum number of general nursing hours to each resident in a 24-hour period on 13 of 13 days.


 Plan of Correction - To be completed: 05/09/2024

Unable to correct past occurrence(s). There were no adverse effects to the residents of the facility.

To prevent future occurrence, the Administrator, Director of Nursing and Human Resources Coordinator will receive education on minimum per patient per day (PPD) staffing requirements, by a Regional Clinical Support Representative.

Staffing meetings will be held 5 days weekly to review from the prior day(s) PPD and the projected staffing for the upcoming week,to ensure appropriate staffing levels are planned. Identified staffing needs will be offered to existing staff, and local staffing agencies, as needed, to enlist and meet the requirements, by the Administrator, Director of Nursing and Human Resource Coordinator. The facility will recruit staff through use of company platforms and recruiter representatives.

Audits of staffing PPD will be completed by the NHA/designee to ensure that the facility meets daily PPD requirements 2 weeks, 2 x weekly for 2 weeks, 1 x weekly thereafter, with reporting through Quality Assurance and Process Improvement for review and or recommendations, effective 05/09/2024 and ongoing.


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