Nursing Investigation Results -

Pennsylvania Department of Health
ARISTACARE AT MEADOW SPRINGS
Patient Care Inspection Results

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ARISTACARE AT MEADOW SPRINGS
Inspection Results For:

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ARISTACARE AT MEADOW SPRINGS - Inspection Results Scope of Citation
Number of Residents Affected
By Deficient Practice
Initial comments:
Based on an Abbreviated Survey in response to two complaints completed June 3, 2022, it was determined that Aristacare At Meadow Springs 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 related to the health portion of the survey process.


 Plan of Correction:


483.25(g)(1)-(3) REQUIREMENT Nutrition/Hydration Status Maintenance: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(g) Assisted nutrition and hydration.
(Includes naso-gastric and gastrostomy tubes, both percutaneous endoscopic gastrostomy and percutaneous endoscopic jejunostomy, and enteral fluids). Based on a resident's comprehensive assessment, the facility must ensure that a resident-

483.25(g)(1) Maintains acceptable parameters of nutritional status, such as usual body weight or desirable body weight range and electrolyte balance, unless the resident's clinical condition demonstrates that this is not possible or resident preferences indicate otherwise;

483.25(g)(2) Is offered sufficient fluid intake to maintain proper hydration and health;

483.25(g)(3) Is offered a therapeutic diet when there is a nutritional problem and the health care provider orders a therapeutic diet.
Observations:

Based on review of facility policy, review of clinical record, and staff interviews, it was determined that the facility failed to identify and re-assess nutrition needs in a timely manner consistent with resident needs related to wound healing for one of 2 residents reviewed (Resident R2).

Findings Include:

Review of facility policy "Prevention of Pressure Ulcers" revealed the dietitian will assess nutrition and hydration and make recommendations based on the resident's assessment. The dietitian will encourage proper dietary and fluid intake.

Review of Resident R2's clinical record revealed the resident was admitted to the facility on October 5, 2021, and had diagnoses of dysphagia (swallowing difficulties) and gastrostomy (surgical opening into the stomach to provide nutrition via feeding tube).

Review of Resident R2's quarterly comprehensive nutrition assessment dated January 3, 2022, revealed the resident was dependent on the tube-feeding to meet nutrition and hydration needs. The dietitian assessed Resident R2's estimated energy and protein needs reflective of having skin intact.

Review of Resident R2's care plan date-initiated February 7, 2022, and revised on May 4, 2022, revealed the resident had actual impairments to his skin integrity.

Review of Resident R2's skin checks dated February 7, 2022, revealed new skin issues were identified and the resident developed in-house acquired wounds to his right outer ankle, right heel, and right lateral shin.

Review of Resident R2's clinical record revealed a progress note dated February 21, 2022, that the resident was noted with a sustained unstageable wound to his sacrum.

Review of Resident R2's clinical record revealed no documented evidence that the dietitian was consulted or made aware of the newly identified skin breakdown to reassess if the tube feeding was provided the required energy needs to support wound healing.

Continued review of Resident R2's clinical record reveled the dietitian did not reassess Resident R2's energy and protein requirements until April 5, 2022.

Review of Resident R2's quarterly comprehensive nutrition assessment dated April 1, 2022, revealed that with the impaired skin integrity, the resident required increased energy and protein needs to support wound healing. The dietitian made recommendations to adjust the resident's tube-feeding to provide an additional 200 calories and 30 grams of protein per day.

An interview with Employee E1, Nursing Home Administrator, on June 3, 2022, at 3:45 p.m. confirmed there was no documented evidence that the dietitian re-assessed Resident R2's nutrition needs upon the development of the in-house acquired wounds.

28 Pa. Code 211.12(d)(3) Nursing services.

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







 Plan of Correction - To be completed: 08/02/2022

R2 was seen by dietitian routinely, wounds improved showing no nutritional interventions needed.

An audit of residents with new wounds will be completed to identify if a nutritional review/assessment was completed.

Wound team educated to alert Dietitian of every new wound.

Dietitian educated to document /assess the nutritional needs for new wounds.

Audits of new wounds will be completed by DON or designee weekly x 4 weeks for a month and then monthly for three months.

Results of all audits will be reported through QA Steering Committee for 3 months. Following the 3 months the Committee will determine the frequency and need of the reports.
483.20(f)(5), 483.70(i)(1)-(5) REQUIREMENT Resident Records - Identifiable Information: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.
483.20(f)(5) Resident-identifiable information.
(i) A facility may not release information that is resident-identifiable to the public.
(ii) The facility may release information that is resident-identifiable to an agent only in accordance with a contract under which the agent agrees not to use or disclose the information except to the extent the facility itself is permitted to do so.

483.70(i) Medical records.
483.70(i)(1) In accordance with accepted professional standards and practices, the facility must maintain medical records on each resident that are-
(i) Complete;
(ii) Accurately documented;
(iii) Readily accessible; and
(iv) Systematically organized

483.70(i)(2) The facility must keep confidential all information contained in the resident's records,
regardless of the form or storage method of the records, except when release is-
(i) To the individual, or their resident representative where permitted by applicable law;
(ii) Required by Law;
(iii) For treatment, payment, or health care operations, as permitted by and in compliance with 45 CFR 164.506;
(iv) For public health activities, reporting of abuse, neglect, or domestic violence, health oversight activities, judicial and administrative proceedings, law enforcement purposes, organ donation purposes, research purposes, or to coroners, medical examiners, funeral directors, and to avert a serious threat to health or safety as permitted by and in compliance with 45 CFR 164.512.

483.70(i)(3) The facility must safeguard medical record information against loss, destruction, or unauthorized use.

483.70(i)(4) Medical records must be retained for-
(i) The period of time required by State law; or
(ii) Five years from the date of discharge when there is no requirement in State law; or
(iii) For a minor, 3 years after a resident reaches legal age under State law.

483.70(i)(5) The medical record must contain-
(i) Sufficient information to identify the resident;
(ii) A record of the resident's assessments;
(iii) The comprehensive plan of care and services provided;
(iv) The results of any preadmission screening and resident review evaluations and determinations conducted by the State;
(v) Physician's, nurse's, and other licensed professional's progress notes; and
(vi) Laboratory, radiology and other diagnostic services reports as required under 483.50.
Observations:

Based on review of clinical records and staff interviews, it was determined that the facility failed to consistently document daily wound treatment for one of two residents reviewed (Resident R2).

Findings Include:

Review of Resident R2's clinical record revealed the resident was admitted to the facility on October 5, 2021, and had diagnoses of traumatic brain injury with loss of consciousness, dysphagia (swallowing difficulties) and gastrostomy (surgical opening into the stomach to provide nutrition via feeding tube).

Review of Resident R2's care plan date-initiated February 7, 2022, and revised on May 4, 2022, revealed the resident had actual impairments to his skin integrity.

Review of Resident R2's skin checks dated February 7, 2022, revealed new skin issues were identified and the resident developed in-house acquired wounds to his right outer ankle, right heel, and right lateral shin.

Review of Resident R2's skin checks dated February 14, 2022, revealed the skin assessment was incomplete and not signed.

Review of Resident R2's clinical record revealed a progress note dated February 21, 2022, that the resident was noted with a sustained unstageable wound to his sacrum.

Review of Resident R2's treatment administration record dated March 1 through March 31, 2022, revealed daily wound care treatment for the resident's left heel, right heel, right lateral shin, and treatments two times per day for the sacrum.

Review of the treatment administration record revealed nursing staff failed to document wound care treatment on 3/1, 3/2, 3/3, 3/6, 3/7, 3/11, 3/15, 3/16, 3/22, 3/24, and 3/25/2022,

Review of Resident R2's treatment administration record dated May 1 through May 31, 2022, revealed daily wound care treatment for the resident's left heel, right heel, right lateral shin, and sacrum.

Review of the treatment administration record revealed nursing staff failed to document wound care treatment on 5/4, 5/9, 5/11, 5/13, 5/15, 5/17, 5/25, 5/26, and 5/29/2022.

Interview with the Nursing Home Administrator, Employee E1, on June 3, 2022, at 3:45 p.m. confirmed wound treatments were not documented as completed.

28 Pa Code 211.5(f) Clinical records
28 Pa Code 211.12(d)(5) Nursing services







 Plan of Correction - To be completed: 08/02/2022

R2 had no ill effects, due to missed documentation

Residents who have wound treatments could potentially be affected.

A random audit will be completed of residents who require daily wound treatments.

Nurses educated on the importance of documentation for daily wound treatment.

A random daily wound documentation audit will be completed by DON or designee weekly x 4 weeks for a month and then monthly for three months.

Results of all audits will be reported through QA Steering Committee for 3 months. Following the 3 months the Committee will determine the frequency and need of the reports.


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