Pennsylvania Department of Health
SWEDEN VALLEY MANOR
Patient Care Inspection Results

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Severity Designations


Minimal Citation - No Harm	Minimal Harm	Actual Harm	Serious Harm

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SWEDEN VALLEY MANOR - Inspection Results	Scope of Citation Number of Residents Affected By Deficient Practice

Initial comments:

Based on a Complaint Investigation completed on May 16, 2024, at Sweden Valley Manor, it was determined that there were no federal deficiencies identified under the requirements of 42 CFR Part 483, Subpart B, Requirements for Long Term Care; however, the facility was not in compliance with 28 PA Code, Commonwealth of Pennsylvania Long Term Care Licensure Regulations.

Plan of Correction:

§ 211.12(f.1)(2) LICENSURE Nursing services. :

(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.

Plan of Correction - To be completed: 07/01/2024

This plan of correction has been prepared and executed because the law requires it. This plan does not constitute an admission that any of the citations are either legally or factually correct. This plan of correction is not meant to establish any standard of care, contract, obligation, or position. Sweden Valley Manor reserves the right to raise all possible contestations and defenses in any civil, criminal, claim, action or proceeding. Please accept this plan of correction as Sweden Valley Manor credible allegation of compliance. All residents received appropriate care and services to meet their needs on the identified days and there was no direct correlation to an individual resident.

Residents of Sweden Valley Manor will be protected from future staff ratios below the 1:12 nurse aide for evenings by a proactive preview of daily staff assignments and schedules to ensure adequate staff coverage by DON/Designee. The nursing scheduler/designee will review projected staffing levels with the DON/designee 3x's a week for a month, then weekly x3 weeks then monthly x2 months until compliance is achieved to ensure that any foreseeable staffing levels below nurse aide ratios are adequately covered. Weekend and Shift Supervisors will immediately contact DON for any day that ratios unexpectedly drop below the nurse aide ratio minimum for immediate review.
Sweden Valley Manor will continue to aggressively advertise externally for recruitment of nursing/C.N.A. applicants to enhance current staffing levels. Sweden Valley Manor will also review potential admissions and reconsider admissions if the facility is unable to meet minimum staffing levels. Sweden Valley Manor has raised all wages for certified aides. Sweden Valley Manor is an approved provider of the Pennsylvania Nurse Aide Training and Competency Evaluation Program and has ongoing class trainings throughout the year. Sweden Valley Manor offers a referral bonus to current employees for recruitment. Sweden Valley Manor also offers extra pay incentives to current staff to cover extra shifts. Staffing ratios will be reviewed by a DON/nursing designee 3x's a week for a month, then weekly x3 weeks then monthly x2 months until compliance is achieved. Results will be reported on a monthly basis during the monthly QAPI committee meeting and at Quarterly Quality Assurance/QAPI meeting.

§ 211.12(f.1)(4) LICENSURE Nursing services. :

(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.

Plan of Correction - To be completed: 07/01/2024

Residents of Sweden Valley Manor will be protected from future staff LPN day and overnight ratios by a proactive preview of daily staff assignments and schedules to ensure adequate staff coverage by DON/Designee. The nursing scheduler/designee will review projected staffing levels with the DON/designee 3x's a week for a month, then weekly x3 weeks then monthly x2 months until compliance is achieved to ensure that any foreseeable staffing levels below LPN ratios are adequately covered. Weekend and Shift Supervisors will immediately contact DON for any day that ratios unexpectedly drop below the LPN ratio minimum for immediate review.
Sweden Valley Manor will continue to aggressively advertise externally for recruitment of nursing applicants to enhance current staffing levels. Sweden Valley Manor will also review potential admissions and reconsider admissions if the facility is unable to meet minimum staffing levels. Administrative RNs are assigned to an on-call schedule and are available to cover shifts when foreseeable staffing levels are below the ratio minimum levels. Sweden Valley Manor offers a referral bonus to current employees for recruitment. Sweden Valley Manor has raised all wages for licensed nursing staff. Sweden Valley Manor also offers extra payment incentives to current staff to cover extra shifts. Staffing ratios will be reviewed by a DON/nursing designee 3x's a week for a month, then weeklyx3 weeks then monthly x2 months until compliance is achieved. Results will be reported on a monthly basis during the monthly QAPI committee meeting and at Quarterly Quality Assurance/QAPI meeting.

§ 211.12(i)(1) LICENSURE Nursing services.:

(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 staffing hours and staff interview, it was determined that the facility failed to ensure that the total of nursing care hours provided in each 24-hour period was a minimum of 2.87 hours per patient per day (PPD), effective July 1, 2023, for 13 of 20 days reviewed.

Findings include:

Review of nursing staff care hours for December 23 through 29, 2023, April 22 through 28, 2024, and May 10 through 15, 2024, revealed that the facility failed to meet the minimum hours per patient day for the following days:

December 23, 2023, hours PPD 2.69
December 24, 2023, hours PPD 2.36
December 25, 2023, hours PPD 2.64
December 26, 2023, hours PPD 2.52
December 27, 2023, hours PPD 2.34
December 28, 2023, hours PPD 2.49
December 29, 2023, hours PPD 2.35
April 22, 2024, hours PPD 2.56
April 23, 2024, hours PPD 2.60
April 24, 2024, hours PPD 2.71
April 27, 2024, hours PPD 2.51
April 28, 2024, hours PPD 2.54
May 11, 2024, hours PPD 2.46

Interview with Employee 1 (Regional Director of Clinical Services), Employee 2 (human resources director), and the Director of Nursing on May 16, 2024, at 3:00 PM, confirmed that the facility was aware that staffing did not meet regulatory daily hours of direct resident care for each resident.

Plan of Correction - To be completed: 07/01/2024

Residents of Sweden Valley Manor will be protected from future staff ratios below 2.87 by a proactive preview of daily staff assignments and schedules to ensure adequate staff coverage by DON/Designee. The nursing scheduler/designee will review projected staffing levels with the DON/designee daily for 3x's a week for a month, then weeklyx3 weeks then monthly x2 months until compliance is achieved to ensure that any foreseeable staffing levels below 2.87 PPD are adequately covered. Weekend and Shift Supervisors will immediately contact DON for any day that ratios unexpectedly drop below the 2.87 minimum for immediate review.
Sweden Valley Manor will continue to aggressively advertise externally for recruitment of nursing/C.N.A. applicants to enhance current staffing levels. Sweden Valley Manor will also review potential admissions and reconsider admissions if the facility is unable to meet minimum staffing levels. Sweden Valley Manor is an approved provider of the Pennsylvania Nurse Aide Training and Competency Evaluation Program and has ongoing class trainings throughout the year. Administrative RNs are assigned to an on-call schedule and are available to cover shifts when foreseeable staffing levels are below the PPD or ratio minimum levels. Sweden Valley Manor has raised all wages for certified aides and licensed nursing staff. Sweden Valley Manor also offers bonus payments and extra incentives to current staff to cover extra shifts.
Nurse Staffing PPD Hours will be reviewed by a DON/nursing designee 3x's a week for a month, then weekly x3 weeks then monthly x2 months until compliance is achieved. Results will be reported on a monthly basis during the monthly QAPI committee meeting and at Quarterly Quality Assurance/QAPI meeting.

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