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

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Severity Designations


Minimal Citation - No Harm	Minimal Harm	Actual Harm	Serious Harm

ARMSTRONG REHABILITATION AND NURSING CENTER
Inspection Results For:

There are 150 surveys for this facility. Please select a date to view the survey results.

Surveys don't appear on this website until at least 41 days have elapsed since the exit date of the survey.


ARMSTRONG REHABILITATION AND NURSING CENTER - 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 on November 19, 2024, it was determined that Armstrong Rehabilitation and Nursing 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:

483.10(i)(1)-(7) REQUIREMENT Safe/Clean/Comfortable/Homelike Environment:

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.

§483.10(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 81°F; and

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

Observations:

Based on observation, and staff interview, it was determined that the facility failed to maintain a clean homelike environment in one of two nursing units (Second Floor).

Findings include:

Review of facility policy "Safe and Homelike Environment" dated 9/12/24, indicated in accordance with residents' rights, the facility will provide a safe, clean, comfortable, and homelike environment.

During an observation on 11/19/24, at 10:50 a.m. the Resident's Day Room (activity/dining area) in the 200 hallway indicated two wheelchairs and a stretcher were being stored in the room.

During an interview on 11/19/24, at 11:08 a.m. Registered Nurse (RN) Employee E1 confirmed the above observation. RN Employee E1 stated, "Resident wheelchairs are stored in the hallway during the morning while staff are getting residents out of bed. In the evenings, equipment is stored in the Day Rooms. The stretcher was left by transport."

During an interview on 11/19/24, at 1:39 p.m. the Director of Nursing confirmed that the facility failed to maintain a clean homelike environment in one of two nursing units as required.

28 Pa. Code 201.29(j) Resident rights.
29 Pa. Code 207.2(2) Administrator's Responsibility.

Plan of Correction - To be completed: 12/16/2024

Wheelchairs and stretcher were immediately removed from the day room.
Day rooms were checked to identify any items needing to be removed on 11/27/24.
Education was provided to nursing department by DON or designee regarding the importance of keeping the day rooms clean and a homelike environment.
Audits will be conducted by the DON or designee 1 x time a week for 3 weeks, then monthly times 1 month to ensure concerns are being addressed in a timely manner. Audit results will be reviewed through the monthly QAPI process/meeting.

483.21(b)(2)(i)-(iii) REQUIREMENT Care Plan Timing and Revision:

§483.21(b) Comprehensive Care Plans
§483.21(b)(2) A comprehensive care plan must be-
(i) Developed within 7 days after completion of the comprehensive assessment.
(ii) Prepared by an interdisciplinary team, that includes but is not limited to--
(A) The attending physician.
(B) A registered nurse with responsibility for the resident.
(C) A nurse aide with responsibility for the resident.
(D) A member of food and nutrition services staff.
(E) To the extent practicable, the participation of the resident and the resident's representative(s). An explanation must be included in a resident's medical record if the participation of the resident and their resident representative is determined not practicable for the development of the resident's care plan.
(F) Other appropriate staff or professionals in disciplines as determined by the resident's needs or as requested by the resident.
(iii)Reviewed and revised by the interdisciplinary team after each assessment, including both the comprehensive and quarterly review assessments.

Observations:

Based on review of facility documents, facility policy, clinical records, and staff interviews, it was determined that the facility failed to ensure that a resident's care plan was updated and revised to reflect the resident's specific care needs for one of five residents (Resident R1).

Findings include:

Review of facility policy "Care Plan Revision Upon Status Change" dated 9/12/24, indicated the comprehensive care plan will be reviewed, and revised as necessary, when a resident experiences a status change.

Review of the clinical record indicated Resident R1 was admitted to the facility on 8/1/24, with diagnoses of depression (a constant feeling of sadness and loss of interest), anxiety (a feeling of worry, nervousness, or unease), and constipation (a problem with passing stool).

Review of a Nursing Progress Note dated 11/6/24, at 10:45 a.m. completed by the Director of Nursing (DON) stated, "Resident demanding to be sent to ER (emergency room) stating that he needed to have a bowel movement. He had however moved his bowels. Sent as per residents request. Physician aware. Nursing to be educated on the protocol."

Review of a Nursing Progress Note dated 11/6/24, at 10:45 a.m. completed by Licensed Practical Nurse (LPN) Employee E3 stated, "Resident OTH (out to hospital) per his request, stating to writer that he is constipated despite going yesterday and today, telling different stories to different staff. Took morning medications by mouth without issue and ate breakfast before departure."

Review of a Nursing Progress Note dated 11/6/24, at 7:17 p.m. completed by Registered Nurse (RN) Employee E1 stated, "Resident returned from hospital around 4:00 p.m. No new orders, continue regular constipation medications."

Review of a Nursing Progress Note dated 11/13/24, at 9:26 a.m. completed by LPN Employee E4 revealed Resident R1 refused his scheduled Senna (medication used to treat constipation) 17.2 milligrams, stating, "the doctor wants him to have a suppository daily."

Review of a Nursing Progress Note dated 11/13/24, at 11:58 a.m. completed by the DON stated, "Spoke with resident today about bowel movements and his refusal of Senna. States that the doctors here don't know anything and that the ER doctor stated on his last admission that he should have regular enemas. Resident educated on facility bowel regimen and that he must follow the protocol. Educated that we do not send him out without following the guidelines and having an abdominal assessment, flat plate (an x-ray of the abdomen), acceptance of medications. States he removes his bowel movements by hand. Physician aware."

Review of a Nursing Progress Note dated 11/16/24, at 8:52 a.m. completed by LPN Employee E5 stated, "Resident called 911 by himself in room due to being constipated. Resident sent to hospital. Supervisor notified."

Review of a Clinical Nurses Note dated 11/16/24, at 10:01 a.m. completed by RN Employee E6 stated, "Resident stating that he needs to go to the hospital due to constipation. Resident stated that his last bowel movement was 3 days ago. LPN and RN tried to encourage resident to remain in house and utilize bowel movement protocol. Notified physician."

Review of Resident R1's care plan on 11/19/24, failed to reveal goals and interventions related to Resident R1's constipation concerns and refusal of physician ordered bowel regimen.

During an interview on 11/19/24, at 1:39 p.m. the DON confirmed that the facility failed to ensure a resident's care plan was updated and revised to reflect the resident's specific care needs for one of five residents as required.

28 Pa. Code 211.5(f) Clinical records.
28 Pa. Code 211.11(a) Resident care plan.
28 Pa. Code 211.12(d)(1)(3)(5) Nursing services.

Plan of Correction - To be completed: 12/16/2024

Resident R1 suffered no ill effects from care plan not being updated timely. Care plans for residents R1 has been updated to reflect their current level of care.
Care plans have been audited to ensure care plans reflect resident specific care plan needs.
RNAC will be re-educated by the DON or designee regarding the importance of updating care plans to reflect resident specific care needs.
Audits will be conducted on a 4 residents weekly X 4 weeks and then monthly X 1 month to ensure compliance. Audit results will be reviewed through the monthly QAPI process/meeting.

483.45(g)(h)(1)(2) REQUIREMENT Label/Store Drugs and Biologicals:

§483.45(g) Labeling of Drugs and Biologicals
Drugs and biologicals used in the facility must be labeled in accordance with currently accepted professional principles, and include the appropriate accessory and cautionary instructions, and the expiration date when applicable.

§483.45(h) Storage of Drugs and Biologicals

§483.45(h)(1) In accordance with State and Federal laws, the facility must store all drugs and biologicals in locked compartments under proper temperature controls, and permit only authorized personnel to have access to the keys.

§483.45(h)(2) The facility must provide separately locked, permanently affixed compartments for storage of controlled drugs listed in Schedule II of the Comprehensive Drug Abuse Prevention and Control Act of 1976 and other drugs subject to abuse, except when the facility uses single unit package drug distribution systems in which the quantity stored is minimal and a missing dose can be readily detected.

Observations:

Based on review of facility policy, observations, and staff interview, it was determined that the facility failed to properly secure a medication cart while not in use for one of four medication carts (Medication Cart 3C).

Findings include:

Review of facility policy "Medication Storage" dated 9/12/24, indicated all drugs and biologicals will be stored in locked compartments (i.e., medication carts, cabinets, drawers, refrigerators, medication rooms) under proper temperature controls. During a medication pass, medications must be under the direct observation of the person administering medications or locked in the medication storage area/cart."

During an observation on 11/19/24, at 11:24 a.m. the 3C Medication Cart was observed outside of resident room 319 with the cart unlocked and unattended.

During an interview on 11/19/24, at 11:25 a.m. Licensed Practical Nurse Employee E2 confirmed the 3C Medication Cart was unlocked and unattended.

During an interview on 11/19/24, at 1:39 p.m. the Director of Nursing confirmed that the facility failed to properly secure a medication cart while not in use for one of four medication carts as required.

28 Pa. Code: 211.9(a)(1)(h)(k)(l)(1) Pharmacy services.
28 Pa. Code:211.12(d)(1)(2)(3)(5) Nursing services.

Plan of Correction - To be completed: 12/16/2024

Residents suffered no ill effects from medication cart being unlocked. Medication cart on unit 3C was immediately locked upon finding it was left unlocked.
Whole house sweep of medication carts was conducted upon notification by the surveyors of the deficient practices.
Education was provided to all licensed nursing staff by DON or designee on the safe storage of medications, including proper labeling and locking medication carts.
Audits will be completed by the DON or designee daily times 3 weeks, and monthly times 1 month on med carts being properly locked. Audit results will be reviewed through the monthly QAPI process/meeting.

§ 205.20(a) LICENSURE Resident bedrooms.:

(a) A bed for a resident shall be placed only in a bedroom approved by the Department.

Observations:

Based on review of approved bed information, observations, and staff interview, it was determined that the facility failed to obtain the Department of Health's approval prior to removing beds from resident bed rooms.

Findings include:

During observations on all nursing units on 11/19/24, from 12:50 p.m. to 1:20 p.m. the following were observed:

Room 200 - licensed for three beds - has two beds.
Room 209 - licensed for four beds - has two beds.
Room 212 - licensed for four beds - has three beds.
Room 216 - licensed for four beds - has three beds.
Room 218 - licensed for four beds - has three beds.
Room 219 - licensed for four beds - has three beds.
Room 220 - licensed for two beds - has one bed.
Room 221 - licensed for four beds - has three beds.
Room 222 - licensed for four beds - has three beds.

Room 300 - licensed for two beds - has one bed.
Room 301 - licensed for two beds - has one bed.
Room 305 - licensed for two beds - has one bed.

During an interview on 11/19/24, at 1:58 p.m. the Nursing Home Administrator confirmed that the facility failed to obtain the Department of Health's approval prior to removing beds from resident bed rooms.

Plan of Correction - To be completed: 12/27/2024

1. Cited rooms will either have beds put into them per license listing, or a restriction requested from the field office. Restriction requested from the field office will be for a desertification of two beds. Restriction will be sent via email 12/6/24.
2. A whole house audit will be conducted to ensure licensed rooms have appropriate number of beds.
3. Audits of the whole house audit will be reviewed by QAPI committee for further review.

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