Nursing Investigation Results -

Pennsylvania Department of Health
MANORCARE HEALTH SERVICES-CHAMBERSBURG
Patient Care Inspection Results

Note: If you need to change the font size, click the "View" menu at the top of the page, place the mouse over the "Text Size" menu item, and select the desired font size.

Severity Designations

Click here for definitions Click here for definitions Click here for definitions Click here for definitions
Minimal Citation - No Harm Minimal Harm Actual Harm Serious Harm
MANORCARE HEALTH SERVICES-CHAMBERSBURG
Inspection Results For:

There are  130 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.
MANORCARE HEALTH SERVICES-CHAMBERSBURG - Inspection Results Scope of Citation
Number of Residents Affected
By Deficient Practice
Initial comments:


Based on a Medicare/Medicaid, State Licensure, Civil Rights survey and an Abbreviated survey in response to four complaints, completed on September 26, 2019, it was determined that Manorcare Health Services Chambersburg 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 REQUIREMENT Quality of Care: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.
483.25 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 review and staff interview, it was determined that the facility failed to ensure that care and services were provided to attain or maintain the resident's highest level of well-being for one of 38 residents reviewed (Resident 154).

Findings include:

Review of Resident 154's clinical record revealed diagnoses that included congestive heart failure (weakness of the heart that leads to buildup of fluid in the lungs and surrounding body tissues) and end stage renal disease (condition where one's kidneys are functioning below 10 percent of their normal function).

Review of Resident 154's September 2019, MAR (Medication Administration Record - form used to document physician orders as well as when and how medications are administered to a resident) revealed an order for daily weights and to notify cardiology congestive heart failure clinic and doctor of a weight gain of three pounds in 24 hours or five pounds in a week. The order was effective November 17, 2018.

Review of Resident 154's weight tracking report revealed that Resident had the following weight gains:
On July 28, 2019, resident's weight was 195.8 lbs and on July 29, 2019, weight was 203.4 lbs (gain of 7.6 lbs).
On August 5, 2019, resident's weight was 204.8 lbs, and on August 6, 2019, resident's weight was 212.4 lbs (gain of 7.6 lbs). On August 13, 2019, resident's weight was 200 lbs and on August 14, 2019, resident's weight was 203.5 lbs (gain of 3.5 lbs). On August 19, 2019, resident's weight was 192 lbs, and on August 20, 2019, resident's weight was 195.2 (gain of 3.2 lbs).
Further review of Resident 154's clinical record failed to reveal evidence that the cardiology clinic or the physician was notified of these weight gains as ordered.
During an interview with the Director of Nursing on September 25, 2019, at 2:07 PM, she revealed that she did not have any evidence that the physician or clinic was notified as ordered. She also revealed the expectation that this should have occurred.

28 Pa. Code 211.12(d)(1)(3)(5) Nursing services.






 Plan of Correction - To be completed: 10/22/2019

1. Physicians were updated for the identified residents.
2. Other residents that have the potential to be affected will have a comprehensive weight change review using the weight change QAPI audit; to ensure that physicians orders were followed related to notifications with weight gain.
3. The facility will take the following actions: Licensed staff will receive Education from the DON on Focus on F-tag 684 and the weight management guidelines.
4. The facility DON/designee will monitor its performance by completing weight change QAPI audit for resident with orders for daily weights; weekly x 4 and monthly x2, to ensure that the physician notifications have occurred where appropriate. Audit results will be provided to QA committee for further review and recommendations.

483.45(g)(h)(1)(2) REQUIREMENT Label/Store Drugs and Biologicals: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.
483.45(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 surveyor observation, facility pharmacy storage recommendations, facility policy, and staff interview, it was determined that the facility failed to discard expired medications for one of four medication carts observed ( Arcadia medication cart) and failed to refrigerate medications requiring refrigeration in two of four medication carts observed (E hall station three medication cart and F hall station three medication cart).

Findings Include:

Review of facility provided document from the pharmacy titled, "Storage Recommendations," revealed "Based on American Diabetes Association guidelines, all unopened insulins are recommended to be stored in a refrigerator. All vials should be dated when opened and discarded 28 days after opening (except Levemir (insulin), Novolin R, Novolin N, and Novolin 70/30 which can be used up to 42 days after opening)."

Review of facility policy titled, "Storage and expiration, dating of drugs, biologicals, syringes and needles," with an effective date of January 1, 2008 and a last revised date of August 2018, revealed "The Nursing Center should ensure that drugs and biologicals: Have not been retained longer than recommended by manufacturer or supplier guidelines." and "Once any drug or biological is opened, the nursing center should follow manufacturer guidelines with respect to expiration dates for opened medications."

Observation of the E hall station three medication cart on September 24, 2019, at 1:58 PM revealed one Basaglar insulin pen being stored unopened, for an unknown period of time, at room temperature.

Observation of the F Hall station three medication carts on September 24, 2019, at 2:09 PM revealed one Basaglar insulin (medication used to treat diabetes) pen being stored unopened, for an unknown period of time, at room temperature.

Observation of Arcadia medication cart on September 24, 2019, at 2:19 PM revealed one vial of Novolog insulin with a "date opened sticker" labeled August 16, 2019, (39 days earlier), one vial of Novolin R insulin with a "date opened sticker" labeled August 5, 2019, (50 days earlier), and one Basaglar insulin pen with a "date opened sticker" labeled August 17, 2019, (38 days earlier).

Review of facility provided documentation on Basaglar insulin revealed, "Storage of Basaglar Kwikpen: Store at room temperature (up to 86 degrees Fahrenheit) only once opened." "Once removed from refrigeration, the Basaglar Kwikpen should be discarded within 28 days, even if it has not been opened and even if it still contains insulin."

Interview with Licensed Practical Nurse (LPN) 1 on September 24, 2019, at 1:58 PM revealed that LPN 1 did not remove the Basaglar pen from refrigeration and placed into E Hall station 3 medication cart, nor did she know how when the pen was removed from refrigeration.

Interview with LPN 2 on September 24, 2019, at 2:19 PM revealed that LPN 2 did not remove the Basaglar pen from refrigeration and placed into F Hall station 3 medication cart, nor did she know how when the pen was removed from refrigeration.

Interview with the Director of Nursing on September 26, 2019, at 9:45 AM revealed that she would have expected the medication to be stored appropriately and disposed of after appropriate expiration dates in accordance with facility policy and pharmacy recommendations.

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

28 Pa. Code 211.9(a)(1)(i) Pharmacy services.

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









 Plan of Correction - To be completed: 10/22/2019

The identified medications were disposed of.
2. A comprehensive review of all medication carts and medication storage areas using the Medication Storage and Labeling, was completed to ensure there were no other expired medications.
3. The facility will take the following action: Licensed staff will receive Education by the DON related to Medication Storage and Labeling.
4. The facility DON/designee will monitor its performance by completing audits of medication carts and medication storage areas weekly x4 and monthly x2; to ensure that there are no expired medications in any of the medication storage areas. Audit results will be provided to the QA committee for further review and recommendations.

483.10(g)(17)(18)(i)-(v) REQUIREMENT Medicaid/Medicare Coverage/Liability Notice: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(g)(17) The facility must--
(i) Inform each Medicaid-eligible resident, in writing, at the time of admission to the nursing facility and when the resident becomes eligible for Medicaid of-
(A) The items and services that are included in nursing facility services under the State plan and for which the resident may not be charged;
(B) Those other items and services that the facility offers and for which the resident may be charged, and the amount of charges for those services; and
(ii) Inform each Medicaid-eligible resident when changes are made to the items and services specified in 483.10(g)(17)(i)(A) and (B) of this section.

483.10(g)(18) The facility must inform each resident before, or at the time of admission, and periodically during the resident's stay, of services available in the facility and of charges for those services, including any charges for services not covered under Medicare/ Medicaid or by the facility's per diem rate.
(i) Where changes in coverage are made to items and services covered by Medicare and/or by the Medicaid State plan, the facility must provide notice to residents of the change as soon as is reasonably possible.
(ii) Where changes are made to charges for other items and services that the facility offers, the facility must inform the resident in writing at least 60 days prior to implementation of the change.
(iii) If a resident dies or is hospitalized or is transferred and does not return to the facility, the facility must refund to the resident, resident representative, or estate, as applicable, any deposit or charges already paid, less the facility's per diem rate, for the days the resident actually resided or reserved or retained a bed in the facility, regardless of any minimum stay or discharge notice requirements.
(iv) The facility must refund to the resident or resident representative any and all refunds due the resident within 30 days from the resident's date of discharge from the facility.
(v) The terms of an admission contract by or on behalf of an individual seeking admission to the facility must not conflict with the requirements of these regulations.
Observations:


Based on review of select facility documents and staff interviews, it was determined that the facility failed to ensure each resident is informed of charges and services not covered under Medicare A for one of three residents reviewed (Resident 59).

Findings Include:

Review of Resident 59's Skilled Nursing Facility Beneficiary Protection Notice form revealed a start date of April 18, 2019, for Medicare Part A Skilled Services and a last covered date of Medicare Part A Skilled Services of May 17, 2019.

Further review of Resident 59's Beneficiary Protection Notice form revealed that neither he or his Resident Representative were provided the Skilled Nursing Facility Advance Beneficiary Notice of Non-coverage form (SNFABN) to notify him of the estimated cost of continued services provided by the facility not covered by the Medicare A benefit.

During an interview with the Nursing Home Administrator (NHA) on September 26, 2019, at 11:01 AM, the NHA revealed that there was a change in social workers a few months previously and that no information was available to indicate that the SNFABN form had been provided.

28 Pa. Code 201.18(a) Management

28 Pa. Code 201.29 Resident rights



























 Plan of Correction - To be completed: 10/22/2019

1. An ABN will be provided to the family for signature.
2. Other residents that have the potential to be affected will have a comprehensive review using the SNF Beneficiary Notification Review tool; to ensure that all patients that have been discontinued from Medicare Payor Services in the last 30 days, have received a NOMNC and ABN as appropriate.
3. The facility will take the following action: Social Services will receive Education by the NHA related to NOMNC and ABN delivery.
4. The facility NHA/designee will monitor its performance by completing NOMNC and ABN audits for any patient discontinued from Medicate weekly x4 and monthly x2; to ensure that NOMNCs are issued according to Medicare guidelines and that the ABN is issued when appropriate. Audit results will be provided to QA committee for further review and recommendations.


Back to County Map


  
Home : Press Releases : Administration
Health Planning and Assessment : Office of the Secretary
Health Promotion and Disease Prevention : Quality Assurance



Copyright 2001 Commonwealth of Pennsylvania. All Rights Reserved.
Commonwealth of PA Privacy Statement

Visit the PA Power Port