Nursing Investigation Results -

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

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MANORCARE HEALTH SERVICES-CHAMBERSBURG
Inspection Results For:

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

Findings of an abbreviated survey in response to three compalints completed on January 7, 2020, at Manorcare Healthservices Chambersburg identified that the facility was not in compliance with the following requirements of 42 CFR Part 483, Subpart B, Requirements for Long Term Care and the 28 PA Code, Commonwealth of Pennsylvania Long Term Care Licensure Regulations



 Plan of Correction:


483.21(b)(1) REQUIREMENT Develop/Implement Comprehensive Care Plan: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.
483.21(b) Comprehensive Care Plans
483.21(b)(1) The facility must develop and implement a comprehensive person-centered care plan for each resident, consistent with the resident rights set forth at 483.10(c)(2) and 483.10(c)(3), that includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment. The comprehensive care plan must describe the following -
(i) The services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being as required under 483.24, 483.25 or 483.40; and
(ii) Any services that would otherwise be required under 483.24, 483.25 or 483.40 but are not provided due to the resident's exercise of rights under 483.10, including the right to refuse treatment under 483.10(c)(6).
(iii) Any specialized services or specialized rehabilitative services the nursing facility will provide as a result of PASARR recommendations. If a facility disagrees with the findings of the PASARR, it must indicate its rationale in the resident's medical record.
(iv)In consultation with the resident and the resident's representative(s)-
(A) The resident's goals for admission and desired outcomes.
(B) The resident's preference and potential for future discharge. Facilities must document whether the resident's desire to return to the community was assessed and any referrals to local contact agencies and/or other appropriate entities, for this purpose.
(C) Discharge plans in the comprehensive care plan, as appropriate, in accordance with the requirements set forth in paragraph (c) of this section.
Observations:



Based on clinical record review and staff interviews, it was determined that the facility failed to ensure the development of a comprehensive plan of care for one of 3 resident records reviewed (Resident 1).

Findings include:

Review of the clinical record for Resident 1 revealed diagnoses that included sleep apnea (temporary suspension of breathing during sleep) and atrial fibrillation (irregular heartbeat).

Review of facility provided reports for Resident 1 revealed a report titled "weights and vitals summary." The report revealed the resident's oxygen saturation levels throughout his stay in the facility. The report revealed on 65 occasions that Resident 1's oxygen saturation levels were documented as having been taken while he was using a BIPAP or CPAP (devices used to provide positive airflow during sleep apnea episodes).

Further review of Resident 1's clinical records revealed a consultation from a pulmonary and sleep medical specialist dated October 14, 2019. The summary of the consultation revealed this consultation was a follow up visit to determine the effectiveness of his BIPAP/CPAP use. The summary concluded; "he is advised to continue using CPAP nightly even when he is discharged from ManorCare."

Review of Resident 1's comprehensive plan of care revealed that it did not contain a care plan to address the use of a BIPAP/CPAP machine.

An interview with the Nursing Home Administrator on January 7, 2020, at 2:10 PM revealed her expectation that a resident would be care planned for the use of a medical device like the BIPAP/CPAP.

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



 Plan of Correction - To be completed: 02/11/2020

1. Resident has been discharged from the facility.
2. Other resident that have the potential to be affected will have a comprehensive review done using the CPAP/BIPAP tool, to ensure that there is an appropriate careplan related to CPAP/BIPAP utilization.
3. Licensed staff will be educated to enter a careplan for CPAP/BIPAP utilization following receipt of an order for CPAP/BIPAP from a physician.
4. DON/Designee will perform audits weeklyx4 using the CPAP/BIPAP tool to ensure that residents have careplans for CPAP/BIPAP utilization.

483.21(b)(3)(i) REQUIREMENT Services Provided Meet Professional Standards: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.
483.21(b)(3) Comprehensive Care Plans
The services provided or arranged by the facility, as outlined by the comprehensive care plan, must-
(i) Meet professional standards of quality.
Observations:

Based on clinical record review and staff interview, it was determined that the facility failed to ensure care and services were provided in accordance with professional standards for performing resident treatments for one of 3 residents reviewed (Resident 1).

Findings include:

Review of the clinical record for Resident 1 revealed diagnoses that included sleep apnea (temporary suspension of breathing during sleep) and atrial fibrillation (irregular heartbeat).

Review of facility provided reports for Resident 1 revealed a report titled "weights and vitals summary." The report revealed the resident's oxygen saturation levels throughout his stay in the facility. The report revealed on 65 occasions that Resident 1's oxygen saturation levels were documented as having been taken while he was using a BIPAP or CPAP (devices used to provide positive airflow during sleep apnea episodes).

Further review of Resident 1's clinical records revealed a consultation from a pulmonary and sleep medical specialist dated October 14, 2019. The summary of the consultation revealed this consultation was a follow up visit to determine the effectiveness of his BIPAP/CPAP use. The summary concluded; "he is advised to continue using CPAP nightly even when he is discharged from ManorCare."

Review of the physician orders for Resident 1 for his entire stay, September 6, 2019 to November 22, 2019, did not reveal an order for this resident to use a BIPAP or CPAP machine.

The medication administration records and the treatment administration records for September, October and November do not reveal an order for the resident to use a BIPAP or CPAP machine during his stay.

An interview with the Nursing Home Administrator on January 7, 2020, at 2:10 PM revealed her expectation that a resident would not be using a medical device without a valid order.

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



 Plan of Correction - To be completed: 02/11/2020

1. Resident has been discharged from the facility.
2. Other residents that have the potential to be affected will have a comprehensive review done using the CPAP/BIPAP tool, to ensure that there is an appropriate order related to CPAP/BIPAP utilization.
3. Licensed staff will be educated to contact the physician for an order upon notification that a resident has brought their CPAP/BIPAP from home.
4. DON/Designee will perform audits weekly x4 using the CPAP/BIPAP tool to ensure that residents have orders for CPAP/BIPAP utilization


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