Pennsylvania Department of Health
QUAKERTOWN CENTER
Patient Care Inspection Results

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Severity Designations


Minimal Citation - No Harm	Minimal Harm	Actual Harm	Serious Harm

QUAKERTOWN CENTER
Inspection Results For:

There are 93 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.


QUAKERTOWN CENTER - Inspection Results	Scope of Citation Number of Residents Affected By Deficient Practice

Initial comments:
Based on a Medicare/Medicaid Recertification survey, State Licensure survey, and Civil Rights Compliance survey completed March 8, 2024, it was determined that Quakertown Center, 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 as the relate to the Health portion of the survey.

Plan of Correction:

483.21(b)(1)(3) 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.
§483.21(b)(3) The services provided or arranged by the facility, as outlined by the comprehensive care plan, must-
(iii) Be culturally-competent and trauma-informed.

Observations:

Based on clinical record review and staff interview, it was determined that the facility failed to develop a comprehensive care plan that addressed individual resident needs as identified in the comprehensive assessment for one of 26 sampled residents. (Resident 119)

Findings include:

Clinical record review revealed that Resident 119 had a Minimum Data Set assessment completed on February 13, 2024. According to the assessment, the resident received nutrition from a feeding tube. According to the "Care Area Assessment" summary from that assessment, the facility identified that nutrition and a feeding tube were problem areas for the resident and should have been included on the comprehensive care plan. Review of the care plan revealed that the facility did not develop interventions to address these care areas.

In an interview on March 8, 2024, at 10:10 a.m., the Director of Nursing confirmed that Resident 119's care plan did not include the areas of potential concern identified in the comprehensive assessment.

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

Plan of Correction - To be completed: 04/16/2024

1. The care plan of Resident 119 was updated to reflect the use of a tube feed for nutrition.
2. A house wide audit was conducted to ensure those residents with use of tube feed is reflected in their individual care plans.
3. NPE or designee will conduct education nursing staff on care plans being updated and individualized for the residents that are receiving care related to enteral feeding.
4. DON and/or Designee will conduct random audits weekly x 60 days for all residents with Enteral feeding to ensure that there is a care plan in place. Audits will be reviewed with the QAPI committee for any further action that may be necessary.

483.45(c)(3)(e)(1)-(5) REQUIREMENT Free from Unnec Psychotropic Meds/PRN Use:

§483.45(e) Psychotropic Drugs.
§483.45(c)(3) A psychotropic drug is any drug that affects brain activities associated with mental processes and behavior. These drugs include, but are not limited to, drugs in the following categories:
(i) Anti-psychotic;
(ii) Anti-depressant;
(iii) Anti-anxiety; and
(iv) Hypnotic

Based on a comprehensive assessment of a resident, the facility must ensure that---

§483.45(e)(1) Residents who have not used psychotropic drugs are not given these drugs unless the medication is necessary to treat a specific condition as diagnosed and documented in the clinical record;

§483.45(e)(2) Residents who use psychotropic drugs receive gradual dose reductions, and behavioral interventions, unless clinically contraindicated, in an effort to discontinue these drugs;

§483.45(e)(3) Residents do not receive psychotropic drugs pursuant to a PRN order unless that medication is necessary to treat a diagnosed specific condition that is documented in the clinical record; and

§483.45(e)(4) PRN orders for psychotropic drugs are limited to 14 days. Except as provided in §483.45(e)(5), if the attending physician or prescribing practitioner believes that it is appropriate for the PRN order to be extended beyond 14 days, he or she should document their rationale in the resident's medical record and indicate the duration for the PRN order.

§483.45(e)(5) PRN orders for anti-psychotic drugs are limited to 14 days and cannot be renewed unless the attending physician or prescribing practitioner evaluates the resident for the appropriateness of that medication.

Observations:

Based on clinical record review, facility policy review, and staff interview, it was determined that the facility failed to ensure that a PRN (as needed) psychotropic medication was limited to 14 days unless the physician documented in the clinical record the rationale for the PRN to be extended beyond 14 days for two of 26 sampled residents. (Residents 43, 67)

Findings include:

Review of the facility policy entitled, "Psychotropic Medication Use," last reviewed October 26, 2023, PRN psychotropic medication should not be ordered for more that 14 days. Residents who were taking PRN psychotropic medications were to have their prescription reviewed by the physician every 14 days.

Clinical record review revealed that Resident 43 had diagnoses that included dementia and depression. On February 8, 2024, a physician ordered that staff administer a psychotropic medication (risperidone) every day as needed for anxiety. The order for the risperidone failed to include a time frame for the continued use of the medication. There was no physician documentation that it was appropriate for the order to be extended beyond 14 days.

Clinical record review revealed that Resident 67 had diagnoses that included dementia and anxiety. On December 29, 2023, a physician ordered that staff administer a psychotropic medication (lorazepam) every 24 hours as needed for agitation. Review of the Medication Administration Record for March 2024, revealed that staff had administered the prn lorazepam three times and the physician's order was still current. The order for the lorazepam failed to include a time frame for the continued use of the medication. There was no physician documentation that it was appropriate for the order to be extended beyond 14 days.

In an interview on March 8, 2024, at 10:10 a.m., the Director of Nursing confirmed that the there was no evidence the physician documented a rationale for continuing the medications beyond 14 days.
.
28 Pa. code 211.12(d)(1)(5) Nursing services.

Plan of Correction - To be completed: 04/16/2024

1. Resident 43 and Resident 67 psychotropic PRN order was reviewed with physician and updated to reflect x 14 days duration.
2. A house-wide audit was conducted to ensure those with PRN psychotropic orders have an end date per physician orders.
3. NPE and/or designee will provide re-education to the nursing staff to ensure the PRN psychotropics have a 14 day stop date for physician orders.
4. DON and/or designee will conduct audits weekly x 60 days to ensure that residents receiving PRN psychotropic have a stop date identified in the order for 14 days.

483.25(d)(1)(2) REQUIREMENT Free of Accident Hazards/Supervision/Devices:

§483.25(d) Accidents.
The facility must ensure that -
§483.25(d)(1) The resident environment remains as free of accident hazards as is possible; and

§483.25(d)(2)Each resident receives adequate supervision and assistance devices to prevent accidents.

Observations:

Based on facility policy review, clinical record review, observation, and resident and staff interview, it was determined that the facility failed to assess and implement safety measures related to smoking for two of two sampled residents. (Resident 6, 83)

Findings include:

Review of the facility policy entitled, "Smoking," last reviewed August 7, 2023, revealed that smoking would be permitted in designated areas, that residents would be assessed on admission, quarterly, and with change in condition for the ability to smoke safely and, if necessary, would be supervised. The policy also required that smoking supplies (including, but not limited to, tobacco, matches, lighters, lighter fluid, batteries, refill cartridges, etc.) would be labeled with the resident 's name, room number, and bed number, maintained by staff, and stored in a suitable cabinet kept at the nursing station.

Clinical record review revealed that Resident 6 had diagnoses that included Post Traumatic Stress Disorder, sacroiliitis, blindness in the left eye, personal history of pulmonary embolism and thrombosis, personal history of hip replacements. According to the Minimum Data Set assessment (MDS), dated August 21, 2023, the resident had no cognitive impairment. Observations on March 5, 2024, at 11:42 a.m., and March 6, 2024, at 10:42 a.m., revealed Resident 6 smoking outside the front of the building. In an interview on March 6, 2024, at 10:42 a.m., Resident 6 reported smoking on a regular basis. There was no documented evidence that the facility completed smoking assessments for Resident 6 after July 8, 2023.

Clinical record review revealed that Resident 83 had diagnoses that included Diabetes with polyneuropathy, chronic kidney disease, and paralytic syndrome following a cerebral infarction. According to the MDS, dated August 25, 2023, the resident had no cognitive impairment. In an interview on March 7, 2024, at 12:05 p.m., Resident 83 reported smoking on a regular basis. There was no documented evidence that the facility completed smoking assessments for Resident 83 after October 1, 2023.

In an interview on March 7, 2024, at 1:40 p.m., the Director of Nursing and Administrator confirmed that Residents 6 and 83 had been permitted to smoke and that quarterly smoking assessments had not been completed.

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

Plan of Correction - To be completed: 04/16/2024

1. Resident 6 and Resident 83 had a smoking assessment completed. Therapy to evaluate these residents deemed safe with smoking. Facility has ensured that all smoking paraphernalia is stored in an appropriate container.
2. Residents that prefer to smoke will be evaluated to ensure an assessment for smoking has been completed and re-education to the resident on the smoking policy.
3. NPE and/or designee will provide re-education to all staff in regards to the smoking policy and a smoking assessment to be completed upon admissions and quarterly for residents that prefer to smoke.
4. DON and/or designee will complete an audit weekly x 60 days to ensure that an assessment has been completed a minimum of quarterly for residents that prefer to smoke. Results of the audit will be reported to the Quality Assurance Performance Improvement Committee monthly.

483.25(c)(1)-(3) REQUIREMENT Increase/Prevent Decrease in ROM/Mobility:

§483.25(c) Mobility.
§483.25(c)(1) The facility must ensure that a resident who enters the facility without limited range of motion does not experience reduction in range of motion unless the resident's clinical condition demonstrates that a reduction in range of motion is unavoidable; and

§483.25(c)(2) A resident with limited range of motion receives appropriate treatment and services to increase range of motion and/or to prevent further decrease in range of motion.

§483.25(c)(3) A resident with limited mobility receives appropriate services, equipment, and assistance to maintain or improve mobility with the maximum practicable independence unless a reduction in mobility is demonstrably unavoidable.

Observations:

Based on clinical record review, observation, and staff interview, it was determined that the facility failed to implement interventions to prevent further decline and/or improve range of motion for one of seven sampled residents. (Resident 49)

Findings include:

Clinical record review revealed that Resident 49 had diagnoses that included multiple sclerosis, quadriplegia, and Parkinson's Disease. The Minimum Data Set assessment dated February 12, 2024, indicated that the resident had memory impairment and required extensive assistance from staff for personal hygiene and dressing. Review of the care plan revealed that staff was to apply bilateral hand carrots (orthotic devices) for four hours to prevent contractures and maintain skin integrity. Review of the current physician's orders revealed that staff was to apply bilateral hand carrots four hours daily, on at 10 a.m. and off at 2 p.m.

Observation on March 5, 2024, revealed the resident in bed at 11:34 a.m., 12:15 p.m., and 1:10 p.m., without the bilateral hand carrots in place. On March 6, 2024, the resident was in bed at 12:45 p.m., and 1:50 p.m., without the bilateral hand carrots in place. On March 7, 2024, the resident was again in bed at 10:55 a.m. and 1:07 p.m., without the bilateral hand carrots in place.

In an interview on March 8, 2024, at 10:45 a.m., the Director of Nursing confirmed that the staff was to apply bilateral hand carrots as ordered by the physician.

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

Plan of Correction - To be completed: 04/16/2024

1. Resident 49's splint has been reassessed by therapy and the splint program is being provided and documented on as recommended by therapy.
2. An initial audit will be completed on current patients with restorative splinting nursing programs to ensure the splinting programs are being completed and documented. Will refer to therapy for any resident that is identified.
3. NPE and/or designee will provide re-education to the Nursing Staff to ensure Restorative Nursing splinting are followed and including application of splints are being worn per physician order wear time.
4. The Director of Nursing/designee will conduct random audits for the next 60 days to ensure that nursing staff are performing and documenting evidence of restorative nursing programs. Results of the audit will be reported to the Quality Assurance Performance Improvement Committee monthly.

483.15(c)(3)-(6)(8) REQUIREMENT Notice Requirements Before Transfer/Discharge:

Least serious deficiency but affects more than a limited number of residents, staff, or occurrences. This deficiency has the potential for causing no more than a minor negative impact on the resident but is not found to be throughout this facility.

§483.15(c)(3) Notice before transfer.
Before a facility transfers or discharges a resident, the facility must-
(i) Notify the resident and the resident's representative(s) of the transfer or discharge and the reasons for the move in writing and in a language and manner they understand. The facility must send a copy of the notice to a representative of the Office of the State Long-Term Care Ombudsman.
(ii) Record the reasons for the transfer or discharge in the resident's medical record in accordance with paragraph (c)(2) of this section; and
(iii) Include in the notice the items described in paragraph (c)(5) of this section.

§483.15(c)(4) Timing of the notice.
(i) Except as specified in paragraphs (c)(4)(ii) and (c)(8) of this section, the notice of transfer or discharge required under this section must be made by the facility at least 30 days before the resident is transferred or discharged.
(ii) Notice must be made as soon as practicable before transfer or discharge when-
(A) The safety of individuals in the facility would be endangered under paragraph (c)(1)(i)(C) of this section;
(B) The health of individuals in the facility would be endangered, under paragraph (c)(1)(i)(D) of this section;
(C) The resident's health improves sufficiently to allow a more immediate transfer or discharge, under paragraph (c)(1)(i)(B) of this section;
(D) An immediate transfer or discharge is required by the resident's urgent medical needs, under paragraph (c)(1)(i)(A) of this section; or
(E) A resident has not resided in the facility for 30 days.

§483.15(c)(5) Contents of the notice. The written notice specified in paragraph (c)(3) of this section must include the following:
(i) The reason for transfer or discharge;
(ii) The effective date of transfer or discharge;
(iii) The location to which the resident is transferred or discharged;
(iv) A statement of the resident's appeal rights, including the name, address (mailing and email), and telephone number of the entity which receives such requests; and information on how to obtain an appeal form and assistance in completing the form and submitting the appeal hearing request;
(v) The name, address (mailing and email) and telephone number of the Office of the State Long-Term Care Ombudsman;
(vi) For nursing facility residents with intellectual and developmental disabilities or related disabilities, the mailing and email address and telephone number of the agency responsible for the protection and advocacy of individuals with developmental disabilities established under Part C of the Developmental Disabilities Assistance and Bill of Rights Act of 2000 (Pub. L. 106-402, codified at 42 U.S.C. 15001 et seq.); and
(vii) For nursing facility residents with a mental disorder or related disabilities, the mailing and email address and telephone number of the agency responsible for the protection and advocacy of individuals with a mental disorder established under the Protection and Advocacy for Mentally Ill Individuals Act.

§483.15(c)(6) Changes to the notice.
If the information in the notice changes prior to effecting the transfer or discharge, the facility must update the recipients of the notice as soon as practicable once the updated information becomes available.

§483.15(c)(8) Notice in advance of facility closure
In the case of facility closure, the individual who is the administrator of the facility must provide written notification prior to the impending closure to the State Survey Agency, the Office of the State Long-Term Care Ombudsman, residents of the facility, and the resident representatives, as well as the plan for the transfer and adequate relocation of the residents, as required at § 483.70(l).

Plan of Correction - To be completed: 04/16/2024

1. Residents 12, 29, 45, 49, 83, 101, 119, and 126 who returned to the facility without any difficulty were provided with the facility Transfer notice.
2. An audit of the last 30 days will be conducted of Residents transferred out of the facility to the hospital to ensure there was no barrier to their return to the facility. Resident's who were transferred out to the hospital without receiving the facility's transfer notice were provided the Transfer notice information.
3.Licensed nursing staff and Department Heads will be educated on the OPS404 Transfer and Discharge Policy by the NHA and/or Designee along with the need to provide and document the notice requirements at the time of transfer to acute care setting.
4. The NHA and/or designee will complete a weekly audit x 60 days of residents who have been transferred to the hospital to ensure transfer notice.

483.15(d)(1)(2) REQUIREMENT Notice of Bed Hold Policy Before/Upon Trnsfr:

§483.15(d) Notice of bed-hold policy and return-

§483.15(d)(1) Notice before transfer. Before a nursing facility transfers a resident to a hospital or the resident goes on therapeutic leave, the nursing facility must provide written information to the resident or resident representative that specifies-
(i) The duration of the state bed-hold policy, if any, during which the resident is permitted to return and resume residence in the nursing facility;
(ii) The reserve bed payment policy in the state plan, under § 447.40 of this chapter, if any;
(iii) The nursing facility's policies regarding bed-hold periods, which must be consistent with paragraph (e)(1) of this section, permitting a resident to return; and
(iv) The information specified in paragraph (e)(1) of this section.

§483.15(d)(2) Bed-hold notice upon transfer. At the time of transfer of a resident for hospitalization or therapeutic leave, a nursing facility must provide to the resident and the resident representative written notice which specifies the duration of the bed-hold policy described in paragraph (d)(1) of this section.

Observations:

Based on clinical record review and staff interview, it was determined that the facility failed to provide a written notice of the facility's bed-hold policy to the resident, family member, or legal representative at the time of transfer for two of 12 sampled residents who were transferred to the hospital. (Residents 45, 101)

Findings include:

Clinical record review revealed that Resident 45 was transferred and admitted to the hospital on December 14, 2023, and December 30, 2023, after changes in condition. There was no documented evidence that the resident, resident's responsible party, or legal representatives were provided written information about the facility's bed-hold policy at the time of transfer.

Clinical record review revealed that Resident 101 was transferred and admitted to the hospital on September 30, 2023, after a change in condition. There was no documented evidence that the resident, resident's responsible party, or legal representatives were provided written information about the facility's bed-hold policy at the time of transfer.

In an interview on March 8, 2024, at 11:20 a.m., the Director of Nursing confirmed that no written notice of the bed-hold policy was given to the resident or residents' representative upon transfer out of the facility.

Plan of Correction - To be completed: 04/16/2024

1. Residents 12, 29, 45, 49, 83, 101, 119, and 126 Residents were provided the Bedhold Policy Information.
2. An initial audit will be conducted of Residents transferred to the hospital due to change in condition to ensure there was no barrier to their return.
3. Licensed Nursing Staff and facility Department Heads will be educated on the facility Bed hold notice policy by the NHA and/or designee along with the need to provide the bedhold notice at time of transfer and the necessary documentation required in the medical record.
4. The NHA and/or designee will complete a weekly audit x 60 days of residents that transferred out to an acute care setting to ensure the medical record documentation requirements are completed and that the Bed hold notice was provided. Audits will be reviewed with the QAPI committee for any further action that may be necessary.

§ 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.

Observations:

Based on a review of nursing time schedules, it was determined that the facility failed to meet the minimum nurse aide (NA) to resident ratios for nine of 21 days reviewed.

Findings include:

Review of nursing schedules for 21 days from November 19 through November 25, 2023, January 21 through January 27, 2024, and February 29 through March 6, 2024, revealed the following:

The facility failed to meet the minimum NA to resident ratio of one NA for 12 residents on evening (3:00 p.m. to 11:00 p.m.) shift on November 22, 2023, January 23, 2024, and March 2, 2024.

The facility failed to meet the minimum NA to resident ratio of one NA for 20 residents on night (11:00 p.m. to 7:00 a.m.) shift on November 19, 21, 22, 23, and 24, 2023, January 22, and 23, 2024, and March 1, and 2, 2024.

In an interview conducted on March 8, 2024, at 12:18 p.m., the Administrator confirmed that the facility failed to meet the required staffing ratios for nurse aides on the previously mentioned dates and shifts.

Plan of Correction - To be completed: 04/16/2024

1. Nurse aide staffing ratios will be reviewed for the last 7 days to evaluate if nurse aide ratio is met.
2. Nursing admin and scheduler will be re-educated on new July 1 nurse staffing and PPD requirements.
3. Weekly audit of nurse aid ratios will be conducted for 60 days by NHA/designee to assure nurse aid ratio is met. Tracking and trends to be submitted to QAPI committee.

§ 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.

Observations:

Based on a review of nursing time schedules, it was determined that the facility failed to meet the minimum licensed practical nurse (LPN) to resident ratios for nine of 21 days reviewed.

Findings include:

Review of nursing schedules for 21 days from November 19 through November 25, 2023, January 21 through January 27, 2024, and February 29 through March 6, 2024, revealed the following:

The facility failed to meet the minimum LPN to resident ratio of one LPN for 30 residents on evening (3:00 p.m. to 11:00 p.m.) shift on November 20, 2023.

The facility failed to meet the minimum LPN to resident ratio of one LPN for 40 residents on night (11:00 p.m. to 7:00 a.m.) shift on November 22, and 25, 2023, January 22, 23, 24, and 26, 2024, and March 1, and 2, 2024.

In an interview conducted on March 8, 2024, at 12:18 p.m., the Administrator confirmed that the facility failed to meet the required staffing ratios for licensed practical nurses on the previously mentioned dates and shifts.

Plan of Correction - To be completed: 04/16/2024

1. LPN staffing ratios will be reviewed for the last 7 days to evaluate if LPN ratio is met.
2. Nursing admin and scheduler will be re-educated on new July 1 nurse staffing and PPD requirements.
3. Weekly audit of LPN ratios will be conducted for 60 days by NHA/designee to assure LPN ratio is met. Tracking and trends to be submitted to QAPI committee.

§ 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 a review of nursing time schedules, it was determined that the facility failed to provide a minimum of 2.87 hours of direct care for each resident for one of 21 days reviewed.

Findings include:

Review of nursing schedules for 21 days from November 19 through November 25, 2023, January 21 through January 27, 2024, and February 29 through March 6, 2024, revealed the following total nursing care hours below minimum requirements:

Saturday March 2, 2024: 2.76 care hours per resident.

In an interview on March 8, 2024, at 12:18 p.m., the Administrator confirmed that the facility failed to provide the minimum hours of direct care for each resident for the day listed above.

Plan of Correction - To be completed: 04/16/2024

1. HPPD will be reviewed for the last 7 days to evaluate if state minimum PPD of 2.87 is met.
2. Nursing admin and scheduler will be re-educated on new July 1 nurse staffing and PPD requirements.
3. Weekly audit of HPPD will be conducted for 60 days by NHA/designee to assure minimal HPPD is met. Tracking and trends to be submitted to QAPI committee.

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