|§483.35 Nursing Services|
The facility must have sufficient nursing staff with the appropriate competencies and skills sets to provide nursing and related services to assure resident safety and attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident, as determined by resident assessments and individual plans of care and considering the number, acuity and diagnoses of the facility's resident population in accordance with the facility assessment required at §483.70(e).
§483.35(a)(3) The facility must ensure that licensed nurses have the specific competencies and skill sets necessary to care for residents' needs, as identified through resident assessments, and described in the plan of care.
§483.35(a)(4) Providing care includes but is not limited to assessing, evaluating, planning and implementing resident care plans and responding to resident's needs.
§483.35(c) Proficiency of nurse aides.
The facility must ensure that nurse aides are able to demonstrate competency in skills and techniques necessary to care for residents' needs, as identified through resident assessments, and described in the plan of care.
Based on a review of information submitted by the facility, grievance reports, employee statements, clinical records and employee personnel files and staff interview, it was determined that the facility failed to assure that nursing staff possessed the necessary knowledge, competencies, and skill sets to provide care and meet a resident's individualized needs as identified in the resident's current plan of care for one resident out of five residents reviewed (Resident 3).
A review of Resident 3's clinical record revealed an admission date of February 26, 2021, with diagnoses including dementia (not a specific disease, dementia is a group of conditions characterized by impairment of at least two brain functions, such as memory loss and judgement) and dysphagia (difficulty swallowing food or liquids).
A review of Resident 3's current plan of care revealed a focus of resistive/noncompliant with treatment/care dated February 26, 2021. The resident's goal was that the resident will participate with care routine/medical regimen. Intervention planned to meet this goal were to allow for flexibility in ADL routine to accommodate the resident's mood, preference and customary routine and if the resident resists care, leave (if safe to do so) and return later.
Review of an employee witness statement provided by Employee 2, Licensed Practical Nurse (Charge Nurse), in response to an allegation of resident neglect of Resident 3, revealed that Employee 1 had approached her at the nurses' station on November 17, 2021, at 10:27 PM, nearing conclusion of the 3 PM to 11 PM shift, relaying that Resident 3 refused all care throughout the shift and remained out of bed. Employee 2 noted in her statement she was not made aware of any refusals of care on the 3:00 PM- 11:00 PM shift until 10:27 PM on that date.
Employee 1's (nurse aide) witness statement indicated that Resident 3 had refused all care during the entire 3 PM to 11 PM shift on November 17, 2021. Employee 1's statement noted that she had informed two nurses and a nurse aide of Resident 3's refusals. The other nurse aide corroborated Employee 1's report.
There was no documented evidence that Employee 1 had implemented Resident 3's dementia care plan to allow for flexibility in ADL routine to accommodate the resident's mood, preference and customary routine and if the resident resists care, leave (if safe to do so) and had returned later in an attempt to promote the resident's acceptance and compliance with care. There was no evidence that Employee 1 had timely informed licensed nursing staff that the resident was refusing all care earlier during the 3 PM to 11 PM shift.
A review of Resident 3's clinical record revealed documentation that the resident had refused most nursing care on the 3:00 PM to 11:00 PM shift on November 17, 2021, for the tasks of bed mobility, dressing, personal hygiene, toilet use, bowel and bladder elimination and incontinence check and change every 2-3 hours.
A review of the employee file for Employee 1, an agency nurse aide, revealed a document dated October 9, 2021, from the staffing agency noting that Employee 1 had completed orientation through the staffing agency. However, the content of the orientation was not available nor was there demonstrated competencies detailed to ensure that the nurse aide had the required skills to carry out Resident 3's dementia-care related care plan and meet the resident's individual needs. The employee's personnel file failed to reveal evidence that Employee 1 was provided any training and orientation at the skilled nursing facility to ensure that the employee was aware and familiar with facility specific policy and possessed the specific competencies and skill sets necessary to care for residents' needs, as identified through the facility assessment, resident-specific assessments, and described in their plan of care.
Interview with the Assistant Nursing Home Administrator on November 30, 2021, indicated that the facility was unable to provide documented evidence that this agency nurse aide possessed the necessary competency and skills to render care as planned for this dementia resident and that the facility had provided the employee with the necessary training and orientation to the facility upon beginning work at the facility.
28 Pa. Code 201.20 (b)(d) Staff Development
28 Pa. Code 211.11(d) Resident care plan
28 Pa Code 211.12 (a)(c)(d)(1)(5) Nursing services
| ||Plan of Correction - To be completed: 12/20/2021|
1.The facility cannot retroactively correct the missing evidence of Agency staff orientation including dementia training to the facility. Moving forward the facility will ensure proof of orientation including competency of dementia training of Agency staff.
2.To identify staff affected the HR director completed an audit of current Agency staff files to ensure evidence of orientation including competency for dementia training is present. The facility cannot retroactively correct the missing evidence of Agency staff orientation to the facility including competency for dementia training. Moving forward the facility will ensure proof of orientation including competency for dementia is present for Agency staff moving forward.
To prevent this from recurring the DCE/designee will provide education to the HR director and scheduler on ensuring proof of orientation including competency for dementia training is present for Agency staff.
To monitor and maintain ongoing compliance the DON/designee will audit the files of 5 agency staff members weekly x 4 then monthly x 2 to ensure proof of orientation including dementia training is present. Any negative findings will be immediately corrected. The results of the audits will be brought to QAPI for review and revision as needed.