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

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Severity Designations


Minimal Citation - No Harm	Minimal Harm	Actual Harm	Serious Harm

SUNNYVIEW NURSING AND REHABILITATION CENTER
Inspection Results For:

There are 109 surveys for this facility. Please select a date to view the survey results.

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SUNNYVIEW NURSING AND REHABILITATION CENTER - Inspection Results	Scope of Citation Number of Residents Affected By Deficient Practice

Initial comments:

Based on an abbreviated survey in response to three complaint's completed on March 11, 2024, it was determined that Sunnyview Nursing and Rehabilitation 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(g)(14)(i)-(iv)(15) REQUIREMENT Notify of Changes (Injury/Decline/Room, etc.):

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)(14) Notification of Changes.
(i) A facility must immediately inform the resident; consult with the resident's physician; and notify, consistent with his or her authority, the resident representative(s) when there is-
(A) An accident involving the resident which results in injury and has the potential for requiring physician intervention;
(B) A significant change in the resident's physical, mental, or psychosocial status (that is, a deterioration in health, mental, or psychosocial status in either life-threatening conditions or clinical complications);
(C) A need to alter treatment significantly (that is, a need to discontinue an existing form of treatment due to adverse consequences, or to commence a new form of treatment); or
(D) A decision to transfer or discharge the resident from the facility as specified in §483.15(c)(1)(ii).
(ii) When making notification under paragraph (g)(14)(i) of this section, the facility must ensure that all pertinent information specified in §483.15(c)(2) is available and provided upon request to the physician.
(iii) The facility must also promptly notify the resident and the resident representative, if any, when there is-
(A) A change in room or roommate assignment as specified in §483.10(e)(6); or
(B) A change in resident rights under Federal or State law or regulations as specified in paragraph (e)(10) of this section.
(iv) The facility must record and periodically update the address (mailing and email) and phone number of the resident
representative(s).

§483.10(g)(15)
Admission to a composite distinct part. A facility that is a composite distinct part (as defined in §483.5) must disclose in its admission agreement its physical configuration, including the various locations that comprise the composite distinct part, and must specify the policies that apply to room changes between its different locations under §483.15(c)(9).

Observations:

Based on clinical records and staff interview, it was determined that the facility failed to notify the resident's responsible party of change in condition for one of eight residents (Resident R1).

Findings include:

Review of the clinical face sheet indicated that Resident R1 was admitted to the facility 1/17/23, with diagnoses that included malignant neoplasm of the brain, bone and lung, type 2 diabetes mellitus and anxiety.

Review of Resident R1 annual MDS assessment (MDS-Minimum Data Set Assessment. Periodic assessment of resident care needs) dated 12/20/23, indicated that the resident diagnoses were current.

Review of Resident R1 medical records indicated that the resident's son was the Power of Attorney (POA).

Review of Resident R1 nurse progress dated 1/15/2024 indicated Wound care RN called and spoke with residents daughter r/t bilateral upper thigh wounds being resolved and informed her of the current treatment plan.

Review of Resident R1 nurse progress dated 2/1/2024 indicated that a message wound update given to daughter r/t current and new pressure wounds.

Review of Resident R1 nurse progress dated 2/11/2024 indicated that that daughter made aware of Resident R1 sliding out of wheelchair.

Review of Resident R1 nurse progress dated 2/13/2024 indicated that wound care called and spoke with daughter for wound update.

Review of Resident R1 nurse progress dated 3/3/2024 indicated daughter was made aware of Resident R1's med error.

During an interview on 3/11/24 at 2:00 p.m., the Nursing Home Administrator confirmed the POA was not notified in the above changes in condition as required.

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

Plan of Correction - To be completed: 04/08/2024

No negative outcomes were noted to resident R1.

Resident representative of R1 was updated with areas cited in deficiency.

A whole house audit will be completed to ensure proper resident representative notification has been completed with change in condition.

Re-education will be provided to appropriate nursing home staff and will be conducted by the DON/designee regarding "Resident Representative" notification for accidents, significant change in condition, room changes, transfer/discharge from facility, or need to alter treatments for the resident as needed.

Audits of resident representatives' notification will be conducted by DON/designee 2 x's weekly for 4 weeks. Results of audits will be reported to QAA.

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