Nursing Investigation Results -

Pennsylvania Department of Health
GARDENS AT WYOMING VALLEY, THE
Patient Care Inspection Results

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Minimal Citation - No Harm Minimal Harm Actual Harm Serious Harm
GARDENS AT WYOMING VALLEY, THE
Inspection Results For:

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GARDENS AT WYOMING VALLEY, THE - Inspection Results Scope of Citation
Number of Residents Affected
By Deficient Practice
Initial comments:

Based on a revisit and abbreviated complaint survey completed on February 12, 2020, it was determined that The Gardens at Wyoming Valley corrected the deficiencies cited during the survey of December 27, 2019, but continued to be out of 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(i)(1)-(7) REQUIREMENT Safe/Clean/Comfortable/Homelike Environment: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.
483.10(i) Safe Environment.
The resident has a right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.

The facility must provide-
483.10(i)(1) A safe, clean, comfortable, and homelike environment, allowing the resident to use his or her personal belongings to the extent possible.
(i) This includes ensuring that the resident can receive care and services safely and that the physical layout of the facility maximizes resident independence and does not pose a safety risk.
(ii) The facility shall exercise reasonable care for the protection of the resident's property from loss or theft.

483.10(i)(2) Housekeeping and maintenance services necessary to maintain a sanitary, orderly, and comfortable interior;

483.10(i)(3) Clean bed and bath linens that are in good condition;

483.10(i)(4) Private closet space in each resident room, as specified in 483.90 (e)(2)(iv);

483.10(i)(5) Adequate and comfortable lighting levels in all areas;

483.10(i)(6) Comfortable and safe temperature levels. Facilities initially certified after October 1, 1990 must maintain a temperature range of 71 to 81F; and

483.10(i)(7) For the maintenance of comfortable sound levels.
Observations:

Based on observations and staff interview it was determined that the facility failed to provide housekeeping services to maintain a sanitary resident environment and failed to maintain clean resident care equipment on one of two nursing units (third floor).

Findings include:

Observations conducted during an environmental tour of the facility on February 12, 2020, at approximately 8:30 a.m. on the third floor revealed a thick layer of black film along the edge of the baseboards on the unit and the entrance way into the private bath/ shower room.

Upon entering the large shower room there was a strong mildew-like odor.

Observation of the large shower room revealed a white drain in the floor by the whirlpool tub, which was coated with dust, cobwebs and hair. A foul odor emanated from the drain.

Observation of the Arjo and Sara 3000 sit-to-stand lifts that were stored in the large shower room revealed a thick layer of dirt and crumbs on the foot plates. The bases of the lifts were coated with dirt. A sling, that is used to secure the resident while the sit-to-stand lift is utilized, was hanging on the Arjo lift. Further observation of the sling revealed that the mesh on the sling was torn with the bottom right of the mesh torn at the seam, away from the pad.

Observation of a white shower chair with light blue mesh that was stored in the large shower room revealed a thick layer of hair and dirt in a pocket located on the back of the chair.

Observation of a blue bariatric recliner outside room 304 revealed a thick layer of dried food on both armrests and both inner side panels. A strong urine-like odor emanated from the chair. Upon inspection of the seat cushion, the odor increased and moisture/wetness was observed beneath the cushion, which extended and ran down the back of the chair seat and formed a puddle on the floor beneath the chair. A large tear at the top of the chair was observed where it attaches to the metal frame. Employee 2, nurse aide, confirmed at the time of this observation, that the recliner was soiled, a strong smell of urine was present and that the puddle beneath the chair had come from the chair.

Observation of resident room 314 revealed a large hole in the wall behind the door.

Observation of a green high back chair in the resident area beside the third-floor nurse's station revealed a thick sticky substance on top of the seat cushion. A tissue was stuffed in the side of the cushion. Upon further inspection of the cushion tissues, a glove, food and garbage were observed beneath the cushion.

Observation of the resident lounge "Sugar Hollow" located on the third floor revealed that a bariatric bed was being stored in the room by the television. A resident was in the room at the time, watching the television.

Interview with the manager of Housekeeping on February 12, 2020, at approximately 1:00 p.m. confirmed the observations of the third-floor resident care areas in need of cleaning and the oiled resident care equipment.

Review of the facility wheelchair cleaning schedule revealed that the resident wheelchairs are cleaned monthly. The facility did not provide a schedule of when other resident care equipment was scheduled to be cleaned.

During an interview with the Nursing Home Administrator and Director of Nursing on February 12, 2020, at approximately 3:00 p.m. the NHA and DON confirmed that resident care equipment and resident care areas should be kept clean.


Pa. Code 207.2 (a) Administrator's responsibility



 Plan of Correction - To be completed: 03/17/2020

The baseboards on the third floor have been cleaned. The drain has been cleaned. No odors are present. The lifts have been cleaned. The sling has been replaced. The shower chair was cleaned. The blue bariatric recliner has been cleaned and disinfected. The hole in room 314 has been filled. The high back chair was cleaned. The bariatric bed was removed.

The housekeeping staff performed an audit for cleanliness on wheelchairs, drains, shower chairs, lifts and slings.

The housekeeping department will be educated regarding the routine cleaning of wheelchairs, drains, shower chairs and lifts.

The Environmental Services Director/Maintenance Director will perform environmental rounds 1x/week to identify areas in need of attention.

The NHA/Designee will audit the environmental rounds to insure completion of tasks identified during the weekly walk through.

The results of the audits will be presented to the QA committee for review and recommendation.


483.60(i)(1)(2) REQUIREMENT Food Procurement,Store/Prepare/Serve-Sanitary: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.
483.60(i) Food safety requirements.
The facility must -

483.60(i)(1) - Procure food from sources approved or considered satisfactory by federal, state or local authorities.
(i) This may include food items obtained directly from local producers, subject to applicable State and local laws or regulations.
(ii) This provision does not prohibit or prevent facilities from using produce grown in facility gardens, subject to compliance with applicable safe growing and food-handling practices.
(iii) This provision does not preclude residents from consuming foods not procured by the facility.

483.60(i)(2) - Store, prepare, distribute and serve food in accordance with professional standards for food service safety.
Observations:

Based on observation and staff interview, it was determined that the facility failed to maintain acceptable practices for the storage of food and supplements to prevent the potential for microbial growth in food or contamination, which increased the risk for foodborne illness.

Findings include:

Food safety and inspection standards for safe food handling indicate that everything that comes in contact with food must be kept clean and food that is mishandled can lead to foodborne illness. Safe steps in food handling, cooking, and storage are essential in preventing foodborne illness. You cannot always see, smell, or taste harmful bacteria that may cause illness according to the USDA (The United States Department of Agriculture, also known as the Agriculture Department, is the U.S. federal executive department responsible for developing and executing federal laws related to food).

An observation of the second-floor pantry on February 12, 2020, at 9:00 AM revealed that four open cartons of Ready Care 2.0 vanilla supplement dated January 21, 2020 were stored in the refrigerator. Manufacturing instructions on the carton of supplement stated to use within 3 days of opening. One container of applesauce was dated to be used by January 10, 2020. One open two-liter bottle of soda with no date when it was opened. The refrigerator was observed to be soiled with spilled juice on the bottom and sticky substances adhered to the shelves.

An interview with Employee 3 LPN (license practical nurse) on February 12, 2020, at 9:06 AM confirmed the above food and beverages in the refrigerator were expired and your beyond their use by dates and the refrigerator was not clean.

An observation of the third-floor pantry on February 12, 2020, at 9:20 AM revealed that one open carton of Ready Care 2.0 vanilla supplement dated January 31, 2020 was stored in the refrigerator. Manufacturing instructions on the carton of supplement stated to use within 3 days of opening. One container of applesauce was dated to be used by January 10, 2020. A second container of applesauce was dated with a use by date of February 11, 2020. One box containing left-over food was observed to be undated. The refrigerator was soiled with spilled juice on the bottom and sticky substances coating the shelves.

An interview with Employee 4 RN (registered nurse) on February 12, 2020, at 9:30 AM confirmed the above food and beverages items in the refrigerator were expired and/or exceeded their use-by date and that the refrigerator was not clean.

An interview with the DON (director of nursing) on February 12, 2020, at approximately 3:00PM confirmed facility failed to maintain acceptable practices for the storage of food and supplements.





28 Pa. Code Administrator ' s responsibility

28 Pa. Code Dietary services









 Plan of Correction - To be completed: 03/17/2020

The second and third floor refrigerators in the pantry were cleaned immediately. All undated items were discarded.

No other refrigerators were affected.
The dietary staff will be in-serviced on the labeling and disposal of food items.

The Dietary manager/ designee will audit the pantry refrigerators daily for outdated items and cleanliness.

The results of the audits will be presented to the QA committee for review and recommendation.


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