Pennsylvania Department of Health
HARMONY PHYSICAL REHABILITATION
Patient Care Inspection Results

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HARMONY PHYSICAL REHABILITATION
Inspection Results For:

There are  36 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.
HARMONY PHYSICAL REHABILITATION - Inspection Results Scope of Citation
Number of Residents Affected
By Deficient Practice
Initial comments:

Based on a Medicare Recertification Survey, State Licensure Survey, Civil Rights Compliance Survey, and an Abbreviated Survey in response to two complaints completed on January 31, 2024 at Harmony Physical Rehabilitation, it was determined that no deficiencies were identified under the 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 for the Health portion of the survey process.




 Plan of Correction:


483.25 REQUIREMENT Quality of Care: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.
§ 483.25 Quality of care
Quality of care is a fundamental principle that applies to all treatment and care provided to facility residents. Based on the comprehensive assessment of a resident, the facility must ensure that residents receive treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the residents' choices.
Observations:

Based on a review of facility policy and investigative documents, it was it was determined that the facility failed to follow physician's orders for one of five residents (Resident R131). This was identified as past non-compliance.

Review of the facility policy "Medication Administration" dated 1/19/23, indicated for staff to compare medication source with MAR (medication administration record) to verify resident name, medication name, form, dose, route, and time.

Review of the clinical record revealed Resident R131 was admitted to the facility on 12/13/23.

Review of the Minimum Data Set (MDS, periodic assessment of resident care needs dated 12/14/23, included diagnoses of CAD and hip fracture.

Review of the physician's order dated 12/14/23, indicated for Resident R131 to receive two 10 mg tablets of baclofen (medication used to treat muscle spasms) every 24 hours, as needed for pain. Total dose ordered was 20 mg.

Review of facility investigation documents indicated that on 12/14/23, at approximately 8:45 a.m. Resident R131 received two 20 mg tablets, for a total dose of 40 mg.

On 12/16/23, the facility initiated a plan of correction that included education for all nursing staff including Registered Nurses and Licensed Practical Nurses to ensure that safe and accurate medication practices are followed as ordered.

The facility provided documentation of the in-service training that was provided to the nursing staff, including Registered Nurses and Licensed Practical Nurses, at the facility on 12/16/23, and 12/17/23, which addressed safe and accurate medication practices. Education on medication practices which included verifying resident name, medication name, form, dose, route, and time.

The facility reviewed like residents for non-compliance with medication practices on 12/16/23, and it was determined that this was an isolated incident.

During an interview on 1/31/24, at approximately 12:00 p.m. the Nursing Home Administrator and the Director of Nursing confirmed that the facility failed to follow physician's orders for one of five residents.



 Plan of Correction - To be completed: 02/20/2024

Past noncompliance: no plan of correction required.
§ 211.12(f.1)(5) LICENSURE Nursing services. :State only Deficiency.
(5) Effective July 1, 2023, a minimum of 1 RN per 250 residents during all shifts.
Observations:
Based on review of nursing time schedules and staff interview it was determined that the facility administrative staff failed to provide a minimum of one Registered Nurse (RN) per 250 residents during the night shift for 21 of 21 days (1/7/24 through 1/27/24).

Findings include:

Review of the facility census data, nursing time schedules, and deployment sheets revealed the following Registered Nurse staffing shortages:

On 1/7, 1/17, 1/18, 1/22, and 1/25/24, the census was 22, which required 1.0 RN's during the night shift. Review of the nursing time schedules revealed 0.0 RN's provided care on the night shift. No additional excess higher-level staff were available to compensate this deficiency.

On 1/8, 1/19, 1/20, 1/21, 1/23, and 1/24/24, the census was 23, which required 1.0 RN's during the night shift. Review of the nursing time schedules revealed 0.0 RN's provided care on the night shift. No additional excess higher-level staff were available to compensate this deficiency.

On 1/15, and 1/16/24, the census was 24, which required 1.0 RN's during the night shift. Review of the nursing time schedules revealed 0.0 RN's provided care on the night shift. No additional excess higher-level staff were available to compensate this deficiency.

On 1/9, 1/10, 1/11, 1/12, 1/13, 1/14, 1/26, and 1/27/24, the census was 25, which required 1.0 RN's during the night shift. Review of the nursing time schedules revealed 0.0 RN's provided care on the night shift. No additional excess higher-level staff were available to compensate this deficiency.

During an interview on 1/31/24, at 12:00 p.m. the Nursing Home Administrator (NHA) confirmed that the facility failed to provide a minimum of one RN per 250 residents during the night shift on 21 of 21 days.


 Plan of Correction - To be completed: 03/31/2024

1. Facility implemented the staffing requirements according to the P5540 regulation as of 3/31/2024.

2. Current Residents have the potential to be affected. The facility will hire an additional nurse for the night shift to implement the staffing ratios
outlined in the P5540 regulation.

3. Administrator and or designee will educate Director of Nursing on the staffing ratio requirements that went into effect July 1, 2023. Harmony Physical Rehabilitation does meet the Hours Per Patient Day requirement; however, it is the ratio portion that was not met.

4. Director of Nursing, or designee will meet and audit the nursing schedule 5x per week for 2 weeks, weekly for 2 months and monthly for 2 months to ensure the facility adheres to the new ratio requirements. Corrected process will be reviewed quarterly by the quality improvement and quality assurance committee for further analysis and recommendation to ensure ongoing compliance.


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