§ 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.
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Observations:
Based on clinical record review, review of select facility policies and procedures, and responsible party and staff interview, it was determined that the facility failed to provide the highest practicable care regarding the use of outside resources for one of nine residents reviewed (Resident 1).
Findings include:
Review of the facility's current policy entitled "Consults," indicates that the responsible party should be involved whenever possible. If the responsible party wishes to take the resident to appointments and is deemed safe that is an option. If the resident is competent and able to answer questions in the appointment, the resident may not need an attendant to go into the actual appointment. If they wish an attendant to go into the actual appointment, one will be arranged to go with the resident.
Review of Resident 1's clinical record revealed that the facility initially admitted her in 2017. Resident 1 has a diagnosis of dementia, depression, cognitive communication deficit, mood disturbance, psychotic disturbance, and anxiety. The facility assessed Resident 1 as being not capable of making her own decisions and of being at high risk for falls.
A nursing note dated February 14, 2023, at 7:19 PM indicated that Resident 1 returned from her orthopedic appointment that was located an hour and 45 minutes from the facility one way. Resident 1 had a fall with a fracture that happened on October 24, 2023, and the appointment was considered a follow up.
There was no documented evidence in Resident 1's clinical record to indicate that the facility notified Resident 1's responsible party of the appointment so that the responsible party could be involved and attend the appointment.
A phone interview with Resident 1's responsible party on February 22, 2024, at 10:50 AM confirmed that the facility did not notify her of the appointment on February 14, 2024. Resident 1's responsible party indicated that she attends all Resident 1's appointments if she is aware of them.
A phone interview with a representative from the facility's transport company on February 23, 2024, at 11:00 AM revealed that the company does not send attendants with residents to be present with them during their appointments.
Documentation provided by the Administrator on February 23, 2024, at 11:12 AM revealed that the transport company picked up Resident 1 at 1:15 PM on February 14, 2024.
Interview with the Administrator on February 23, 2024, at 11:30 AM revealed that the facility does not have an agreement or contract with the transport company that took Resident 1 to her appointment. The Administrator indicated that the facility just calls the company and then receives a bill.
Resident 1, who was totally dependent on staff for care, was out of the facility for 6 hours without any assistance from facility staff.
Interview with the Administrator and Director Nursing on February 23, 2024, at 1:20 PM acknowledged the above findings for Resident 1.
28 Pa. Code 211.10 (a)(c)(d) Resident care policies
28 Pa. Code 211.12(d)(1)(3)(5) Nursing services
| | Plan of Correction - To be completed: 03/26/2024
Preparation and/ or execution of this plan of correction does not constitute admission or agreement by the provider of the truth of the facts alleged or conclusions set forth in the statement of deficiencies. The plan of correction is prepared and/or executed solely because it is required by the provisions of federal and state law.
1. Resident One responsible party notified of appointment and findings from appointment. Reviewed all upcoming appointments to confirm she has been notified of them as well identified what appointments she would not be attending to set up caregiver to attend with resident one if responsible party would not be attending.
2. Facility audited appointments for last month to make responsible party was notified of appointment via telephone.
3.Facility audit to make sure any resident with a BIMS of 10 or less had a caregiver attend appointment with them if responsible party was unable to do so.
4. Facility Educated Transportation department on notifying responsible party of appointment as well as scheduling a caregiver to attend appointment if person scores 10 or less on BIMS assessment.
5. Facility will audit notifying responsible party for appointments and sending caregiver to appointments for appropriate residents weekly x 4 then monthly x 3.
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