Pennsylvania Department of Health
UPMC HERITAGE PLACE
Patient Care Inspection Results

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UPMC HERITAGE PLACE
Inspection Results For:

There are  175 surveys for this facility. Please select a date to view the survey results.

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UPMC HERITAGE PLACE - Inspection Results Scope of Citation
Number of Residents Affected
By Deficient Practice
Initial comments:

Based on an Abbreviated survey in response to a complaint completed on February 13, 2024, it was determined that UPMC Heritage Place 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:


483.15(b)(1)-(3)(c)(9) REQUIREMENT Equal Practices Regardless of Payment Source: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.
§483.15(b) Equal access to quality care.
§483.15(b)(1) A facility must establish, maintain and implement identical policies and practices regarding transfer and discharge, as defined in §483.5 and the provision of services for all individuals regardless of source of payment, consistent with §483.10(a)(2);

§483.15(b)(2) The facility may charge any amount for services furnished to non-Medicaid residents unless otherwise limited by state law and consistent with the notice requirement in §483.10(g)(18)(i) and (g)(4)(i) describing the charges; and

§483.15(b)(3) The State is not required to offer additional services on behalf of a resident other than services provided in the State plan.

§483.15(c)(9) Room changes in a composite distinct part. Room changes in a facility that is a composite distinct part (as defined in § 483.5) are subject to the requirements of § 483.10(e)(7) and must be limited to moves within the particular building in which the resident resides, unless the resident voluntarily agrees to move to another of the composite distinct part's locations.
Observations:

Based on a review of facility admission information packet, resident records, and staff interviews, it was determined that the facility failed to provide advanced (48 hours) written notification of changes in the covered services provided to the residents for all payment sources for three of four residents (Resident R1, R2 and R3),

Findings include:

A review of facility " Admission Information" packet section N: Discharge Planning indicated that each resident's case is reviewed on a regular basis to determine if their medical needs continue to warrant the services provided by the facility. Discharge or transfer to a lesser level may occur when it has be determined that such services are no longer necessary. Residents and family members are notified in advance of the changes in provided services.

During a review of facility documents it was determined that the facility failed to provide advanced written notice to Resident R1, R2 and R3 of the determination for the necessity of covered services as provided by the facility.

During an interview on 2/7/24, at 10:25 am Registered Nurse Case Manager Employee E2 confirmed that the facility provides advanced written notice of change in covered services to resident's covered by a Medicare provider and failed to provide advance notice of changes in covered services to residents whose insurance provider includes Medicaid and commercial insurance companies.

During an interview on 2/7/24, at 2:00 pm the Nursing Home Administrator and Mobile Director of Nursing Employee E5 confirmed that the facility failed to provide advanced written notice of the change in covered services equally to all residents regardless of the resident's payment source.

PA Code: 201.25 Discharge Policy



 Plan of Correction - To be completed: 04/01/2024

Residents R1, R2, and R3 were discharged. Employee E1 has been provided individual education by Administrator regarding the need to provide advance written notification of covered services ending regardless of payer type as indicated.

All residents with an anticipated impending discharge will be reviewed to ensure advance written notification of covered services ending regardless of payer type has been provided as indicated.

The Administrator and/ or designee will educate the social workers and care manager regarding the need to ensure advance notification of covered services ending regardless of payer type has been provided indicated.

The Administrator and /or designee will audit 5 discharges per week for one month and 5 discharges monthly thereafter or until substantial compliance is achieved to ensure advance written notification of covered services ending regardless of payer type as indicated.

Results will be reviewed at the Quarterly QA Meeting.

483.15(c)(1)(i)(ii)(2)(i)-(iii) REQUIREMENT Transfer and Discharge Requirements: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.
§483.15(c) Transfer and discharge-
§483.15(c)(1) Facility requirements-
(i) The facility must permit each resident to remain in the facility, and not transfer or discharge the resident from the facility unless-
(A) The transfer or discharge is necessary for the resident's welfare and the resident's needs cannot be met in the facility;
(B) The transfer or discharge is appropriate because the resident's health has improved sufficiently so the resident no longer needs the services provided by the facility;
(C) The safety of individuals in the facility is endangered due to the clinical or behavioral status of the resident;
(D) The health of individuals in the facility would otherwise be endangered;
(E) The resident has failed, after reasonable and appropriate notice, to pay for (or to have paid under Medicare or Medicaid) a stay at the facility. Nonpayment applies if the resident does not submit the necessary paperwork for third party payment or after the third party, including Medicare or Medicaid, denies the claim and the resident refuses to pay for his or her stay. For a resident who becomes eligible for Medicaid after admission to a facility, the facility may charge a resident only allowable charges under Medicaid; or
(F) The facility ceases to operate.
(ii) The facility may not transfer or discharge the resident while the appeal is pending, pursuant to § 431.230 of this chapter, when a resident exercises his or her right to appeal a transfer or discharge notice from the facility pursuant to § 431.220(a)(3) of this chapter, unless the failure to discharge or transfer would endanger the health or safety of the resident or other individuals in the facility. The facility must document the danger that failure to transfer or discharge would pose.

§483.15(c)(2) Documentation.
When the facility transfers or discharges a resident under any of the circumstances specified in paragraphs (c)(1)(i)(A) through (F) of this section, the facility must ensure that the transfer or discharge is documented in the resident's medical record and appropriate information is communicated to the receiving health care institution or provider.
(i) Documentation in the resident's medical record must include:
(A) The basis for the transfer per paragraph (c)(1)(i) of this section.
(B) In the case of paragraph (c)(1)(i)(A) of this section, the specific resident need(s) that cannot be met, facility attempts to meet the resident needs, and the service available at the receiving facility to meet the need(s).
(ii) The documentation required by paragraph (c)(2)(i) of this section must be made by-
(A) The resident's physician when transfer or discharge is necessary under paragraph (c) (1) (A) or (B) of this section; and
(B) A physician when transfer or discharge is necessary under paragraph (c)(1)(i)(C) or (D) of this section.
(iii) Information provided to the receiving provider must include a minimum of the following:
(A) Contact information of the practitioner responsible for the care of the resident.
(B) Resident representative information including contact information
(C) Advance Directive information
(D) All special instructions or precautions for ongoing care, as appropriate.
(E) Comprehensive care plan goals;
(F) All other necessary information, including a copy of the resident's discharge summary, consistent with §483.21(c)(2) as applicable, and any other documentation, as applicable, to ensure a safe and effective transition of care.
Observations:

Based on a review of facility policies, review of medical records, and insurance provider reviewer and staff interviews it was determined that the facility failed to properly implement a facility initiated discharge for one of 10 residents (Resident R1)

Findings include:

A review of facility "Admission, Transfer Discharge - Resident Discharge" policy last reviewed October 2023, indicated that the purpose is to promote continuity of care and prepare the resident for discharge.

A review of facility face sheet (admission record) for Resident R1 revealed that the resident was admitted to the facility on 1/8/24 with the diagnosis of total right knee replacement, diabetes, and asthma.

A review of Resident R1's progress notes dated 1/11/24, at 14:54 revealed that Social Worker Employee E1 wrote a note indicating the she attempted to meet with Resident R1 to inquire about discharge plans as insurance coverage ends today (1/11/24),

During an interview on 2/7/24, at 10:25 am Registered Nurse (RN) Case Manager Employee E2 revealed that her position as case manager is to facilitate facility initiated resident discharges that are based on insurance providers ending coverage of skilled services. She indicated that she had not begun to initiate the discharge process for Resident R1 due to the resident's next medical status review date was scheduled for 1/12/24. She further confirmed that she had not been notified by Resident R1's insurance provider of a date when the insurance company would no longer provide covered services and that she was informed via an email sent to Real Time Census Data for Heritage (email group used to notify staff of census changes) by Social Worker Employee E1 dated 1/11/24 at 11:50 am that Resident R1 was will discharge either on 1/11/24 or 1/12/24 depending on notification of the resident's caregiver.

During an interview on 2/7/24, at 1:20 pm Registered Nurse (RN) Reviewer Employee E3 for the insurance provider confirmed that the insurance company began covered services on 1/8/24, and authorized as per company policy for seven days (1/15/24). RN Reviewer Employee E3 further confirmed that she was notified that the resident discharged from the facility on 1/11/24, when she had contacted the facility on 1/15/24, to receive a health condition status assessment for Resident R1. She further confirmed that the insurance provider had not notified the facility of a date when the insurance company would no longer provide Resident R1 with covered skilled services.

A review of an email dated 1/11/24, at 3:16 pm sent to Resident R1's physician by Social Worker Employee E1 that due to Resident R1's discharge from the facility requested that the physician sign prescriptions for the resident as well as complete a History and Physical for Resident R1 as the resident had not yet been seen by the physician.

During an interview on 2/7/24, at 12:20 pm Occupation Therapist Employee E6 confirmed that based on 1/11/24,
Facility Morning Stand Up Meeting communication she completed Resident R1's discharge summary for occupation services. She further confirmed that she did not initiate Resident R1's discharge from the facility

During an interview on 2/7/24, at 12:35 Physical Therapist (PT) Employee E7 confirmed that based on 1/11/24, Facillity Morning Stand Up Meeting communication she completed Resident R1's discharge summary for physical therapy. She further confirmed that she did not initiate or recommend that Resident R1 be discharge from the facility. Based on her evaluation of Resident R1 and information provided that Resident R1 was being discharged home with caregiver support in the home three times a week PT Employee E7 confirmed she recommended that Resident R1 be discharged home with Home Health services and a wheeled walker.

During an interview on 2/7/24, at 1:50 pm Certified Registered Nurse Practioner (CRNP) Employee E4 revealed that the attending physician requested that she complete an evaluation of Resident R1 due to the resident being discharged. CRNP Employee E4 confirmed that she did not initiate Resident R1's discharge, although she wrote the discharge order based on information that the resident had 24 hour caregiver support at home.

During an interview on 2/7/24, at 2:00 pm the Nursing Home Administrator and Mobile Director of Nursing Employee E5 confirmed that Resident R1's discharge from the facility was based on Social Worker Employee E1 inaccurately communicating to Resident R1 and the staff of the facility that the insurance coverage for Resident R1 was ending.

Pa Code: 201.25 Discharge Policy
Pa Code: 201.29(f)(g)(h) Resident Rights


 Plan of Correction - To be completed: 04/01/2024

Resident R1 was discharged from the facility. Employee E1 has been provided individual education by the Administrator regarding the discharge planning process during a facility-initiated discharge and the importance of communicating with the resident and /or responsible party related to the discharge planning process and documenting the conversation as indicated.

A review of the facility-initiated discharges over the last 30 days will be completed by the Administrator and/or Designee to ensure communication regarding discharge planning is documented by the social worker as indicated.

The Administrator and/ or designee will educate the social workers, care manager, and all Full and Part Time Physical and Occupational therapists on the discharge planning process during a facility-initiated discharge and the importance of communicating with the resident and /or responsible party related to the discharge planning process and documenting the conversation as indicated.

The Administrator and /or designee will audit 5 discharges per week for one month and monthly thereafter or until substantial compliance is achieved to ensure facility-initiated discharges are identified and that all steps in any facility-initiated discharge process are completed and documented in the clinical record as indicated.

Results will be reviewed at the Quarterly QA Meeting.

483.15(c)(3)-(6)(8) REQUIREMENT Notice Requirements Before Transfer/Discharge: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.
§483.15(c)(3) Notice before transfer.
Before a facility transfers or discharges a resident, the facility must-
(i) Notify the resident and the resident's representative(s) of the transfer or discharge and the reasons for the move in writing and in a language and manner they understand. The facility must send a copy of the notice to a representative of the Office of the State Long-Term Care Ombudsman.
(ii) Record the reasons for the transfer or discharge in the resident's medical record in accordance with paragraph (c)(2) of this section; and
(iii) Include in the notice the items described in paragraph (c)(5) of this section.

§483.15(c)(4) Timing of the notice.
(i) Except as specified in paragraphs (c)(4)(ii) and (c)(8) of this section, the notice of transfer or discharge required under this section must be made by the facility at least 30 days before the resident is transferred or discharged.
(ii) Notice must be made as soon as practicable before transfer or discharge when-
(A) The safety of individuals in the facility would be endangered under paragraph (c)(1)(i)(C) of this section;
(B) The health of individuals in the facility would be endangered, under paragraph (c)(1)(i)(D) of this section;
(C) The resident's health improves sufficiently to allow a more immediate transfer or discharge, under paragraph (c)(1)(i)(B) of this section;
(D) An immediate transfer or discharge is required by the resident's urgent medical needs, under paragraph (c)(1)(i)(A) of this section; or
(E) A resident has not resided in the facility for 30 days.

§483.15(c)(5) Contents of the notice. The written notice specified in paragraph (c)(3) of this section must include the following:
(i) The reason for transfer or discharge;
(ii) The effective date of transfer or discharge;
(iii) The location to which the resident is transferred or discharged;
(iv) A statement of the resident's appeal rights, including the name, address (mailing and email), and telephone number of the entity which receives such requests; and information on how to obtain an appeal form and assistance in completing the form and submitting the appeal hearing request;
(v) The name, address (mailing and email) and telephone number of the Office of the State Long-Term Care Ombudsman;
(vi) For nursing facility residents with intellectual and developmental disabilities or related disabilities, the mailing and email address and telephone number of the agency responsible for the protection and advocacy of individuals with developmental disabilities established under Part C of the Developmental Disabilities Assistance and Bill of Rights Act of 2000 (Pub. L. 106-402, codified at 42 U.S.C. 15001 et seq.); and
(vii) For nursing facility residents with a mental disorder or related disabilities, the mailing and email address and telephone number of the agency responsible for the protection and advocacy of individuals with a mental disorder established under the Protection and Advocacy for Mentally Ill Individuals Act.

§483.15(c)(6) Changes to the notice.
If the information in the notice changes prior to effecting the transfer or discharge, the facility must update the recipients of the notice as soon as practicable once the updated information becomes available.

§483.15(c)(8) Notice in advance of facility closure
In the case of facility closure, the individual who is the administrator of the facility must provide written notification prior to the impending closure to the State Survey Agency, the Office of the State Long-Term Care Ombudsman, residents of the facility, and the resident representatives, as well as the plan for the transfer and adequate relocation of the residents, as required at § 483.70(l).
Observations:

Based on a review of facility policies, documents, resident records and staff interviews it was determined that the facility failed to properly provide written motivation of discharge from the facility for one of 10 residents (Resident R1),

Findings include:

A review of facility "Admission, Transfer Discharge - Resident Discharge" policy last reviewed October 2023, indicated that the purpose is to promote continuity of care and prepare the resident for discharge.

A review of facility " Admission Information" packet section N: Discharge Planning indicated that each resident's case is reviewed on a regular basis to determine if their medical needs continue to warrant the services provided by the facility. Discharge or transfer to a lesser level may occur when it has be determined that such services are no longer necessary. Residents and family members are notified in advance of the changes in provided services.

A review of facility face sheet (admission record) for Resident R1 revealed that the resident was admitted to the facility on 1/8/24 with the diagnosis of total right knee replacement, diabetes, and asthma.

A review of Resident R1's progress notes dated 1/11/24, at 14:54 revealed that Social Worker Employee E1 wrote a note indicating the she attempted to meet with Resident R1 to inquire about discharge plans as insurance coverage ends today (1/11/24),

During a review of Resident R1's medical record provided no evidence that the facility properly provided written notification to Resident R1 or a family member that outlined:
* the reason for Resident R's discharge from the facility
* the process to appeal the decision of discharge
* contact information for the insurance provider's appeal department
* contact information for the local Ombudsman's office.
as required.

During an interview on 2/12/24, at 11:30 am the Director of Nursing confirmed that the facility failed to provide written notification containing pertinent information regarding discharge from the facility to Resident R1 as required.

Pa Code: 201.29(f)(g) Resident Rights


 Plan of Correction - To be completed: 04/01/2024

Resident R1 was discharged from the facility. Employee E1 has been provided individual education by the Administrator regarding the discharge planning process during a facility-initiated discharge and the importance of communicating the reason for the discharge and documenting the conversation as indicated.

A review of the facility-initiated discharges over the last 30 days will be completed by Administrator and/or designee regarding the discharge planning process during a facility-initiated discharge and the importance of communicating the reason for the discharge and documenting the conversation as indicated.

The Administrator and/ or designee will educate the social workers and care manager on the discharge planning process during a facility-initiated discharge and the importance of communicating the reason for the discharge and documenting the conversation as indicated.

The Administrator and /or designee will audit five discharges per week for one month and monthly thereafter or until substantial compliance is achieved to ensure that the reason for the discharge is communicated and documented with any facility-initiated discharge process as indicated.

Results will be reviewed at the Quarterly QA Meeting.

483.15(c)(7) REQUIREMENT Preparation for Safe/Orderly Transfer/Dschrg: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.
§483.15(c)(7) Orientation for transfer or discharge.
A facility must provide and document sufficient preparation and orientation to residents to ensure safe and orderly transfer or discharge from the facility. This orientation must be provided in a form and manner that the resident can understand.
Observations:

Based on a review of facility policies, documents, resident medical records and staff interviews it was determined that the facility failed to implement a safe and orderly discharge from the facility for one of 10 residents (Resident R1)

Findings include:

A review of facility "Admission, Transfer Discharge - Resident Discharge" policy last reviewed October 2023, indicated that the purpose is to promote continuity of care and prepare the resident for discharge.

A review of facility face sheet (admission record) for Resident R1 revealed that the resident was admitted to the facility on 1/8/24 with the diagnosis of total right knee replacement, diabetes, and asthma.

A review of Resident R1's progress notes dated 1/11/24, at 14:54 revealed that Social Worker (SW) Employee E1 wrote a note indicating the she attempted to meet with Resident R1 to inquire about discharge plans as insurance coverage ends today (1/11/24),

A review of emails revealed the following:
* an email dated 1/11/24 at 11:50 am to Real Time Census Data for Heritage from SW Employee E1 indicated that Resident R1 would discharge from the facility either today (1/11/24) or tomorrow (1/12/24). She further indicated that she would order Home Health services.
* an email dated 1/11/24, at 3:16 pm to Resident R1's attending physician indicating that Resident R1 was leaving the facility that evening. SW Employee E1 requested the physician complete the resident's history and physical documentation and orders for home health care and a shower chair. (Note: Resident R1 was not seen by the attending physicial due to the short length of stay).
* an email dated 1/11/24, at 3:19 pm to a Home Health Provider 1 from SW Employee E1 indicated that SW Employee E1 had referred Resident R1 to this provider for home health care and requested that the provider notify SW Employee E8 as she was covering for SW Employee E1 who would be out of the office.
* an email dated 1/11/24 at 4:06 pm to Home Health Provider 1 from SW Employee E8 revealed that the facility had submitted the physician order to the provider.
* an email dated 1/11/24 at 4:12 pm to SW Employee E8 from Home Health Provider 1 indicated that the provider declined accepting Resident R1 as their patient.
* an email dated 1/12/24 at 9:28 am to SW Employee E8 from Home Health Provider 2 indicated that this provider would accept Resident R1 as a patient with a start of care on 1/14/24.

During an interview on 2/7/24 at 12:35 pm Physical Therapist Employee E7 confirmed that in her discharge summary she recommended Resident R1 be discharged home with Home Health Services and a wheeled walker.

During a review of Resident R1's discharge order revealed that Certified Registered Nurse Practioner Employee E4 completed the discharge order that indicated that the resident was to discharge home with Home Health. The was was documented evidence of the services of the durable medical equipment that was necessary for the resident's safe and planned discharge.

A review of Resident R1's medical record failed to provide evidence that the facility met and reviewed Resident R1's discharge summary with the resident. The facility failed to provide a written notification to the resident that indicated the name and contact information for the home health provider, the services provided by the home health provider, durable medical equipment that was ordered and the company's name and contact information. The facility also failed to provide the resident with follow up instructions and appointments with the resident's physician.

During an interview on 2/7/24 at 2:00 pm The Nursing Home Administrator and Mobile Director of Nursing it was confirmed that the facility failed to arrange home health services and the delivery of durable medical equipment prior to Resident R1's discharge from the facility. The Facility also failed to provide written notification of Resident R1's Discharge Summary to the resident at the time of discharge resulting in an an unplanned, unsafe discharge.

Pa Code: 201.25 Discharge Policy

Pa Code: 201.29(f)(g) Resident Rights


 Plan of Correction - To be completed: 04/01/2024

Resident R1 was discharged from the facility. Employee E1 has been provided individual education by the Administrator regarding the discharge planning process during a facility-initiated discharge, and the importance of ensuring a safe, orderly discharge plan has been coordinated and documented as indicated.

A review of the facility-initiated discharges over the last 30 days will be completed by Administrator and/or designee regarding the discharge planning process during a facility-initiated discharge and the importance of ensuring a safe and orderly discharge plan has been coordinated and documented as indicated.

The Administrator and/ or designee will educate the social workers and care manager on the discharge planning process during a facility-initiated discharge and the importance of ensuring a safe and orderly discharge plan has been coordinated and documented as indicated.

The Administrator and /or designee will audit five discharges per week for one month and monthly thereafter or until substantial compliance is achieved to ensure that a safe and orderly discharge plan has been coordinated and documented as indicated.

Results will be reviewed at the Quarterly QA Meeting.


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