Pennsylvania Department of Health
RIVERTON REHABILITATION AND HEALTHCARE CENTER
Patient Care Inspection Results

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RIVERTON REHABILITATION AND HEALTHCARE CENTER
Inspection Results For:

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RIVERTON REHABILITATION AND HEALTHCARE CENTER - Inspection Results Scope of Citation
Number of Residents Affected
By Deficient Practice
Initial comments:
Based on a Medicare/Medicaid Recertification survey, State Licensure survey, Civil Rights Compliance survey, and an Abbreviated complaint survey, completed January 11, 2024, it was determined that Riverton Rehabilitation and Healthcare Center was not in compliance with the following 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.


 Plan of Correction:


483.60(i)(1)(2) REQUIREMENT Food Procurement,Store/Prepare/Serve-Sanitary:This is a less serious (but not lowest level) deficiency but was found to be widespread throughout the facility and/or has the potential to affect a large portion or all the residents.  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.
§483.60(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 facility policy review, observation, and staff interview, it was determined that the facility failed to store food in a sanitary manner in the dietary department and in one of three country kitchens. (Second floor)

Findings include:

Review of the facility's policy entitled, "Food Receiving and Storage," last reviewed March 9, 2023, revealed all foods stored in the refrigerator and freezer were to be labeled and dated and items were to be discarded after the use-by date.

Observations during the kitchen tour on January 9, 2024, at 8:45 a.m., revealed the following:

In the protein cooler, there was a package of opened lunch meat that was not dated. In the freezer, there was an opened box of muffins that was not dated. In the produce cooler, there was a package of opened whipped topping that was not dated. There were four large bins of cut melons, three had a use-by date of January 4, 2024, and one had a use-by date of January 5, 2024.

In the dry storage room, the top of the portable air conditioning unit had a layer of white food debris.

In the meat cooler in second floor country kitchen, there were four containers soup that were not labeled or dated. There was a packet of sour cream with a use-by date of December 5, 2022.

In an interview on January 9, 2024, at 9:45 a.m., the FSD confirmed that items should have been labeled and dated, and the expired items removed.

28 Pa. Code 201.14(a) Responsibility of licensee.


 Plan of Correction - To be completed: 02/13/2024

1.Any food items that were undated or expired were dated or discarded. The air conditioning unit in food storage area was cleaned by dietary staff.

2.The Dietary Manager has conducted an audit of dietary and pantry refrigerators to ensure that all opened food items are accurately dated. Walk in refrigerators and dietary storage areas have been inspected to ensure no sanitation issues are present.

3.Regional Dietary Services Manager has educated the Dietary Manager and Dietary staff to the policy for Food receiving and Storage.

4.The Dietary Manager or Designee will conduct daily audits of refrigerators to ensure that items are dated and not expired weekly x4 weeks and then weekly x 2 months. Results of the audits will be presented to the monthly QAPI meeting for further recommendations and review.
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 clinical record review and staff interview, it was determined that the facility failed to ensure physicians' orders were implemented for two of 22 sampled residents. (Residents 26 and 83)

Findings include:

Clinical record review revealed that Resident 26 had diagnoses that included hypertension (high blood pressure). On June 19, 2023, the physician ordered that staff administer a medication (metoprolol tartrate) two times a day for hypertension. Staff was not to administer the medication if the resident's systolic blood pressure (SBP, the first measurement of blood pressure when the heart beats and the pressure is at its highest) was less than 100 millimeters of mercury (mm/Hg). Review of Resident 26's medication administration record (MAR) revealed that staff administered the medication nine times in December 2023, when the resident's SBP was less than 100 mm/Hg.

Clinical record review revealed that Resident 83 had diagnoses that included hypertension. On November 14, 2023,
the physician ordered that staff administer a medication (amlodipine besylate) one time a day for hypertension. Staff was not to administer the medication if the resident's SBP was less than 110 mm/Hg. Review of Resident 83's MAR revealed that staff administered the medication two times in December 2023, and four times in January 2024, when the resident's SBP was less than 110 mm/Hg.

In an interview on January 11, 2024, at 9:50 a.m., the Director of Nursing confirmed that the medications were administered outside established blood pressure parameters for Residents 26 and 83.

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


 Plan of Correction - To be completed: 02/13/2024

1.Residents 26 and 83, the physician was notified and has reviewed medication orders. Both residents had no negative effects related to medication administration.

2.Director of Nursing or Designee has audited current residents with hypertensive medications with parameters to validate medications have been administered per physician orders.

3.Director of Nursing or Designee will educate licensed nursing staff on the Medication Administration policy; following physician orders.

4.Director of Nursing or Designee will audit hypertension medications with ordered parameters to ensure that physician orders are being followed weekly x4 weeks and then monthly x2 months. Results of the audits will be presented to the monthly QAPI meeting for further recommendations and review.
483.10(f)(5)(i)-(iv)(6)(7) REQUIREMENT Resident/Family Group and Response:Least serious deficiency but was found to be widespread throughout the facility and/or has the potential to affect a large portion or all the residents. This deficiency has the potential for causing no more than a minor negative impact on the resident.
§483.10(f)(5) The resident has a right to organize and participate in resident groups in the facility.
(i) The facility must provide a resident or family group, if one exists, with private space; and take reasonable steps, with the approval of the group, to make residents and family members aware of upcoming meetings in a timely manner.
(ii) Staff, visitors, or other guests may attend resident group or family group meetings only at the respective group's invitation.
(iii) The facility must provide a designated staff person who is approved by the resident or family group and the facility and who is responsible for providing assistance and responding to written requests that result from group meetings.
(iv) The facility must consider the views of a resident or family group and act promptly upon the grievances and recommendations of such groups concerning issues of resident care and life in the facility.
(A) The facility must be able to demonstrate their response and rationale for such response.
(B) This should not be construed to mean that the facility must implement as recommended every request of the resident or family group.

§483.10(f)(6) The resident has a right to participate in family groups.

§483.10(f)(7) The resident has a right to have family member(s) or other resident representative(s) meet in the facility with the families or resident representative(s) of other residents in the facility.
Observations:
Based on a review of facility food committee meeting minutes and resident interview, it was determined that the facility failed to address grievances voiced by the resident group. (Residents 4, 31, 46, 57, and 63)

Findings include:

In a group interview conducted on January 10, 2023, at 10:37 a.m., Residents 4, 31, 46, 57, and 63 stated that the food was often served cold. Review of food committee meeting minutes dated November 8 and 28, 2023, and December 28, 2023, revealed that multiple residents reported that the food was often served cold. There was a lack of evidence that the facility had addressed the residents' ongoing concerns of cold food.

28 Pa. Code 201.14(a) Responsibility of licensee.



 Plan of Correction - To be completed: 02/13/2024

1.Administrator and Dietary Manager reviewed November 2023 food committee concerns. The Grievance process has been initiated to address resident concerns of food temperatures.

2.The Administrator and Dietary Manager have reviewed the last 3 months of Food Committee minutes to identify any additional food related concerns.

3.Dietary Manager/Designee will obtain food temperatures, daily, to ensure foods are being served within designated parameters for hot and cold palatable ranges. Logs will be maintained and reviewed for past 24-72 hours by the NHA.

4.Administrator/designee will audit food committee meeting minutes monthly x 4 to ensure resident satisfaction with meal temperatures. Results of the audits will be presented to the monthly QAPI meeting for further recommendations and review.
§ 211.12(f.1)(2) LICENSURE Nursing services. :State only Deficiency.
(2) Effective July 1, 2023, a minimum of 1 nurse aide per 12 residents during the day, 1 nurse aide per 12 residents during the evening, and 1 nurse aide per 20 residents overnight.

Observations:

Based on a review of nursing time schedules, it was determined that the facility failed to meet the minimum nurse aide (NA) to resident ratios for 18 of 21 days reviewed.

Findings include:

Review of nursing schedules for 21 days from September 1 through 7, 2023, December 1 through 7, 2023, and January 4 through 10, 2024, revealed the following:

The facility failed to meet the minimum NA to resident ratio of one NA for 12 residents on day shift (7:00 a.m. to 3:00 p.m.) on January 5 and 9, 2024.

The facility failed to meet the minimum NA to resident ratio of one NA for 12 residents on evening shift (3:00 p.m. to 11:00 p.m.) on September 3 and December 4, 2023.

The facility failed to meet the minimum NA to resident ratio of one NA for 20 residents on night shift (11:00 p.m. to 7:00 a.m.) on September 1 through 7, 2023, December 1, 2, 5, and 7, 2023, and on January 4 through 9, 2024.



 Plan of Correction - To be completed: 02/13/2024

1.Facility cannot retroactively correct ratios.

2.Facility will review ratios during labor meetings for Nurse Aides. A variety of methods for staffing and recruitment will be utilized in order to fill vacant positions. Methods will be reviewed for effectiveness during labor meetings and adjusted according to facility need.

3.Administrator or designee will educate the staffing coordinator on the ratio regulation for Nurse Aides.

4.Administrator or designee will audit ratios weekly x4 weeks and then monthly x2 months. Results of the audits will be presented to the monthly QAPI meeting for further recommendations and review.
§ 211.12(f.1)(4) LICENSURE Nursing services. :State only Deficiency.
(4) Effective July 1, 2023, a minimum of 1 LPN per 25 residents during the day, 1 LPN per 30 residents during the evening, and 1 LPN per 40 residents overnight.
Observations:

Based on a review of nursing time schedules, it was determined that the facility failed to meet the minimum licensed practical nurse (LPN) to resident ratios for 19 of 21 days reviewed.

Findings include:

Review of nursing schedules for 21 days from September 1 through 7, 2023, December 1 through 7, 2023, and January 4 through 10, 2024, revealed the following:

The facility failed to meet the minimum LPN to resident ratio of one LPN for 30 residents on evening shift (3:00 p.m. to 11:00 p.m.) on January 6, 2024.

The facility failed to meet the minimum LPN to resident ratio of one LPN for 40 residents on night shift (11:00 p.m. to 7:00 a.m.) on September 1 through 7, 2023, December 1, 2, 3, 6, and 7, 2023, and on January 4 through 10, 2024.



 Plan of Correction - To be completed: 02/13/2024

1.Facility cannot retroactively correct ratios.

2.Facility will review ratios during labor meetings for Licensed Practical Nurses. A variety of methods for staffing and recruitment will be utilized in order to fill vacant positions. Methods will be reviewed for effectiveness during labor meetings and adjusted according to facility need.

3.Administrator or designee will educate the staffing coordinator on the ratio regulation for Licensed Practical Nurses.

4.Administrator or designee will audit ratios weekly x4 weeks and then monthly x2 months. Results of the audits will be presented to the monthly QAPI meeting for further recommendations and review.

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