Pennsylvania Department of Health
YORK SOUTH SKILLED NURSING AND REHABILITATION CENTER
Patient Care Inspection Results

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YORK SOUTH SKILLED NURSING AND REHABILITATION CENTER
Inspection Results For:

There are  136 surveys for this facility. Please select a date to view the survey results.

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YORK SOUTH SKILLED NURSING AND REHABILITATION CENTER - Inspection Results Scope of Citation
Number of Residents Affected
By Deficient Practice
Initial comments:

Findings of an abbreviated complaint survey completed on February 9, 2024, at York South Skilled Nursing and Rehabilitation Center identified that the facility 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:


483.25 REQUIREMENT Quality of Care: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.
§ 483.25 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 care and services were provided in accordance with professional standards of practice to meet each resident's physical, mental, and psychosocial needs for five of seven newly admitted residents reviewed (Residents 1, 4, 5, 7, 8).

Findings Include:

Review of Resident 1's clinical record revealed diagnoses that included cellulitis of left lower limb (bacterial infection involving the inner layers of the skin) and diabetes mellitus (impairment in the way the body regulates and uses sugar [glucose] as a fuel resulting in too much sugar circulating in the bloodstream).

Review of Resident 1's January and February 2024 MARs (Medication Administration Records - forms used to document physician orders as well as when and how medications are administered to a resident) revealed orders for insulin glargine twice daily for diabetes mellitus, and hydralazine three times a day for hypertension (high blood pressure) and metoprolol every 12 hours for hypertension.

Further review of the MAR revealed that the evening dose of insulin was not administered to Resident 1 on January 19, 2024; the evening dose of hydralazine was not administered to Resident 1 on February 3, 2024; and the evening dose of metoprolol was not administered on February 6, 2024.

Review of nursing progress notes revealed the following: on January 19, 2024 - Resident 1's insulin was not administered due to "awaiting from pharmacy"; on February 3, 2024, hydralazine was not administered because "Medication unavailable, out of stock"; and on February 6, 2024, metoprolol was not administered because "unavailable."

Further review of available clinical documentation failed to reveal that the physician was notified of the aforementioned missed doses of medications.

Review of Resident 4's clinical record revealed diagnoses that included atrial fibrillation (irregular heart beat) and chronic pain.

Review of Resident 4's February 2024 MAR revealed orders for Gabapentin (used to relieve nerve pain) at nighttime for neuropathy (nerve damage or dysfunction that can result from various conditions) and Eliquis (anticoagulant) twice daily for atrial fibrillation.

Further review of the MAR revealed that Resident 4 did not receive Gabapentin and the evening dose of Eliquis on February 2, 2024.

Review of Resident 4's nursing progress notes for February 2, 2024, revealed that Gabapentin and Eliquis were not administered since the medications had not yet arrived from the pharmacy.

Further review of available clinical documentation failed to reveal any evidence that the physician was notified that Gabapentin and Eliquis were not administered as noted above.

Review of Resident 5's clinical record revealed diagnoses that included acute bronchitis (inflammation of the bronchial tubes) and acute respiratory failure (inadequate gas exchange by the respiratory system).

Review of Resident 5's February 2024 MAR revealed an order for Cefpodoxime Proxetil twice daily for pneumonia (lung infection that can result in coughing, fever and difficulty breathing).

Further review of the MAR revealed that the evening dose of this medication was not administered to Resident 5 on February 6, 2024.

Review of Resident 5's nursing progress notes for the aforementioned date revealed that Cefpodoxime Proxetil was not administered due to "new admit awaiting pharmacy delivery."

Further review of available clinical documentation failed to reveal any evidence that the physician was notified that Cefpodoxime Proxetil was not administered to Resident 5 as noted above.

Review of Resident 7's clinical record revealed diagnoses that included Parkinson's (long-term movement disorder where the brain cells that control movement start to die and cause changes in how one moves, feels, and acts) and hypertension.

Review of Resident 7's January and February 2024 MARs revealed orders for: Azilect (increases the levels of certain chemicals in the brain) daily for Parkinson's; Sinemet (used to treat symptoms of Parkinson's) three times a day for Parkinson's; metoprolol twice daily for coronary artery disease (happens when the arteries that supply blood to heart muscle become hardened and narrowed); Clopidogrel Bisulfate (used to prevent blood clots) daily for aortic stenosis (narrowing of the exit of the left ventricle of the heart); and Coenzyme Q10 (antioxidant) daily for supplement.

Further review of the MARs revealed that Azilect was not administered on January 28, 2024; Sinemet was not administered on January 28 and 29, 2024; metoprolol was not administered on January 28, 2024; Coenzyme Q10 was not administered on January 28-31, 2024, and February 3, 4, and 6, 2024; and clopidogrel was not administered on January 29, 2024.

Review of Resident 7's nursing progress notes for the aforementioned dates revealed that Azilect, Sinemet, metoprolol, clopidogrel, and Coenzyme Q10 were not administered due to being unavailable from the pharmacy.

Further review of available clinical documentation failed to reveal any evidence that the physician was notified that these medications were not administered to Resident 7 as noted above.
Review of Resident 8's clinical record revealed diagnoses that included tubulo interstitial nephritis (inflammation of the kidneys) and congestive heart failure (CHF - weakness of the heart that leads to buildup of fluid in the lungs and surrounding body tissues).

Review of Resident 8's February 2024 MAR revealed orders for: pantoprazole sodium (used to treat certain stomach and esophagus problems) at bedtime for GERD (gastroesophageal reflux disease - digestive disease where the muscle rings between the stomach and esophagus become weak or relax inappropriately allowing the stomach's contents to flow up into the esophagus); gabapentin at bedtime for neuropathy; Spironolactone daily for acute renal failure (sudden episode of kidney failure or damage); Rosuvastatin Calcium (slows production of cholesterol by the body) daily for hyperlipidemia (abnormally elevated levels of fats, oils, and waxes in the blood); Fenofibrate (lowers high cholesterol) daily for hyperlipidemia; Duloxetine (antidepressant) twice daily for depression; Bupropion (antidepressant) twice daily for depression; amlodipine Besylate daily for hypertension; and Levaquin daily for five days for urinary tract infection.

Further review of the MAR revealed that pantoprazole and gabapentin were not administered on February 6, 2024, and that spironolactone, Rosuvastatin, Fenofibrate, Duloxetine, Bupropion, amlodipine, and Levaquin were not administered on February 7, 2024.

Review of Resident 8's nursing progress notes for the aforementioned dates revealed that pantoprazole, gabapentin, spironolactone, Rosuvastatin, Fenofibrate, Duloxetine, Bupropion, amlodipine, and Levaquin were not administered due to being unavailable from the pharmacy.

Further review of clinical documentation failed to reveal any evidence that the physician was notified that these medications were not administered to Resident 8 as noted above.

During an interview with the Director of Nursing on February 8, 2024, at 1:25 PM , she revealed that she was not able to provide evidence that the physician was notified of the aforementioned missed medication doses.

28 Pa. Code 211.12(d)(1)(3)(5) Nursing services


 Plan of Correction - To be completed: 04/02/2024

1. Residents #1, 4, 5, 7 and 8 have been found to have not been affected by the alleged deficient practice. Physician notification of unavailable medications is expected. Nursing measures will be documented.
2. Current residents' Medication records (MAR) will be reviewed for orders, notifications and documentation to ensure compliance. The look back period for the review will begin on 2/9, the date of complaint visit exit. Review will be completed by 2/29. Weekly zoom meetings with DON, Director of Project Management and Pharmacy Key Account Manager are ongoing to discuss opportunities for improvement. Optimization of in-house back-up medication dispensing machine is underway.
3. Nursing staff will be re-educated on following physician orders, notifications and documentation per facility protocol for missed medications.
4. Audits utilizing the 24 hour report for missed medications and physician notification will be completed for 5 residents per week for 4 weeks by DON/designee. Results will be reviewed by QAPI.

§ 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 review of facility-provided staffing data and staff interview, it was determined that the facility failed to ensure a required minimum of one Nurse Aide (NA) per 12 residents on both day and evening shifts and one NA per 20 residents on the overnight shift for one of eight days reviewed (February 4, 2024).

Findings include:

Review of facility provided staffing ratio/resident census information for January 30, 2024, and February 2-8, 2024, revealed the following NA ratios, which did not meet the minimum NA ratio required for the facility census of residents on those shifts:
February 4th day shift - 135 residents and 10.99 NAs; February 4th evening shift - 135 residents and 10.12 NAs; and February 4th night shift - 135 residents and 6.22 NAs.

In email correspondence received from the Director of Nursing on February 9, 2024, at 10:51 AM, she confirmed that the facility did not meet the required NA ratios on February 4, 2024.


 Plan of Correction - To be completed: 04/02/2024

1. Nursing ratios were adjusted to ensure a 1:12 ratio on days and Evenings and 1:20 on night shift.
2. Nursing ratios will be scheduled at a 1:12 ratio for days and evening Shifts and 1:20 for night
shifts. Weekly labor management calls with HRD, NHA, DON and scheduler to review current
and expected staffing needs are ongoing. Three RNs participate in an on-call
rotation to be notified of any call outs that fall below the state minimum ppd and nurse and CNA
ratios.
3. Education has been provided to the scheduler and HRD to ensure a 1:12 ratio is met daily
and 1:20 for nights per regulations. Education has also been provided to clinical staff about the
attendance policy and the consequences of the attendance infractions. Education on the ratios
will be provided to department heads and nursing supervisor staff that report to nursing
administration on call.
4. DON/designee will do random audits of 5 shifts per week for 4 weeks
to ensure compliance. Results will be submitted to QAPI to determine if audits will continue
beyond 4 weeks.

§ 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 review of facility-provided staffing data and staff interview, it was determined that the facility failed to ensure a required minimum of one licensed practical nurse (LPN) per 40 residents on the overnight shift for one of eight days reviewed (February 2, 2024).

Findings include:

Review of facility provided staffing ratio/resident census information for January 30, 2024, and February 2-8, 2024, revealed the following LPN ratio, which did not meet the minimum LPN ratio required for the facility census of residents on those shifts: February 2nd night shift - 136 residents and 3.19 LPNs.

In email correspondence received from the Director of Nursing on February 9, 2024, at 10:13 AM, she confirmed that the facility was unable to meet the LPN staffing ratio as noted above despite efforts to cover the shift.


 Plan of Correction - To be completed: 04/02/2024

1. Nursing ratios were adjusted to ensure a 1:25/30/40 ratio on days, evenings and nights.
2. Nursing ratios will be scheduled at a 1: 25/30/40 ratio for day, evening and night shifts.
Weekly labor management calls with HRD, NHA, DON and scheduler to review current and
expected staffing needs are ongoing. Three RNs participate in an on-call rotation to
be notified of any call outs that fall below the state minimum ppd and nurse and CNA ratios.
3. Education has been provided to the scheduler and HRD to ensure appropriate LPN ratios are
met daily per regulations. Education has been provided to clinical staff about the
attendance policy and the consequences of the attendance infractions. Education on the ratios
will be provided to department heads and nursing supervisor staff that report to nursing
administration on call.
4. DON/designee will do random audits of 5 shifts per week for 4 weeks to ensure compliance.
Results will be submitted to QAPI to determine if audits will continue beyond 4 weeks.

§ 211.12(i)(1) LICENSURE Nursing services.:State only Deficiency.
(1) Effective July 1, 2023, the total number of hours of general nursing care provided in each 24-hour period shall, when totaled for the entire facility, be a minimum of 2.87 hours of direct resident care for each resident.

Observations:

Based on review of staffing data furnished by the facility and staff interview, it was determined that the facility failed to ensure the total number of nursing care hours provided in each 24 hour period be a required minimum of 2.87 hours of direct care for each resident for one of eight days reviewed (February 4, 2024).

Findings include:

Review of staffing data provided by the facility dated January 30, 2024, and February 2-8, 2024, revealed that the facility provided only 2.62 hours of direct care for each resident on February 4, 2024.

In email correspondence received from the Director of Nursing on February 9, 2024 at 10:51 AM, she confirmed that the facility did not meet the required direct care hour per resident ratio on February 4, 2024.


 Plan of Correction - To be completed: 04/02/2024

1. Nursing PPD was adjusted to ensure a 2.87 PPD.
2. Nursing PPD will be scheduled at a minimum of 2.87 PPD.
3. Education has been provided to the scheduler and HRD to ensure a 2.87 PPD is met daily
per regulations. In addition, the scheduler has been provided with a scheduling calculator and
educated to its use, to double check the schedule prior to posting to again ensure compliance.
Education on the ppd will be provided to department heads and nursing supervisor staff that
report to the nursing administration on call. Scheduler has an employee list of contacts to pull in
off duty/auxiliary staff during anytime of call offs. DON, ICP and UM's all rotate on-call status to
cover additional shifts as needed. Option for PRN agency RNs/LPNs/CNAs during times of
staffing shortages.
4. DON/designee will do random audits of 5 schedules per week for 4 weeks to ensure
compliance. Audits will be reviewed by QAPI.


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