Initial Comments:
A focused fundamental survey was conducted October 2-4 and October 7, 2024, to determine compliance with the requirements of the 42 CFR Part 483, Subpart I Requirements for Intermediate Care Facilities. The census during the survey was four and the sample consisted of two individuals. Two deficiencies were identified.
Plan of Correction:
483.430(e)(4) STANDARD
STAFF TRAINING PROGRAM
Name - Component - 00
Staff must be able to demonstrate the skills and techniques necessary to implement the individual program plans for each client for whom they are responsible.
Observations:
Based on observation, documentation and record review, and staff interview, it was determined that the facility failed to ensure staff demonstrated the skills and techniques necessary to implement the program plans for each individual for whom they are responsible. This was noted for two individuals in the home (Individuals #2 and #3). The findings included:
A) Observations were conducted in the home on October 3, 2024, from 3:45 PM until 6:45 PM. During these observations, Staff #1 was administering medications in the kitchen, while Staff #2 was providing the individuals with personal care and repositioning. Staff #2 was observed using the mechanical hoyer lift independently to transfer Individuals #2 and #3 from their wheelchairs to recliners. In addition, the legs of the mechanical lift were left in the closed position during the transfer of Individual #2.
B) Record review of Individual #2 revealed a physical therapy (PT) evaluation, dated July 11, 2024. This evaluation indicated that Individual #2 may be transferred via a two-person hoyer, or one-person in the case of an emergency. Record review for Individual #3 revealed a PT evaluation, dated October 12, 2023, which indicated transfers may be conducted via stand pivot with a one-person assist from even surfaces, a two-person lift, or a hoyer lift if needed.
C) Documentation review revealed a PT In-Service training, which outlines proper lifting and transferring techniques that staff are trained to use. In the section titled " Proper Body Mechanics during Transfers " it states that mechanical lifts require the use of two people.
D) The facility administrator was interviewed on October 4, 2024, at 12:45 PM. The administrator confirmed that the facility protocol for use of the mechanical lift with two staff was not followed during the above-mentioned observations.
Plan of Correction:Merakey Allegheny Valley School, 840 Middletown Road makes its best effort to operate in full compliance with both Federal and State Law. Nothing included in this Plan of Correction is an admission otherwise. Merakey Allegheny Valley School, 840 Middletown Road has submitted this Plan of Correction to comply with its regulatory obligation and does not waive any objections to its merits or form of any allegations contained herein. Please note that Merakey Allegheny Valley School, 840 Middletown Road may contest the merits and/or form of any deficiency or finding alleged below and take reasonable steps to appeal them.
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Merakey Allegheny Valley School, 840 Middletown Road will ensure staff are able to demonstrate the skills and techniques necessary to implement the individual program plans for each client for whom they are responsible.
All current supervisory and direct care staff will receive re-training on proper procedures in utilizing mechanical lifts as well as proper lifting/transferring techniques, provided by the Physical Therapist or designee by October 25th, 2024. Training will be verified by written documentation and signatures obtained on a Staff Attendance Sheet (SA). In addition to re-training, all current supervisory and direct care staff will be expected to review the current positioning mobility client profiles by October 25th, 2024. Review of the positioning mobility client profiles will be verified by written documentation and signatures obtained on a Staff Attendance Sheet (SA). Updates to the individualized program plan (IPP), will be communicated via the standard distribution process. This process includes distributing a copy of the updated individualized program plan (IPP) to the appropriate departments/sites and implementing as indicated. The positioning mobility client profiles will be updated by the Physical Therapist or Designee and distributed as well, for review. Review and acknowledgement of the updated positioning mobility client profiles will be verified by written documentation and signatures obtained on a Staff Attendance Sheet (SA).
In order to monitor that staff are following appropriate lifting and transferring techniques, beginning November 2024 random observations will be conducted by the House Manager or Designee on varied shifts. Random observations will occur twice a week for three months, followed by once a week for three months for a total of thirty-nine observations. Completed observations will be documented on a designated tracking sheet. Any concerns noted during observations will be immediately addressed and referred to the Administrator for further follow-up via standard disciplinary process.
483.460(a)(3) STANDARD
PHYSICIAN SERVICES
Name - Component - 00
The facility must provide or obtain preventive and general medical care.
Observations:
Based on record review and staff interview, it was determined that the facility failed to ensure that specialized treatment was received in accordance with recommendations from the provider. This was noted for both individuals listed in the sample (Individual #1 and Individual #2). The findings included:
The records of Individuals #1 and #2 were reviewed on October 3-4, 2024. This review revealed the following:
A) Individual #1:
1. An occupational assessment, completed on June 19, 2024, recommended an oral stimulation program be implemented two times per day. The interdisciplinary team (IDT) did not meet to discuss this recommendation until August 14, 2024. There was an eight-week gap before this specialized treatment was implemented on August 15, 2024.
2. A physical therapy assessment, completed on August 22, 2024, indicated that Individual #1 ' s Molded Ankle-Foot Orthosis (MAFO) for both feet, were held due to them not fitting properly and needing to be flared. On August 29, 2024, the physical therapist contacted the medical supply facility who requested an appointment to assess and flare the MAFOs. It was documented that the physical therapist relayed this information to the house manager on August 29, 2024. There was no documentation in the record to support this appointment has been scheduled to date. There was a six-week gap where Individual #1 has not been receiving specialized treatment for the use of the ordered MAFOs.
B) Individual #2
1. An occupational assessment, completed on June 19, 2024, recommended an oral stimulation program be implemented two times per day. The IDT did not meet to discuss this recommendation until August 14, 2024. Further review of this individual ' s record revealed this goal plan did not formally begin until October 2, 2024, three and a half months after the recommendation was made.
C) The qualified intellectual disabilities professional (QIDP) was interviewed on October 4, 2024, at 1:00 PM. The QIDP acknowledged the above-mentioned recommendations by specialists were not implemented in a timely manner.
Plan of Correction:Merakey Allegheny Valley School, 840 Middletown Road makes its best effort to operate in full compliance with both Federal and State Law. Nothing included in this Plan of Correction is an admission otherwise. Merakey Allegheny Valley School, 840 Middletown Road has submitted this Plan of Correction to comply with its regulatory obligation and does not waive any objections to its merits or form of any allegations contained herein. Please note that Merakey Allegheny Valley School, 840 Middletown Road may contest the merits and/or form of any deficiency or finding alleged below and take reasonable steps to appeal them.
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Merakey Allegheny Valley School, 840 Middletown Road will ensure the facility provides or obtains preventative and general medical care.
The facility Occupational Therapist (OT), Physical Therapist (PT), Motor Development Specialists (MDS), Qualified Intellectual Disabilities Professionals (QIDP) and department heads will be re-trained on the standard process in communicating and distributing updates to the individualized program plan (IPP). Training to also include the importance of completing follow-up, ensuring that specialized treatments are received in accordance with recommendations from the provider within a timely manner. Updates to the individualized program plan (IPP), will be communicated via the standard distribution process. This process includes distributing a copy of the updated individualized program plan (IPP) on their designated forms to the appropriate departments/sites and implementing as indicated. All above mentioned training will be completed and documented on a Staff Attendance Sheet (SA) by November 1st, 2024.
In order to monitor that the facility is providing or obtaining preventative and general medical care, a tracking sheet will be implemented and utilized by the Program Director or Designee. The purpose of the tracking sheet is to ensure follow-up and related training is completed and done so within a timely manner. This tracking sheet will be reviewed biweekly by the Program Director or Designee for a period of 3 months. Additionally, the Social Services Supervisor will review all interdisciplinary team (IDT) meetings to ensure recommendations are completed and noted on the individualized program plan (IPP) form when applicable. Any concerns identified during the biweekly review will be addressed and referred to the Administrator for further re-training or follow-up via standard disciplinary process.
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