Initial Comments:
Based on the findings of an unannounced state re-licensure survey conducted on February 27 and February 28, 2024, St. Joseph's Center at Trinity Child Care Center was found not to be in compliance with the following requirements of Act 54 of 1999, the Prescribed Pediatric Extended Care Center Act, 35 P.S. Section 449.61 et seq.
Plan of Correction:
REQUIREMENT
ADMINISTRATOR
Name - Component - 00
SECTION 15. Regulations. Requirements. (b)(2)
The department shall require that the PECC has employed an administrator whose qualifications are that of a physician who has a current, active, unrestricted license in the Commonwealth, a certified registered nurse practitioner licensed to practice in this Commonwealth, a licensed nursing home administrator, personal care home administrator, a child day-care administrator or a registered nurse with five years of documented experience in pediatric medicine. The administrator shall be responsible for the operation of the PECC.
Observations:
Based on review of center policies/procedures and medical records, and based on interview with a registered nurse (RN-Employee #2) and the administrator (Employee #10), the administrator failed to ensure tube feedings were administered as per physician orders included on the plan of care for two (2) of three (3) clients. (Clients #1 and #5)
Findings include:
On February 28, 2024 at approximately 2:28 PM, review of the center policy titled "Documentation of Development and Review of Individual Plan of Care" revealed the following: 3. Physician orders will be implemented by the staff.
Client #1: Between February 27, 2024 at approximately 11:55 AM and February 28, 2024 at approximately 9:32 AM, review of the medical record revealed the client is 3 years of age and that gastric tube (GT) feeding is to be administered as follows as ordered on the plan of care for the recertification period beginning 02/01/2024: Complete Organic Blend 180 milliliters (ml--feed volume) via GT at 260 ml per hour via pump at 7:00 AM, 10:00 AM and 1:00 PM at daycare.
Review of skilled nursing (SN) daily assignment sheet/note and/or "Treatment Administration Record" documentation revealed the GT feed volume administered by center staff was 185 ml for 12 of 12 days in February 2024.
Client 5: On February 28, 2024 at approximately 10:37 AM, review of the medical record revealed the client is 18 months of age and that the GT feeding is to be administered as follows as ordered on the plan of care for the recertification period beginning 02/01/2024: Kate Farms 100 ml two (2) times a day...may take as much volume orally over 30 minutes and give the rest over 30 minutes via GT.
Review of SN daily assignment sheet/note documentation failed to reveal SN staff administered the GT feedings over 30 minutes on the following dates:
-Employee #2 on 02/07, 02/08, 02/09, 02/13, 02/14, 02/15 and 02/16/2024 and Employee #11 on 02/12/2024.
During interview conducted on 02/28/2024 at approximately 2:45 PM, Employee #2 reported that the RN was unaware that physician orders included for the GT feeding to be administered over 30 minutes.
During interview conducted on February 28, 2024 at 2:50 PM, the administrator confirmed the GT feedings were not administered per the physician orders included on the plan of care for Clients #1 and #5.
Plan of Correction:The Plan of Correction for the deficiency noted during the DOH survey on 2/28/2024 is as follows:
1. A review of diet orders on Plans of Care and TAR for all enrolled children will be completed to note any discrepancies similar to ones noted in the 2/28/2024 survey.
This review was completed by the Director, MJ, by March 5, 2024.
2. Diet orders for all children will be reviewed by staff with the Director, MJ, or Clinical Coordinator, MF.
3. A monitor checklist to increase accountability and documentation of same will be implemented for the monthly POC, TAR/MAR and daily assessment starting with the April 2024 certification period through June 2024 certification period.
4. The monitor will be completed prior to each new month and document the review of POC, MAR, And TAR by the assigned Supervisor for each room.
5.Staff will be in-serviced by the Director, MJ, on the monitor, its purpose, and desired outcome by 4/1/2024.
6. The initial monitor will be completed with the Director, MJ, or Clinical Coordinator, MF, and Supervisor for each childcare room prior to the 4/1/2024 certification period.
7. An evaluation of the monitor will be completed by the Director, MJ, and Clinical Coordinator, MF, after three consecutive months to determine next steps.
8. Relias training will be utilized for RN staff on Minimizing Medical Errors and The Legal Side of Medical Documentation.
REQUIREMENT
INDIVIDUALIZED CARE PLAN
Name - Component - 00
SECTION 15. Regulations. Requirements. (b)(6)
Each child shall have an individualized care plan which is designed by the attending physician; the PECC treatment team; a parent or legal guardian; and, when appropriate, the child. The care plan shall be reviewed at least monthly and revised as the child's care needs change. Staffing shall be adequqate to provide for the needs of each child as identified on the child's care plan.
Observations:
Based on review of center policies/procedures and medical records, and based on interview with the administrator (Employee #10), the center failed to ensure the "Plan of Care" included physician orders for the route of medication administration for two (2) of two (2) clients (children) for whom oral and tube feedings were included on the plan of care. (Clients #1 and #5)
Findings include:
On February 28, 2024 at approximately 2:28 PM, review of the center policy titled "Documentation of Development and Review of Individual Plan of Care" revealed the following:
1. Each child will be assessed upon enrollment. From this assessment, an individualized plan of care will be developed.
2. Physician orders will specify the services needed to each child.
3. Physician orders will be implemented by the staff.
Client #1: Between February 27, 2024 at approximately 11:55 AM and February 28, 2024 at approximately 9:32 AM, review of the medical record revealed the client is 3 years of age and that feedings are to be administered orally and via gastric (feeding) tube as ordered on the plan of care for the recertification period beginning 02/01/2024.
Review of the medication list included on the plan of care revealed Miralax is to be administered as needed for constipation but the route of Miralax administration (orally or via gastric tube) was not included on the plan of care.
Client 5: On February 28, 2024 at approximately 10:37 AM, review of the medical record revealed the client is 18 months of age and that feedings are to be administered orally and via gastric (feeding) tube as ordered on the plan of care for the recertification period beginning 02/01/2024.
Review of the medication list included on the plan of care revealed Tylenol, simethicone drops, Klonopin, Miralax, Sabril packet, ibuprofen, hydrocortisone tablet and Gabapentin are to be administered but the route of administration for the aforementioned medications was not included on the plan of care.
During interview conducted on February 28, 2024 at 2:50 PM, the administrator confirmed the plan of care did not include the route of medication administration for the above referenced medications for Clients #1 and #5.
Plan of Correction:The Plan of Correction for the deficiency noted during the DOH survey on 2/28/2024 is as follows:
1. A review of POC for all enrolled children will be completed to note any discrepancies similar to ones noted in 2/28/2024 survey.
This review was completed by the Director, MJ, by March 5, 2024.
2. POC for all children will be reviewed by staff with the Director, MJ or Clinical Coordinator, MF.
3. The monitor will include a documentation area that Supervisor will note that the POC has necessary elements of medication administration.
4. The initial review of POC orders for the certification period April 2024 will be completed with RN staff and Director, MJ, or Clinical Coordinator, MF.
5. Each monthly review will then be completed by the room Supervisor.
6. The Relias training will be utilized to review medication administration.
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