Pennsylvania Department of Health
AMBLER EXTENDED CARE CENTER
Patient Care Inspection Results

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Severity Designations


Minimal Citation - No Harm	Minimal Harm	Actual Harm	Serious Harm

AMBLER EXTENDED CARE CENTER
Inspection Results For:

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AMBLER EXTENDED CARE 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 completed on March 1, 2024, it was determined that Ambler Extended Care 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(e)(1)(2) REQUIREMENT Therapeutic Diet Prescribed by Physician:

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.

§483.60(e) Therapeutic Diets
§483.60(e)(1) Therapeutic diets must be prescribed by the attending physician.

§483.60(e)(2) The attending physician may delegate to a registered or licensed dietitian the task of prescribing a resident's diet, including a therapeutic diet, to the extent allowed by State law.

Observations:

Based on clinical record review, observation, and resident and staff interview, it was determined that the facility failed to provide therapeutic diets as ordered by the physician for two of 19 sampled residents. (Residents 37, 61)

Findings include:

Clinical record review revealed that Resident 37 had diagnoses that included diabetes, chronic obstructive pulmonary disease, and Ehlers-Danlos Syndrome (a disorder that affects the connective tissues of the body). A physician's order dated December 1, 2022, directed staff to provide a low concentrated sweets and no added salt diet. Review of the care plan revealed a potential for nutritional problems related to diabetes. The intervention was for staff to provide the diet as ordered. Observation on February 28, 2024, at 12:44 p.m., revealed that the resident was provided regular sugar with his meal tray. In an interview at that time, Resident 37 stated that he had not received any sugar substitute in over a week and was given regular sugar packets instead. Observation on February 29, 2024, at 12:39 p.m., revealed that the resident was again served his lunch with no sugar substitute provided on the meal tray and given regular sugar packets. Review of the resident's meal tray ticket revealed that he was to receive four sugar substitute packets with his coffee.

Clinical record review revealed that Resident 61 had diagnoses that included diabetes, chronic kidney disease, hyperglycemia (high blood sugar), and dysphagia (difficulty with swallowing). A physician's order dated March 31, 2023, directed staff to provide a low concentrated sweets and no added salt diet. Review of the care plan revealed a risk for unstable blood glucose (sugar) and a potential for nutritional problems related to diabetes. The intervention was for staff to provide the diet as ordered. Observation on February 28, 2024, at 12:20 p.m. revealed that Resident 61 was provided regular sugar with his meal. In an interview at that time, Resident 61 stated he frequently received sugar instead of sugar substitute with his meals.

During a confidential group interview on February 28, 2024, at 10:30 a.m., the resident group stated that the facility often does not have sugar substitute packets for their drinks. The residents stated that sugar packets were given to them in place of a sugar substitute.

In an interview on February 29, 2024, at 12:15 p.m., the Registered Dietitian stated that residents on a low concentrated sweets diet were to receive sugar substitute with their meals and that regular sugar packets should not have been given as a replacement for sugar substitute.

201.14(a) Responsibility of licensee.

211.12(d)(3)(5) Nursing services.

Plan of Correction - To be completed: 03/27/2024

1.Residents #37 & #61 not affected by deficient practice
2.Like residents reviewed, no other resident affected by deficient practice
3.NHA/Designee completed In-service to dietary manager and dietary department on therapeutic diets, following such diets, and making manger and NHA aware if an item is unavailable so a substitute can be given.
4.Dietary Manager will maintain supply order 2 times a week to assure items/supplies are available, and to get appropriate substitute if not available. Dietary Manager/ Dietitian will complete audits 5 times a week x 4 weeks, then monthly for 2 months and submitted to NHA for review in monthly quality assurance performance improvement program
* Preparation and submission of this POC is required by state and federal law. This POC does not constitute an admission for purposes of general liability, professional malpractice or any other court proceeding.

483.10(e)(3) REQUIREMENT Reasonable Accommodations Needs/Preferences:

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.

§483.10(e)(3) The right to reside and receive services in the facility with reasonable accommodation of resident needs and preferences except when to do so would endanger the health or safety of the resident or other residents.

Observations:

Based on clinical record review, observation, and staff interview, it was determined that the facility failed to ensure that a call bell was accessible for one of 19 sampled residents. (Resident 8)

Findings include:

Clinical record review revealed that Resident 8 had diagnoses that included cirrhosis of the liver (scarring of the liver), chronic viral hepatitis (inflammation of the liver lasting more than six months), and encephalopathy (change in brain function due to injury or disease). According to the Minimum Data Set assessment dated December 5, 2023, the resident was able to communicate needs to staff and required assistance for mobility and activities of daily living, including toileting, grooming, and hygiene. Observations on February 28, 2024, at 10:30 a.m., and 12:30 p.m., revealed the resident was in bed and the call bell was wrapped under the wheel of the bed, out of reach. Observations on February 29, 2024, at 9:40 a.m., 11:30 a.m., and 1:00 p.m., revealed Resident 8 was in bed and the call bell was wrapped under the wheel of the bed, out of reach.

In an interview on March 1, 2024, at 9:24 a.m., the Administrator confirmed the resident's call bell was wrapped under the wheel of the bed and should have been within reach.

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

Plan of Correction - To be completed: 03/27/2024

1. Call bell was untangled from the wheel and placed correctly for Resident #8
2. To identify others with the potential to be affected, Audit completed for other residents, No resident affected by deficient practice
3. To prevent this from reoccurring, NHA/Designee completed in-service to IDT on Calls bells, concierge rounds, and thorough inspection of calls bells in resident rooms. Ongoing monitoring for compliance, Audit will be completed by maintenance daily and submitted weekly to NHA for 4 weeks, then completed monthly for 2 months
4. Results will be submitted for review during monthly quality assurance performance improvement program

* Preparation and submission of this POC is required by state and federal law. This POC does not constitute an admission for purposes of general liability, professional malpractice or any other court proceeding.

483.20(g) REQUIREMENT Accuracy of Assessments:

§483.20(g) Accuracy of Assessments.
The assessment must accurately reflect the resident's status.

Observations:

Based on clinical record review and staff interview, it was determined that the facility failed to ensure that the Minimum Data Set (MDS) assessment was completed to accurately reflect the resident's current status for one of 19 sampled residents. (Resident 55)

Findings include:

Clinical record review revealed that Resident 55 had diagnoses that included end-stage renal (kidney) disease and dependence on renal dialysis (the process of removing water and toxins from the blood in people whose kidneys can no longer perform those functions). Resident 55's care plan indicated that the resident had dialysis scheduled three times per week. Nursing documentation noted that the resident attended dialysis during the assessment period. The MDS assessment dated December 12, 2023, did not identify Resident 55 as receiving dialysis under section O, Special Treatments and Programs.

In an interview on March 1, 2024, at 11:28 a.m., the Nursing Home Administrator confirmed that Resident 55's MDS assessment was inaccurate.

Plan of Correction - To be completed: 03/27/2024

1. Resident #55 not affected by deficient practice
2. Audit completed for like resident, no resident affected by deficient practice
3. MDS coordinator in serviced on MDS accuracy
4. Audits will be completed weekly for 4 weeks and monthly for 2 months by MDS coordinator and submitted to NHA for review during monthly quality assurance performance improvement program.

* Preparation and submission of this POC is required by state and federal law. This POC does not constitute an admission for purposes of general liability, professional malpractice or any other court proceeding.

483.25(d)(1)(2) REQUIREMENT Free of Accident Hazards/Supervision/Devices:

§483.25(d) Accidents.
The facility must ensure that -
§483.25(d)(1) The resident environment remains as free of accident hazards as is possible; and

§483.25(d)(2)Each resident receives adequate supervision and assistance devices to prevent accidents.

Observations:

Based on facility policy review, clinical record review, observation, and resident and staff interview, it was determined that the facility failed to assess and implement safety measures related to smoking for two of four sampled residents who smoke. (Residents 37, 49)

Findings include:

Review of the facility policy entitled, "Resident Smoking Policy," last reviewed January 26, 2024, revealed that any resident who smoked or had the desire/intent to smoke would be assessed for smoking safety awareness and the need for reasonable physical or safety accommodations on admission, readmission, quarterly, and with any significant change in condition.

Clinical record review revealed that Resident 37 had diagnoses that included diabetes, chronic obstructive pulmonary disease, and Ehlers-Danlos Syndrome (a disorder that affects the connective tissues of the body). According to the Minimum Data Set (MDS) assessment, dated November 22, 2023, the resident had no cognitive impairment. In an interview on February 27, 2024, at 12:30 p.m., Resident 37 reported smoking on a regular basis. Observations on February 27, 2024, at 1:30 p.m., and February 28, 2024, at 11:30 a.m., revealed Resident 37 outside the back of the building, in the designated smoking area, smoking. There was no documentation in the clinical record to support that the resident's smoking safety was evaluated by the facility.

Clinical record review revealed that Resident 49 had diagnoses that included hemorrhagic thrombocythemia (chronic blood disorder), tobacco use, and hypertension (high blood pressure). According to the MDS assessment, dated December 13, 2023, the resident had cognitive impairment. Review of Resident 49's care plan revealed he was a supervised smoker with an intervention for staff to complete smoking assessments to ensure safety. There was no documentation in the clinical record to support that the resident's smoking safety was evaluated quarterly per facility policy after June 23, 2023.

In an interview on February 29, 2024, at 1:48 p.m., the Nursing Home Administrator confirmed that smoking assessments should be completed at least quarterly.

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

Plan of Correction - To be completed: 03/27/2024

1. Smoking assessments were completed for residents # 37, & #49
2. Smoking assessments reviewed for other smokers, no resident affected by deficient practice
3. DON/designee completed in service for smoking assessment completion to licensed nurses.
4. Audits will be completed by Social services weekly for 4 weeks and monthly for 2 months to assure assessments are completed timely, and review in monthly quality assurance performance improvement program
* Preparation and submission of this POC is required by state and federal law. This POC does not constitute an admission for purposes of general liability, professional malpractice or any other court proceeding.

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