Pennsylvania Department of Health
FOREST CITY NURSING AND REHAB CENTER
Patient Care Inspection Results

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Severity Designations


Minimal Citation - No Harm	Minimal Harm	Actual Harm	Serious Harm

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FOREST CITY NURSING AND REHAB CENTER - Inspection Results	Scope of Citation Number of Residents Affected By Deficient Practice

Initial comments:

Based on an Abbreviated Complaint survey completed on July 26, 2023, at Forest City Nursing and Rehabilitation Center it was determined that there were no deficienciwas cited under the requirements of 42 CFR Part 483 Subpart B Requirements for Long Term Care Facilities, but the facility was not in compliance with the following requirements of the 28 PA Code Commonwealth of Pennsylvania Long Term Care Licensure Regulations.

Plan of Correction:

§ 211.12(f.1)(2) LICENSURE Nursing services. :

(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 nurse staffing and staff interview, it was determined that the facility failed to ensure the minimum nurse aide staff to resident ratio was provided on each shift for five shifts out of 21 reviewed.

Findings include:

A review of the facility's weekly staffing records revealed that on the following dates the facility failed to provide minimum nurse aide staff of 1:12 on the day and evening shifts and 1:20 on the night shift based on the facility's census.

July 19, 2023 - 6 nurse aides on the day shift, versus the required 7 for a census of 75

July 22, 2023 - 6 nurse aides on the day shift, versus the required 7 for a census of 75

July 23, 2023 - 6 nurse aides on the day shift, versus the required 7 for a census of 75

July 25, 2023 - 6 nurse aides on the day shift, versus the required 7 for a census of 75

July 25, 2023 - 6 nurse aides on the evening shift, versus the required 7 for a census of 75

An interview with the Nursing Home Administrator on July 26, 2023, at 1:55 PM, confirmed the facility had not met the required nurse aide to resident ratios on all three shifts on the above dates.

Plan of Correction - To be completed: 08/29/2023

Preparation and/or execution of this plan of correction does not constitute an admission or agreement by the provider of the truth of the facts alleged or conclusions set forth in the statement of deficiencies. The plan of correction is prepared solely because it is by the provisions of federal and state law. The plan of correction represents the facility's credible allegation of compliance.
The facility cannot retroactively correct the Nursing Assistant ratios.
The facility is focusing on retention of existing nursing assistants and recruitment of new nursing assistants through efforts of the retention/recruitment committee.
The Scheduler will be educated regarding the new ratios for nursing assistants.
Calculation of the daily nursing assistant ratios will be completed and reviewed for accuracy by the scheduler/designee.
Daily ratios will be audited weekly x4 then monthly x2.
The audits will be reviewed x 2 months at monthly QAPI.

§ 211.12(f.1)(4) LICENSURE Nursing services. :

(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 nurse staffing and staff interview, it was determined that the facility failed to ensure the minimum licensed practical nurse staff to resident ratio was provided on each shift for two shifts out of 21 reviewed.

Findings include:

A review of the facility's weekly staffing records revealed that on the following dates the facility failed to provide minimum licensed practical nurse (LPN) staff of 1:25 on the day shift based on the facility's census.

July 20, 2023 - 2 LPNs on the evening shift, versus the required 3 for a census of 74

July 24, 2023 - 1 LPN on the night shift, versus the required 2 for a census of 75

An interview with the Nursing Home Administrator on July 26, 2023, at 1:55 PM, confirmed the facility had not met the required LPN to resident ratios on the day shift on the above dates.

Plan of Correction - To be completed: 08/29/2023

The facility cannot retroactively correct the LPN ratios.
The facility is focusing on retention of existing LPNs and recruitment of new LPNs through efforts of the retention/recruitment committee.
The Scheduler will be educated regarding the new ratios for LPNs.
Calculation of the daily LPN ratios will be completed and reviewed for accuracy by the scheduler/designee.
Daily ratios will be audited weekly x4 then monthly x2.
The audits will be reviewed x 2 months at monthly QAPI.

§ 211.12(i)(1) LICENSURE Nursing services.:

(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 a review of nurse staffing and resident census and staff interview, it was determined that the facility failed to consistently provide minimum general nursing care hours to each resident daily.

Findings include:

A review of the facility's weekly staffing records revealed that on the following dates the facility failed to provide minimum nurse staffing of 2.87 hours of general nursing care to each resident:

July 21, 2023 - 2.72 nursing hours per resident per 24 hours

July 22, 2023 - 2.66 nursing hours per resident per 24 hours

July 23, 2023 - 2.81 nursing hours per resident per 24 hours

July 25, 2023 - 2.56 nursing hours per resident per 24 hours

On the above noted dates, the facility failed to provide the minimum of 2.87 hours of direct nursing care daily for each resident, which was confirmed during an interview with the Nursing Home Administrator on July 26, 2023.

Plan of Correction - To be completed: 08/29/2023

The facility cannot retroactively correct the nursing hours.
Calculation of daily PPD will be completed and reviewed for accuracy by the scheduler/
The NHA/designee and Human Resources/designee will continue recruitment efforts through job postings, sending needs out to agencies, offering sign on bonuses, recruitment bonuses and offering shift pick up bonuses.
Re-education to NHA/DON/ADON/scheduler on calculation of PPD that was effective July 1, 2023.
Daily PPD will be audited weekly x4, then monthly x2.
The audits will be reviewed x 2 months at monthly QAPI

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