§483.70(a) Licensure.
A facility must be licensed under applicable State and local law.
§483.70(b) Compliance with Federal, State, and Local Laws and Professional Standards.
The facility must operate and provide services in compliance with all applicable Federal, State, and local laws, regulations, and codes, and with accepted professional standards and principles that apply to professionals providing services in such a facility.
§483.70(c) Relationship to Other HHS Regulations.
In addition to compliance with the regulations set forth in this subpart, facilities are obliged to meet the applicable provisions of other HHS regulations, including but not limited to those pertaining to nondiscrimination on the basis of race, color, or national origin (45 CFR part 80); nondiscrimination on the basis of disability (45 CFR part 84); nondiscrimination on the basis of age (45 CFR part 91); nondiscrimination on the basis of race, color, national origin, sex, age, or disability (45 CFR part 92); protection of human subjects of research (45 CFR part 46); and fraud and abuse (42 CFR part 455) and protection of individually identifiable health information (45 CFR parts 160 and 164). Violations of such other provisions may result in a finding of non-compliance with this paragraph.
|
Observations:
Based on a review of vendor invoices, and interviews with staff, it was determined that the facility failed to operate in compliance with state regulations and codes. The facility's failure created a situation which placed all residents in immediate jeopardy of the likelihood of serious bodily injury, harm, or death.
Findings include:
28 PA Code Commonwealth of Pennsylvania Long Term Care Licensure Regulations, subsection 201.14(g), dated July 24, 1999, revealed that a facility owner shall pay in a timely manner bills incurred in the operation of a facility that are not in dispute and that are for services without which the resident's health and safety are jeopardized.
Information provided by the facility revealed that the facility's vendor C.L. McKeirnan, Inc. a
transportation company has a past due balance of $10,253.79 as of February 27, 2024. The last payment was made on May 22, 2023, in the amount of $575.20. The vendor notified the facility in writing that services would be unavailable until full payment is received.
Information provided by the facility revealed that the facility's vendor Anderson Shortell Inc. a
generator company has a past due balance of $23,878.44. Review of invoices from January 4, 2023, through February 27, 2024, lacked evidence of any payment's being made. The vendor notified the facility in writing that services would be unavailable until full payment is received.
Information provided by the facility revealed that the facility's vendor Hobart Service a kitchen equipment repair company has a past due balance of $1,281.82. Review of the invoice dated February 27, 2024, lacked evidence that a payment has been made since April 12, 2023. The vendor notified the facility in writing that services would be unavailable until full payment is received.
Information provided by the facility revealed that the facility's vendor Hillegass Technologies
Corp. a wander guard (alarming device placed on a resident to alert staff of their unauthorized exit from the facility) repair and replacement company has a past due balance of $491.00. Review of an invoice dated March 10, 2023, lacked evidence of any payments being made. The vendor notified the facility in writing that services would be unavailable until full payment is received.
Information provided by the facility revealed that the facility's vendor CertaSite a fire and life safety company has a past due balance of $9,150.40. Review of invoice dated February 27, 2024, lacked evidence that a payment was made since November 4, 2023. The vendor notified the facility in writing that services would be unavailable until full payment is received.
Interview conducted on February 27, 2024, at 7:30 a.m. with Registered Nurse Supervisor Employee E1 revealed he/she has not received a paycheck and was due to be paid on February 23, 2024.
Interview conducted on February 27, 2024, at 7:35 a.m. with Nursing Assistant Employee E2 revealed he/she has not received a paycheck and was due to be paid on February 23, 2024.
Interview conducted on February 27, 2024, at 7:40 a.m. with Housekeeping Employee E3 revealed he/she has not received a paycheck and was due to be paid on February 23, 2024.
Interview with the Nursing Home Administrator (NHA) and the Director of Nursing (DON) on February 27, 2024, at 8:30 a.m. revealed that they have been contacted by phone and mailings from numerous vendors used by the facility regarding non-payment for services that they have provided. The facility's credit cards that are on file at several local establishments such as the pharmacy and Dollar General are no longer accepted forcing staff to pay with their own debit and/or credit cards to ensure the residents have over the counter medications and supplies. The facility owes various staff members a total of $890.59 for these purchases. They are no longer able to utilize Agency Staffing services to ensure adequate staffing for resident care due to the facility's failure to pay and there is a lawsuit pending. Additionally, all staff members were due to receive their paychecks on February 23, 2024, and they have not been paid totaling $108,338.29 based on review of Payroll documents.
Interview conducted with Maintenance Director on February 27, 2024, at 9:00 a.m. revealed the trash bill was not paid resulting in his personal owned vehicle being used to take the trash to the local dump and the payment made by him/her.
Interview with the Registered Nurse Assessment Coordinator on February 27, 2024, at 9:30 a.m. revealed Pharmacy Consultations have not been completed since October 2023 due to the facility's failure to pay for services provided.
Review of an e-mail communication from the Pharmacy Consultant dated January 2, 2024, at 10:37 a.m. revealed that he/she has not done any pharmacy reviews for the facility since October 2023.
On February 27, 2024, at 2:07 p.m. the Nursing Home Administrator was given the Immediate Jeopardy template and informed that the health and safety of the residents were placed in Immediate Jeopardy due to the failure to operate in compliance with state regulations and codes by not paying in a timely manner bills incurred in the operation of a facility.
An immediate action plan was submitted and contained the following:
All vendors had payments processing, and were up to date by February 27, 2024, or had automatic payment arrangements for future dates.
All employees will receive their paychecks at the latest on February 28, 2024.
A Pharmacy Consultant who will work full time will start the week of March 4, 2024.
A staffing plan was put in place from February 27, 2024, through February 29, 2024.
The DON will continue to reach out to staff to fill call offs or any unforeseen resignations.
DON will also continue to reconnect with nursing applicants that were going to come on board and decided not to due to no payroll being paid out.
The facility NHA and accounts payable representative will contact each vendor with outstanding balances to establish payment plans with the Chief Financial Officer.
Each vendor balance will be updated as payment is made to include remaining balance with notation of payment arrangements made.
Effective immediately, all invoices received by the facility will be reviewed by the facility Business Office Manager and submitted to the company's accounts payable department via email for processing.
On a weekly basis, beginning March 4, 2024, the controller will provide the facility Nursing Home Administrator with a statement of invoices paid for the prior week and a monthly statement of accounts payable for all vendors.
The Immediate Jeopardy was lifted on February 28, 2024, at 6:22 p.m. when it was confirmed that payments were being made and received by the vendors with outstanding balances and/or a payment plan was in place, staff in all departments received their paychecks, and staff was reimbursed for their out-of-pocket expenses.
28 Pa. Code 201.14 (g) Responsibility of licensee
28 Pa. Code 201.18 (e)(1) Management
| | Plan of Correction - To be completed: 04/12/2024
1. Lakeview Healthcare and Rehabilitation Center on 2/27/2024 responded to the identify concerns with remedy listed for immediate resolution.
a. All employees were paid on 02/28/2024.
b. All employees purchased items with personal funds for resident care needs were reimbursed on 2/28/2024 for $890.59.
c. All vendors listed below were paid in full on 2/27/2024.
- C.L. McKeirnan - $10,253.79 - paid in full (proof of payment was submitted)
- Hobart Service - $1,281.82 – paid in full (proof of payment was submitted)
- Hillegass Technologies Corp. $491.00 - paid in full (proof of payment was submitted)
- CertaSite $9,150.40 - paid in full (proof of payment was submitted)
d. All vendor(s) listed below were agreed upon for a payment plan.
- Anderson Shortell, Inc. $23,878.44 (proof of payment plan was submitted)
2. Consultant Pharmacist - The organization has secured a full-time pharmacist to be employed by the company to provide the required oversight with anticipated start date the week of 3/4/2024. This date was pushed to 4/1/2024 but are in place to begin and review all drug regimen reviews going forward.
3. Adequate staffing requirements were made for weekend coverage starting on 2/27/2024 to satisfy federal and Pennsylvania guidelines for resident care utilizing facility level employees. Plan was as follows: The plan was implemented and provided sustainably care for our residents from 2/27 - 2/29.
- DON continued to reach out to staff to fill call offs or any unforeseen resignations and was able to bring back one CNA and one LPN that left due to not being paid.
- DON will also continue to reconnect with nursing applicants that were going to come on board and decided not to due to no payroll being paid out.
4. The facility Nursing Home Administrator and accounts payable representative will contact each vendor with outstanding balances to establish payment plans with the Chief Financial Officer. Each vendor balance will be updated as payment is made to include remaining balance with notation of payment arrangements made monthly and BOM or designee will conduct an audit monthly x 3 to ensure outstanding balances are being addressed.
5. Invoices received by the facility were and will continue to be reviewed by the facility Business Office Manager and submitted to the company's accounts payable department via email for processing in a timely manner. On a weekly basis, beginning 3/04/2024, the controller will provide the facility Nursing Home Administrator with a statement of invoices paid for the prior week and a monthly statement of accounts payable for all vendors. BOM or designee will also include this in the monthly audit x 3. If an invoice has not been paid, the administrator will contact AP and find out if there was a problem in payment. If the administrator gets no responds from AP, then administrator will take concern to higher management level to receive status of payment. Administrator will continue to follow up with vendor and AP to ensure payment was sent and received.
6. Court appointed Receiver was put into place February 29, 2024, to oversee the financial stability of the facility.
7. All findings will be reported to QAA on a monthly basis x 3.
|
|
