Milton Rehabilitation And Nursing Center

Based on observation and staff interview, it was determined that the facility failed to properly secure and account for resident medications and biologicals on one of two nursing units (West Side Nursing Unit). Findings include: Observation on November 6, 2024, at 8:45 AM during the resident medication pass with Employee 2, licensed practical nurse, revealed a clear medication cup in the top drawer of the medication cart. The cup contained three pills: two round, brown-colored pills and a smaller pink colored one. The medication cup contained no labels, and it was unclear on the identity of the pills. A concurrent interview with Employee 2 revealed that it was unknown how long the cup of pills was in the cart because they were there when the employee started the shift. Further observation of the medication cart revealed three unsecured pills in the bottom drawer of the cart. One pill was a half of a smaller round white colored pill, another was a pink colored oblong tablet, and the third was a round white colored pill. A concurrent interview with Employee 2 revealed it was unknown…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observations and staff interviews, it was determined that the facility failed to provide a clean, comfortable, home-like environment on two of two nursing units (East Nursing Unit and [NAME] Nursing Unit; Residents 4, 7, 25, 52, 99, and 110). Findings include: Observation of a storage room with various respiratory equipment and tube feedings with the title Coat Rack on the door located on the East Side Nursing Unit on December 13, 2023, at 12:54 PM revealed: a green lidded bowl on top of a water heater that held contents, which were covered in a white, fuzzy, mold-like substance, a large plastic fountain drink cup with a straw in the lid discarded under the rack that held tube feedings, a balled-up surgical mask on a shelf holding respiratory supplies, and half a 12-ounce can of soda on a shelf next to exam gloves. These findings were reviewed with Employee 10, a licensed practical nurse, on December 13, 2023, at 1:10 PM. Observation of a shower/bathroom located next to the nutrition room on the East Nursing Unit on December 13, 2023, at 1:14 PM revealed the following: a…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, clinical record review, and staff interview, it was determined that the facility failed to provide appropriate respiratory care and services for five of five residents reviewed (Residents 6, 25, 29, 44, and 69). Findings include: According to the American Association for Respiratory Care proper cleansing of respiratory (nebulizer) equipment reduces infection risk. The longer a dirty nebulizer sits and is allowed to dry, the harder it is to clean thoroughly. Parts of the aerosol drug delivery device should be rinsed and then washed with soap and hot water after each treatment. Once completely dry, store the nebulizer cup and mouthpiece in a zip-lock bag. Clinical record review for Resident 44 revealed a current physician's order for staff to administer Albuterol Sulfate nebulizer solution 0.083% one vial inhale orally via nebulizer every 6 hours as needed for wheezing or shortness of breath. Observation of Resident 44's bedside stand on December 12, 2023, at 11:23 AM and December 13, 2023, at 10:22 AM revealed that there was a nebulizer machine with nebulizer…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on review of select facility policies, observation, clinical record review, and staff interview, it was determined that the facility failed to ensure a medication error rate below five percent (Residents 17 and 52). Findings include: The facility's medication error rate was 15.15 percent based on 33 medication opportunities with two medication errors. The facility policy entitled, Administering Medications, last reviewed without changes on October 13, 2023, revealed that medications must be administered in accordance with physician orders. The individual administering the medication must check the label to verify the right medication, right dosage, right time, and the right method of administration before giving the medication. Observation of a medication administration pass on December 12, 2023, at 8:42 AM revealed Employee 1, licensed practical nurse, preparing to administer Spiriva (treats breathing disorders) one capsule to inhale orally, Fenofibrate (treats high cholesterol) 145 mg (milligrams), Raloxifene (treats osteoporosis) 60 mg, and Ditropan XL (treats overactive…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation and staff interview, it was determined that the facility failed to store food in a manner to prevent the potential spread of foodborne illness in the main kitchen and one of two nursing units (East Nursing Unit). Findings include: Observation of the facility's kitchen on December 12, 2023, at 10:11 AM revealed Employees 3 and 4, dietary aides, were utilizing the dishwasher to clean breakfast dishes. Concurrent observation of the dishwasher gauges revealed that the wash temperature was 110 degrees Fahrenheit, and the final rinse temperature was 142 degrees Fahrenheit. There was no sanitizing agent connected to the dishwasher. Employee 5, dietary manager, acknowledged the low wash and rinse temperatures on the dishwasher and began cleaning out the three-tiered sink to hand wash dishes. She indicated that the concern was identified that morning and a contractor was onsite to fix the hot water boiler currently. Employees 3 and 4 did not identify the low water temperatures and that the facility's dishes were not being sanitized by high temperatures prior to being…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on review of employee personnel records, select facility policy review, and staff interview, it was determined that the facility failed to adequately implement its established abuse prohibition policy for two of five employees reviewed (Employees 7 and 8). Findings include: In accordance with Act 13 Elder Abuse Mandatory Reporting and Act 169 Criminal Background Checks, nursing facilities are required to obtain a criminal background check on all newly hired employees. Facilities are required to obtain the Pennsylvania State Police background check within 30 days of hire on all prospective employees. The policy entitled Abuse last reviewed October 13, 2023, indicates that a criminal background check will be conducted on all prospective employees. A significant finding on the background check will result in denied employment consistent with the criminal background check policy in accordance with State and Federal Regulation. The policy entitled Pre-Employment Criminal Background Screening last reviewed on July 5, 2023, indicates that continued employment depends on successful…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on clinical record review and staff interview, it was determined that the facility failed to ensure assessments accurately reflected resident status for two of 23 residents reviewed (Residents 12 and 58). Findings include: Clinical record review for Resident 58 revealed the resident was admitted to the facility on [DATE]. An admission MDS (Minimum Data Set, an assessment tool completed at specific intervals to determine resident care needs) for Resident 58 dated September 24, 2023, noted the facility staff assessed the resident as receiving an anticoagulant six days in the assessment period. Further clinical record review revealed no evidence that Resident 58 received an anticoagulant during the assessment period for the MDS noted above. An interview with Employee 11, the Registered Nurse Assessment Coordinator, on December 14, 2023, at 11:09 AM confirmed that Resident 58 did not receive an anticoagulant. The above information was reviewed in a meeting with the Nursing Home Administrator and Director of…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on review of select facility policy and procedures, clinical record review, and staff interview, it was determined that the facility failed to maintain an acceptable parameter of nutritional status for one of six residents reviewed for nutrition concerns (Resident 58). Findings include: The policy entitled Weight Assessment and Intervention Policy, last reviewed without changes on October 13, 2023, revealed that, Any weight change of greater than or less than five pounds within 30 days will be retaken for confirmation. A significant weight change is defined as: more or less than five percent within 30 days, and more or less than 10 percent within six months. The policy further noted that if the weight loss meets the definition of significant then the dietitian should discuss with the interdisciplinary team and make recommendations. The policy noted the dietitian will also review the monthly weights by the 10th of the month to follow individual weight trends over time. Negative trends will be assessed and addressed by the dietitian whether the definition of significant weight…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on review of facility policies, clinical record review, and staff interview, it was determined that the facility failed to provide the highest practicable care regarding physician ordered pain medications for one of three resident reviewed (Resident 83). Findings include: The facility policy entitled, Administering Pain Medications, last reviewed without changes on October 13, 2023, revealed that the facility will assess a resident's level of pain prior to administering non-narcotic or narcotic analgesics. Staff will follow the medication administration per the physician's order and utilize standardized pain assessment tools including the 10-point pain intensity scale. The facility policy did not identify what mild, moderate, and/or severe pain was per the 10-point pain intensity scale. Review of Physiopedia's and Wikipedia's definition of the numeric pain rating scale (parameters) from zero to 10 indicated that no pain was identified as zero, mild pain was identified as one to three, moderate pain was identified as four to six, and severe pain was identified as seven to 10.…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on clinical record review and staff and resident interview, it was determined that the facility failed to identify triggers related to a resident's diagnosis of Post-Traumatic Stress Disorder, to provide culturally, competent, trauma-informed care, and to eliminate or mitigate re-traumatization for one of five residents reviewed for mood/behavior (Resident 18). Findings include: Clinical record review for Resident 18 revealed a diagnosis of Chronic Post Traumatic Stress Disorder (PTSD, a mental and behavioral disorder that develops related to a terrifying event) since admission on [DATE]. During an interview with Resident 18 related to her diagnosis of PTSD on December 12, 2023, at 10:47 AM revealed that she did not want to discuss her triggers, she stated that she has talked to a professional about it. A review of Resident 18's most recent quarterly minimum data set (MDS, an assessment completed by the facility at intervals to determine care needs) assessment, dated September 1, 2023, indicated PTSD was…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on clinical record review and staff interview, it was determined that the facility failed to develop and implement an individualized person-centered care plan to address dementia and cognitive loss displayed by one of one resident reviewed (Resident 52). Findings include: Clinical record review for Resident 52 revealed the facility admitted her on May 4, 2022, with a diagnosis including Dementia (loss of memory, language, problem-solving, and other thinking abilities that interfere with daily life). A review of Resident 52's most recent annual Minimum Data Set Assessment (MDS, a form completed at specific intervals to determine care needs) dated March 1, 2023, indicated that the facility assessed Resident 52 as having a diagnosis of dementia. The facility determined that a care plan for dementia and cognitive loss would be developed. A review of Resident 52's care plan revealed that there was no indication that the facility had developed and implemented a person-centered care plan to address the resident's dementia and cognitive loss. The findings were reviewed with the…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on clinical record review and resident and staff interview, it was determined that the facility failed to assist a resident to obtain routine dental services for one of two residents reviewed for dental concerns (Resident 18). Findings include: Interview with Resident 18 on December 12, 2023, at 12:46 PM revealed that she could not remember when she last saw the dentist. Clinical record review for Resident 18 revealed that the facility admitted her on October 1, 2020, with payment sources that included the state Medicaid benefit. Further review of Resident 18's clinical record revealed she last saw the dentist on March 2, 2023. A review of this progress note revealed that Resident 18 was scheduled for her next visit for prophylactic dental cleaning on July 27, 2023. Further review of the progress note revealed Resident 18's oral condition would benefit from Peridex (medication used to treat swelling, redness, and bleeding gums), and daily use of high-concentrate fluoride toothpaste, noting that the facility should consult Resident 18's physician regarding these…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on closed clinical record review and staff interview, it was determined that the facility failed to provide and arrange appointments for outside services for one of 24 residents reviewed (Resident 115). Findings include: Review of Resident 115's closed clinical record revealed that the facility admitted her on October 19, 2023. A review of Resident 115's hospital Discharge summary dated [DATE], indicated that the hospital prescheduled Resident 115 for a follow up with her neurologist to be completed October 24, 2023, at 1:30 PM. There was no documented evidence in Resident 115's closed clinical record to indicate that the facility acknowledged the follow up appointment for Resident 115's neurologist or planned arrangements for Resident 115 to attend the appointment. There was also no documented evidence to indicate the facility rescheduled or cancelled Resident 115's appointment with her neurologist. Interview with the Administrator on December 14, 2023, at 10:05 AM confirmed the above findings for…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, clinical record review, and staff interview, it was determined that the facility failed to ensure an environment free from the potential spread of infection regarding transmission-based precautions and linen containment on one of two nursing units (East Nursing Unit, Resident 110). Findings include: Nursing documentation for Resident 110 dated December 4, 2023, at 11:19 AM revealed the resident was on isolation precautions for Methicillin-resistant Staphylococcus aureus (MRSA; a bacteria that infects the body and is resistant to certain antibiotics). Review of the current physician orders for Resident 110 revealed the resident was on contact precautions (transmission based precautions that requires additional personal protection equipment such as a gown and gloves to avoid direct or indirect contact with a resident and/or their environment to prevent the spread of infection) due to MRSA. Observation of Resident 110's room on December 13, 2023, at 11:48 AM and again at 1:00 PM revealed a sign on the door that indicated the resident was on contact isolation.…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on review of select facility policies and procedures, clinical record review, and staff interview, it was determined that the facility failed to ensure a resident received the pneumococcal immunization for one of five residents reviewed for immunization concerns (Resident 107). Findings include: Review of the policy entitled Influenza and Pneumococcal Immunizations, last reviewed without changes on October 13, 2023, revealed that the facility will provide pneumococcal immunizations to minimize the risk of residents acquiring, transmitting, or experiencing complications from pneumococcal disease. Review of the immunizations for Resident 107 revealed no evidence of a pneumococcal immunization for the resident who was admitted to the facility on [DATE]. An interview with Employee 12, Infection Preventionist, on December 15, 2023, at 12:05 PM revealed that Resident 107 did not receive and was not offered a pneumococcal immunization by the facility. Further review of Resident 107's clinical record revealed…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on clinical record review and resident and staff interview, it was determined the facility failed to provide activities of daily living assistance for resident's dependent on staff assistance for three of four residents reviewed for activity of daily living concerns (Residents 35, 37, and 162). Findings include: During an interview with Resident 35 on January 3, 2023, at 12:03 PM the resident reported that he prefers bed baths. He reported that he is not always washed up, and sometimes the agency staff do not wash him or give him a bed bath until 12:00 PM or 1:00 PM, and some agency staff give him a washcloth and they don't use a wash basin with soap and water. He reported the reason being is that staff are too busy. Review of Resident 35's quarterly MDS (Minimum Data Set, an assessment tool completed at specific intervals to determine resident care needs) dated November 16, 2022, documentation revealed that he required extensive assistance from staff for bathing. Review of Resident 35's task documentation for bathing from November 1 through November 30, 2022, revealed the…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on clinical record review, select facility policy review, and staff interview, it was determined that the facility failed to provide the highest practicable care regarding physician ordered interventions for one of 23 residents reviewed (Resident 59), assessment and treatments of non-pressure wounds for one of three residents reviewed (Resident 48), and glucose monitoring and insulin administration for two of three residents reviewed (Residents 35 and 48). Findings include: A review of the current physician orders for Resident 59 revealed an order dated September 12, 2022, that instructed staff to utilize geri-sleeves (a type of sleeve worn to help protect the arms from injuries) and to remove for hygiene and when soiled. A review of the current care plan for Resident 59 revealed the resident has a potential for skin breakdown. An intervention included geri-sleeves as ordered. Observation of Resident 59 on January 3, 2023, at 11:07 AM revealed the resident was sitting in a wheelchair in his room. The resident was wearing a short-sleeved shirt with no noted geri-sleeves. A…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on review of select facility policies, clinical record review, and staff interview, it was determined that the facility failed to provide physician ordered services to maintain a resident's range of motion for two of four residents reviewed (Residents 43 and 57). Findings include: Review of the facility policy entitled, Restorative Nursing, last reviewed without changes on December 12, 2022, revealed that the facility will provide a restorative nursing program with interventions that promote the resident's ability to adapt and adjust to living as independently. The restorative program is found in the clinical record and care plan. The restorative record is initialed as programs are completed daily. Clinical record review for Resident 43 revealed that therapy staff discharged her on December 21, 2022, with recommendations for her to utilize a left elbow extension splint from breakfast time and doff (remove) at lunch time. A current physician's order for her to utilize a left elbow extension splint from breakfast time and doff at lunch time as needed (PRN), not daily per…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on clinical record review and staff and resident interview, it was determined that the facility failed to implement interventions to care for and monitor a resident's urinary catheter for one of three residents reviewed (Resident 162) and care for and monitor a resident's colostomy for one of two residents reviewed (Resident 162). Findings include: Clinical record review for Resident 162 revealed that he was admitted on [DATE], with a urinary catheter and colostomy (a surgical opening in the abdominal wall to remove fecal material from the large or small bowel). Review of Resident 162's task interventions (an action intended to improve the resident's health and comfort) revealed that staff was to provide ileostomy (a surgical opening in the abdominal wall to remove fecal material from the small bowel) care. Empty bag and clean as needed on day, evening, and night shift. Review of Resident 162's December 2022 and January 2023 task documentation revealed that staff did not provide ileostomy care to Resident…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on clinical record review and staff interview, it was determined that the facility failed to ensure that the resident and/or their responsible party received written notice of the facility bed hold policy at the time of transfer for two of 11 residents reviewed for hospitalization concerns (Residents 68 and 92). Findings include: Clinical record review for Resident 68 revealed nursing documentation dated November 24, 2022, at 1:14 PM that indicated the resident was more lethargic. The physician assistant was notified, and new orders were received to send Resident 68 to the emergency room. He was admitted to the hospital for hypercarbia (an increase in carbon dioxide in the blood stream) related to his lung function. Resident 68's clinical record did not contain evidence that the facility provided a written copy of the facility's bed hold policy to Resident 68's responsible party when he was transferred to the hospital on November 24, 2022. Interview with the Nursing Home Administrator and the Director of Nursing on January 5, 2023, at 2:30 PM confirmed that the facility failed…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on clinical record review and resident and staff interview, it was determined that the facility failed to promote resident involvement with care plan development for one of one resident reviewed (Resident 48). Findings include: During an interview with Resident 48 on January 4, 2023, at 9:16 AM revealed that the resident received letters concerning the date of his care plan conferences and would have liked to attend conferences about his care. Resident 48 reported that he did not attend because he assumed that they would be held in his room because he is dependent on staff to get out of bed. He reported that he did not know where the conferences were held, and no one came to get him. Clinical record review for Resident 48 revealed he had a quarterly MDS (Minimum Data Set, an assessment tool completed at specific intervals to determine resident care needs) assessment on August 23, 2022, and an annual MDS assessment on November 2, 2022. MDS documentation dated November 2, 2022, revealed that the resident had a BIMS (BIMS, Brief Interview for Mental Status, assessment that scores…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, clinical record review, and resident and staff interview, it was determined that the facility failed to provide the highest practicable care to promote optimal pressure ulcer healing for one of six residents reviewed for pressure ulcer concerns (Resident 35). Findings include: Interview with Resident 35 on January 3, 2023, at 12:05 PM revealed that he developed a pressure ulcer of his lower back at a hospital before admission to the nursing facility. He reported that it is improving but the dressing changes are done too close together at times. Resident 35 reported his admission date as May 19, 2022. Review of a late entry skin/wound progress note by a nurse practitioner dated May 26, 2022, at 10:15 AM assessed Resident 35 as having a Stage IV (full thickness skin and tissue loss with exposed or directly felt fascia, muscle, tendon, ligament, cartilage, or bone in the ulcer) sacral (low back) pressure ulcer that measured 32 cm (centimeter) length by 5 cm width by 2.5 cm depth. Review of the most recent wound evaluation dated December 14, 2022, by the wound care…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on clinical record review, observation, and staff interview, it was determined that the facility failed to administer supplemental oxygen consistent with professional standards of practice for three of six residents reviewed (Residents 26, 36, and 94) and failed to store supplemental oxygen equipment per professional standards of practice for two of six residents reviewed (Residents 26 and 36). Findings include: According to the American Association for Respiratory Care proper cleansing of respiratory (nebulizer) equipment reduces infection risk. The longer a dirty nebulizer sits and is allowed to dry, the harder it is to clean thoroughly. Parts of the aerosol drug delivery device should be rinsed and then washed with soap and hot water after each treatment. Once completely dry, store the nebulizer cup and mouthpiece in a zip lock bag. Clinical record review for Resident 26 revealed a diagnoses list that included chronic respiratory failure with hypoxia (blue discoloration of the skin that may result from poor oxygenation), chronic obstructive pulmonary disease (COPD, chronic…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on clinical record review and staff interview, it was determined that the facility failed to provide care consistent with professional standards of practice, for a resident who required dialysis services for one of one resident reviewed for dialysis concerns (Resident 26). Findings include: Clinical record review for Resident 26 revealed a diagnoses list that included dependence on renal dialysis (requires a machine that performs a basic function of the kidney by cleansing the blood of impurities). A current care plan for Resident 26 indicated the resident needs hemodialysis related to renal failure. The care plan noted the resident received hemodialysis three times a week at a dialysis center. A review of the current physician orders for Resident 26 revealed no orders related to the assessment of the resident's left arm fistula (surgically created connection between an artery and a vein to provide an access for hemodialysis). A review of the dialysis paperwork for Resident 26 from the most recent dialysis center visits revealed the resident's left arm fistula was being…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on review of staff education records and staff interview, it was determined that the facility failed to ensure 12 hours of nurse aide in-service education was achieved for one of three employees reviewed (Employee 2). Findings include: Review of staff education records revealed that Employee 2, nurse aide, only completed 3.5 hours of training for the year 2022. Interview with the Nursing Home Administrator on January 6, 2023, at 8:30 AM confirmed the above findings for Employee 2. 483.35(d)(7) Nurse Aide Perform Review-12 Hr/yr In-Service Previously cited 1/21/22 28 Pa. Code 201.20(a)(c) Staff development

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on clinical record review and resident and staff interview, it was determined that the facility failed to provide a physician ordered therapeutic diet for one of 23 residents reviewed (Resident 26) Findings include: Clinical record review for Resident 26 revealed a diagnoses list that included type two diabetes (high blood sugar caused by an insufficient production of insulin), morbid obesity, moderate protein-calorie malnutrition, nutritional anemia (deficiency of blood cells caused by diet), hemodialysis (a machine that performs a basic function of the kidney by cleansing the blood of impurities) and hyperglycemia (high blood sugar). A current care plan for Resident 26 indicated the resident had a nutritional problem related to morbid obesity, history of hyperkalemia (high potassium levels), end-stage renal disease (an advanced state of kidney disease), open areas, heart failure, and is on a therapeutic diet. The care plan instructed staff to provide and serve the diet as ordered and for the registered…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on review of select facility policies and procedures, clinical record review, and responsible party and staff interviews, it was determined that the facility failed to implement an infection control program to prevent the potential spread of infection for one of one resident reviewed (Resident 9). Findings include: The facility policy entitled, Scabies, last reviewed without changes on December 12, 2022, indicated that the purpose is to use treat and prevent the spread of scabies (a contagious itchy skin condition caused by a tiny burrowing mite) to other residents, staff, and visitors. The policy indicated that residents suspected of or diagnosed with scabies should follow contact precautions (interventions implemented when a resident has a type of bacteria, virus, skin issue, or sore that can be spread to someone else if that person touches the infected individual or surfaces or equipment near the infected person) for a period of 24 hours after the last treatment. Cleaning protocols for day one for the resident's environment included to wash the cubicle curtain, remove all…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.