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Sunday, November 09, 1997 Page:
East Mountain Manor
101 E. Mountain Drive, Wilkes-Barre
Survey completed: July 25, 1997
The facility failed to:
Make the most recent survey results available to residents for
examinationMaintain a sanitary, orderly and comfortable interior. Among the
problems observed by surveyors: A right bolster pillow on a wheelchair was
soiled with food; a geriatric chair was ripped and torn beneath the arm rest;
a resident’s wheelchair and bed table were covered with dried food; the left
arm rest of a wheelchair was torn and tattered with strings hanging from the
bottom and the right arm rest was wrapped with silver tape; and the cushion of
a highback wheelchair was soiled and stained and a two-foot metal track bar
was hanging from the upper pane of a window and rubber stripping was hanging
over the lower portion of the window.
In six rooms, the bases of bed tables were rusted and/or heavily stained or
soiled. Several of the table surfaces were chipped or cracked or were missing
large portions. A soiled geriatric chair was stored outside a resident’s room;
the laminated tray area was cracked and covered with gray tape.
The base of a toilet in one bathroom was not secured to the floor and the
floor area was soiled with a dark-colored material.
A heavily soiled plunger was found on the floor of one bathroom; later,
surveyors noted the bathroom smelled of urine and the toilet bowl was stopped
up.
“There was no evidence that the facility took steps to avoid the use of
this bathroom area until the identified plumbing problem was resolved.”
Develop a comprehensive care plan for each resident that includes
measurable objectives and timetables to meet the needs identified in the
resident’s assessment. In one case, the care plan did not reflect a
physician’s order; in another, a care plan did not address a resident’s
frequent incontinence; in the third, the plan did not address the need for or
care of a resident’s catheter.
Develop a comprehensive plan within seven days of completion of an
assessment. In six cases, the facility failed to give residents choices in
planning their care. Five residents were rolled through the halls accompanied
by full-size cylindrical oxygen tanks, both cumbersome and possibly unsafe.
The surveyors were told that residents had not complained but, if they had,
would have been provided with a more suitable oxygen carrier. There was no
evidence the facility had ever asked the residents which type of oxygen
carrier they preferred. In another case, a family member complained that a
resident’s shower schedule was changed when she was moved; there was no
evidence she had been asked about the change.
Provide service in accordance with each resident’s written plan of care.
One resident was not provided bolstered wheelchair arms or side rails in
accordance with the care plan. A resident whose care plan called for partial
assistance at mealtime was fed totally by a staff member. Another resident’s
care plan called for intervention to handle agitation before medication is
given; there was no evidence of that intervention.
Ensure that each resident is provided care to attain or maintain the
highest physical well-being. A resident whose care plan called for staff
members to encourage her to eat half of her food was observed eating alone
twice. Documented meal consumption averaged 29 percent for breakfast; 38
percent for lunch and 44 percent for supper. In one month, her weight dropped
6.5 pounds. Additionally, resident’s meal times were changed, and the
physician who had ordered medication at mealtime was not made aware that the
times had changed.
Ensure that a resident who enters the facility without pressure sores does
not develop pressure sores unless the clinical condition indicates they were
unavoidable. A resident who was identified as a high risk for pressure sores
did not receive weekly skin assessments as required by facility procedure.
Heel protectors and other devices were not used as prescribed for a resident
with a recent pressure sore on her outer ankle. Treatment prescribed for a
third resident with a pressure area was not carried out.
Ensure that one resident who entered the facility without an indwelling
catheter was not catheterized unless the clinical condition justified it.
Ensure that a resident with a limited range of motion receives treatment to
increase the range of motion and/or prevent further decrease. A resident whose
physician orders called for a splint only during the night was wearing the
splint during the day.
Maintain complete, accurate, readily accessible and systematically
organized clinical records. One resident’s records did not include the order
for a urinary catheter the resident was using or instructions for its care.
Another resident’s records used two different terms to describe the same sore.
The nursing treatment record for another resident were initialed, indicating
treatment was followed, when it was not.
Franciscan Skilled Care Center
687 N. Church St., Hazleton
Survey completed: Oct. 31, 1996
The facility failed to:
Complete a comprehensive care plan for each resident that includes
measurable objectives and timetables for needs identified in the assessment.
There was no evidence that a plan of care had been developed for a resident
who needed help dressing and bathing and who expressed a desire to die. Social
services also was not notified that the resident said she wanted to die.
Provide the necessary care and services to help residents attain or
maintain the highest practicable physical, mental and psychosocial well-being.
A resident who had difficulty swallowing was observed eating without
supervision twice. For another resident, the dietitian recommended reducing
the daily calorie count, but the physician was not notified of the
recommendation for seven days until the matter was brought to the facility’s
attention by surveyors.
Hampton House
1548 Sans Souci Parkway, Wilkes-Barre
Survey completed: Dec. 6, 1996
The facility failed to:
Allow residents to participate in decisions about their care plans.
Documents show that two residents were invited to their quarterly care review
meetings but did not attend because they were at church services. The facility
disputes the deficiency, pointing out that both residents have attended care
meetings in the past; the residents say they attend when they want to. Meeting
times are modified on request to fit residents’ schedules.
Provide therapeutic social service interventions to two residents. One
resident’s mother died and there was no evidence that social services provided
any help on the day he learned of her death. There also was no evidence that
social services had intervened with a resident yelling repeatedly at other
residents over a three-week period. The facility disputes the deficiency noted
for the grieving resident, saying comfort was offered.
Develop a comprehensive care plan for each resident that includes
measurable objectives and timetables. One resident’s care plan included pain
management education, but she was unable to explain the pain management
program prescribed her hospice caregivers. The care plan of another resident
did not address negative “acting-out” behaviors, including a threat to throw
herself down the stairs.
Hazleton Nursing and Geriat ric Center
1000 W. 27th St., Hazleton
Survey completed: Feb. 13, 1997
The facility failed to:
Demonstrate a systematic approach to use of restraints; restraints should
be utilized only when justified by medical symptoms. A resident who had not
fallen in six months was strapped in a wheelchair by a velcro belt.
Keep residents’ drug regimens free from unnecessary drugs. A resident was
given an anti-depressant even though no psychosocial, mood and/or adjustment
adifficulties had been noted.
Heritage House
80 E. Northampton St., Wilkes-Barre
Survey completed: April 3, 1997
The facility failed to:
Develop comprehensive care plans for three residents that include
measurable objectives and timetables to meet the needs identified in their
assessments. One resident had a potential for dehydration; another who was
terminally ill required special feeding instructions; a third needed specific
eating goals.
Store, prepare, distribute and serve food under sanitary conditions.
Dishwasher rinse temperature was below the required 180 degrees. The problem
was corrected during the inspection, and a chemical sanitizing agent has been
added to the rinse cycle.
Maintain complete, accurately documented, readily accessible and
systematically organized clinical records. Staff members could not locate the
plan of care for one resident who had died; in another case, medication orders
and the label of the bottle did not match.
Highland Manor Nursing and Convalescent Center
750 Schooley Ave., Exeter
Survey completed: Jan. 6, 1997
The facility failed to:
Allow one resident to make her own decision about a medical procedure. The
resident was deemed capable of exercising her rights and responsibilities.
When problems developed with an intravenous line, a physician ordered surgical
placement of a central line. Neither the procedure nor its implications was
discussed with the resident; and permission was obtained from her son. The
facility responded that the resident routinely denies treatment and clearly
makes staff aware of her denials. She did not deny or resist placement of the
central line. The facility changed its procedure; capable residents will be
asked to say “yes” to procedures before they are carried out.
Develop comprehensive care plans for two residents within seven days of
completion of their assessments. The care plans for both residents did not
include assessments by hospice staff.
Ensure that residents receive proper treatment and care for special
services. The facility was not consistently documenting the site of all
insulin injections to ensure a rotation.
Maintain a safe environment for residents, staff and the public. Dispensers
of instant hand sanitizer containing ethyl alcohol, an ingredient requiring a
poison warning, were located in hallways accessible to anyone.
Kingston Health Care Center I
702 Third Ave., Kingston
Survey completed: June 5, 1997
The facility failed to:
Ensure that residents were free from physical restraints not required to
treat medical conditions in three of seven cases reviewed. The facility had
not assessed the use of side bed rails for those residents.
Develop comprehensive care plans within seven days of the completion of the
assessments of two of 15 residents. In one case, the resident’s nutritional
status was not reflected in the care plan; the other did not include ongoing
assessment of treatments to prevent urinary tract infections.
Maintain an environment as clear of potential accident hazards as possible.
One resident was found on the floor on his back at 3:05 a.m.; his bed alarm
did not sound because the switch was off, according to facility rec ords.
Another resident identified as a high risk for falls waited more than a month
for a bed alarm, which needed a part. Other changes had not been made to
ensure the resident’s safety.
Lakeside Nursing Center
RD #4, Box 357, Dallas
Survey completed: Aug. 15, 1997
The facility failed to:
Immediately report, in writing, that one resident slipped away from the
facility. The resident left the facility three times in one month; there is no
evidence that state officials were notified.
Develop a comprehensive care plan for each resident that includes
measurable objectives and timetables to meet the needs identified in the
resident’s assessment. One resident complaining of pain was given pain
medication 133 times in 3 months; there was no evidence that alternative
treatments were considered. The same resident was given sleeping pills 33
times in 1 months and there is no documented evidence that the facility
identified sleeplessness as a problem in his care plan.
Evaluate and/or revise approaches to resident care. The plan for one
resident, who attempted frequently to leave the facility, did not include
information on the diversion that was most effective in redirecting her.
Provide one resident who was discharged with a discharge summary that
includes a post-discharge plan of care.
Ensure that each resident receives adequate supervision and assistance
devices to prevent accidents. A resident attempted to leave the facility by
removing a large screen from the window in her room; an surveyor found locks
on the screen that were easily manipulated, allowing her to remove the screen
at will.
Provide a monthly review of each resident’s drug regimen by a licensed
pharmacist. The pharmacist failed to notify the attending physician and/or
director of nursing of an “as-needed” drug being administered every day for
more than 30 days.
Manorcare Health Services/East
200 Second Ave., Kingston
Survey completed: Oct. 4, 1996
The facility failed to:
Ensure that residents were free from physical restraints not required to
treat medical conditions in six of 14 cases whose records were reviewed. In
some cases, family members had requested the restraints, which were utilized
without assessments of their need.
Ensure that the residential environment remains as free of accident hazards
as possible. In one case, resident injured herself by attempting to get out of
bed with two side rails up, but there was no evidence the facility attempted
to make modifications.
Meadows Nursing Center
55 W. Center Hill Road, Dallas
Survey complete: May 8, 1997
The facility failed to:
Inform residents in writing of all rules and regulations governing conduct
and responsibilities during their stay. Residents and their families were not
told in writing how to exit the second and third floors by elevator, which
requires a keypad combination to operate.
Promote care for each resident in a manner that maintains or enhances his
or her dignity in recognition of his or her individuality. In one case a
resident was left sleeping for 15 minutes with a spoon in her hand while
seated in a wheelchair in front of her lunch tray. Other residents in
wheelchairs and geri atric chairs were left waiting for lunch in a row in the
hall.
Provide an ongoing program of activities designed to provide the well-being
of each resident. Four of 17 low-functioning residents were not provided
programming based on their interests and physical and psychosocial well-being.
One resident was observed sitting in her wheelchair for extended periods of
time with no stimulation or diversions offered. Four other residents were left
for extended periods of time next to the nurses’ station. Another resident was
placed in the hallway and told to “sit down and watch the traffic go by.”
Ensure that a resident who enters the facility without an indwelling
catheter is not catheterized unless the resident’s clinical condition
demonstrates that catheterization was necessary. The plans of care for three
residents did not include justifications for the continued use of catheters.
Mercy Center Nursing Unit
Lake Street, Dallas
Survey completed: Jan. 23, 1997
The facility failed to:
Develop a comprehensive care plan within seven days of the completion of
the comprehensive assessment in one of 14 residents whose records were
reviewed. Members of the care plan team were not aware of changes in treatment
for a resident.
Ensure that a resident who enters the facility without an indwelling
catheter is not catheterized unless clinical condition demonstrates it was
necessary. Documents did not show justification in three of five residents
catheterized.
Ensure that residents using anti-psychotic drugs receives gradual dose
reductions and behavioral interventions, unless clinically contradicted, in an
effort to discontinue these drugs. That was not done in one of the four
residents on anti-psychotic drugs.
Mercy Health Care Center
147 Newport St., Nanticoke
Survey completed: Jan. 9, 1997
The facility failed to:
Ensure that residents were free from physical restraints not required to
treat medical conditions. In three of nine cases reviewed, restraints were
used without trying less restrictive devices and discussing the risks vs.
benefits of the device with family members requesting it.
Mountain City Convalescent and Rehabilitation Center
1000 W. 27th St., Hazleton
Survey completed: Sept. 19, 1997
The facility failed to:
Make a comprehensive assessment of a resident’s needs based on uniform data
and using an approved assessment form. In three cases, there was no evidence
the facility assessed resident problems.
Develop a comprehensive care plan for that includes measurable objectives
and timetables to meet the resident’s needs. The care plan for a resident with
cancer did not address pain management, monitoring of the progression of the
disease or use of a catheter and the abnormal appearance of her urine.
Ensure that services are provided by qualified persons in accordance with
the resident’s plan of care. In one case, there was no evidence that nursing
had assessed a resident’s pain.
Ensure that each resident receive adequate supervision and assistance
devices to prevent accidents. In one case, the facility failed to investigate
and plan care for a resident after a fall to prevent further falls.
Riverstreet Manor
440 N. River St., Wilkes-Barre
Survey completed: Dec. 19, 1996
The facility failed to:
Provide medically related social services for two of the 24 residents whose
cases were reviewed. Records did not show that the staff was following a plan
of intervention for a resident who wanders and is physically and verbally
abusive. Records also did not show the social services staff assisted with a
resident whose primary language is Italian and who refused to take medication
and was agitated and combative.
Ensure that a resident who enters the facility without pressure sores does
not develop pressure sores unless they were unavoidable. In one case, a device
designed to provide pressure relief was applied incorrectly. In another, a
pressure relief boot ordered for continuous wear had been used on the wrong
foot.
Ensure that a resident who enters the facility without an indwelling
catheter is not catheterized unless clinical condition indicates that
catheterization is necessary. A catheter had been inserted in one resident
without medical justification.
Ensure that residents with urinary incontinence are provided services to
maintain and/or improve bladder function. Facility had discontinued bladder
training program for one resident.
Provide adequate supervision and assistance devices to prevent accidents. A
totally dependent resident fractured her left femur.
Act promptly on recommendations by pharmacist. Saint Luke Manor
1711 E. Broad St., Hazleton
Survey completed: April 4, 1997
The facility failed to:
Conduct an assessment of each resident with appropriate participation of
health professionals.
Develop a comprehensive care plan that describes services needed to attain
the resident’s highest practicable physical well-being in two of 20 cases
reviewed. In one case, there was no plan to monitor or care for an area with
sutures until the resident began to exhibit signs of infection.
Document the development of pressure sores and report their development to
the dietitian.
Implement timely nutritional intervention for one resident who was rapidly
losing weight (12.5 pounds in two weeks). Family members had been asked to
approve a feeding tube, but the family did not respond to the request for
almost four weeks.
Store, prepare, distribute and serve food under sanitary conditions. Tray
covers and tray bottoms were cracked and chipped.
Act on reports of pharmaceutical irregularities. The consulting pharmacist
recommended reviewing use of a drug by a resident, but there was no action for
several weeks.
Properly handle soiled linens for a resident who is on isolation
precautions for an infection.
Saint Luke Pavilion
1000 Stacie Drive, Hazleton
Survey completed: Oct. 31, 1996
The facility failed to:
Resolve grievances of some residents, including those with respect to the
behavior of other residents. Residents complained repeatedly about problems of
other residents wandering into their rooms, and “wander strips” placed across
the doorways to some rooms were not always fastened.
Keep residents free of physical restraints not appropriate for medical
conditions. Documents did not show that two residents of 24 residents whose
cases were reviewed had been evaluated for the appropriateness of the
restraints that were used.
Provide medically related social services to help residents attain and
maintain the highest practicable physical, mental and psychosocial well-being
in five cases.
Develop a comprehensive care plan for four residents.
Maintain acceptable nutritional parameters in one of seven residents whose
records were reviewed. In that case, the weight of a resident who required
total help in eating dropped from 152 to 129 pounds in less than four months.
Smith Nursing and Convalescent Home
453 South Main Road, Mountaintop
Survey completed: April 10, 1997
The facility failed to:
Notify resident’s family and physician of accidents resulting in an injury
or significant change in physical status in two of 13 cases. In one case, a
resident fell, resulting in a laceration near the right eye.
Provide an environment that maintains and respects the individuality of
residents in seven of 35 residents observed. Residents were not dressed in
supportive footwear.
Provide an ongoing activities program. No activities were scheduled after
3:30 p.m. or on weekends.
Develop a comprehensive care plan for two of 13 residents whose cases were
reviewed. In one case, a resident’s poor vision had not been identified in his
care plan.
Develop a comprehensive care plan within seven days of the completion of
the comprehensive assessment in one of 13 cases reviewed. In one case, a
resident with memory problems and nutritional problems, depended on the staff
to eat and drink. Her physician noted morbidity, refusing to eat and drink,
and the beginnings of dehydration, but the facility did not develop or
implement alternative treatments to increase fluid intake and prevent further
dehydration. Therapist’s recommendations to help her swallow were not included
in the written care plan.
Maintain clinical records on each resident in two of 13 cases reviewed.
Summit Health Care Center
50 N. Pennsylvania Ave., Wilkes-Barre
Survey completed: Aug. 29, 1997
The facility failed to:
Provide care in an environment that maintains or enhances each resident’s
dignity and respect in full recognition of his or her individuality. Small
amounts of dried stool were found in a shower and floor of a shower/bath room;
an administrator said the stool might have been there since the day before.
Ten residents had reserved showers in the room since that time. In other
cases, breakfast was more than an hour late for some residents and other
residents requiring help had to wait 45 minutes for assistance; another
resident could be seen from the hallway wearing only an adult diaper; a female
resident clenching her fingers into her hands had long, jagged nails and
facial hair; and the time to reposition residents was announced over the
loudspeaker.
Provide an ongoing program of activities to promote residents’ well-being.
Residents interviewed said they were not interested in the activities
provided. The only activities offered on Sundays are church services and
watching movies.
Provide medically related social services to attain or maintain the
resident’s well-being. Social services had not been notified of resident’s
depression.
Develop a comprehensive care plan that includes measurable objectives and
timetables to meet the needs identified in the resident’s assessment. In one
case, the plan did not include a specific approach to keep resident from
dragging feet on floor while being transported in her wheelchair; another
resident’s care plan did not address a foot rash or ways to maintain his
muscle development and ambulation; another plan did not address a resident’s
blood pressure as it relates to an ordered medication.
Provide services in accordance with each resident’s written care plan. One
resident’s care plan calls for palm protectors in both hands; there was no
evidence that the palm protectors were used. Another resident’s plan called
for a right hand extension splint to be used daily; the resident refused to
wear the splint and no alternative measures had been developed.
Ensure that residents receive proper treatment and care for special
services. In one case, the facility failed to provide preventative foot care
to a resident with diabetes and a circulatory disorder.
Valley Crest Nursing Home
1551 East End Boulevard, Wilkes-Barre
Survey completed: Aug. 14, 1997
The facility failed to:
Provide care in an environment that maintains or enhances each resident’s
dignity and respect in full recognition of his or her individuality. Six
residents were observed ungroomed or in undignified positions, including a
woman observed with thick, white mucous dried on her lips at two different
times of the day.
Conduct assessment promptly after a significant change in one resident’s
physical well-being.
Ensure the accuracy of assessments by appropriate health professionals.
Problems identified by the nursing staff in three cases were not notified in
the residents’ assessments.
Develop a comprehensive care plan that includes objectives and timetables
to meet the resident’s needs. In three cases, the facility failed to develop a
care plan for identified problems.
Review and revise two residents’ current care plans periodically. In one
case, the resident left the building six times with the staff’s knowledge and
attempted to leave the building 26 times. Although the facility identified
that intervention plans were ineffective, they failed to revise the plan.
Provide services in accordance with the care plans. The plan for a resident
who had threatened suicide several times called for the facility to initiate a
suicide watch; documents did not indicate that a watch was initi ated. The
plan for another resident called for meal intake monitoring; there was no
evidence in the documents of the monitoring.
Provide treatment and services to promote healing of pressure sores and to
prevent new sores from developing. There was no evidence that the facility had
identified one of the sores on a resident with four sores.
Ensure that residents with a limited range of motion receive treatment to
increase the range and/or to prevent further decrease in the range. Documents
did not indicate that a splint ordered for one resident always was used.
Provide residents with sufficient fluids. Documents did not show that the
physician and dietitian were notified that one resident was not drinking
enough liquids.
Wesley Village
209 Roberts Road, Pittston
Survey Completed: April 11, 1997
The facility failed to:
Promptly notify physicians that two residents required treatment. Surveyors
reviewed 27 cases. One resident had a bed sore that ultimately required
hospital treatment; the skin of the other resident’s feet was red and peeling.
Develop comprehensive plan of pain management for three of four residents.
One resident clutched at the nurse’s hand during treatment; another had not
been evaluated for decreased food consumption; for another, the nurses
administering the treatment decided whether pain medication was needed.
Follow a plan of care for three of 27 residents. In one case, the dietitian
was not notified of abnormal blood test results; in another, a resident with
severely contracted arms and hands was not provided physician-ordered devices;
in the third, a resident with skin problems was not dressed in Posey boots or
white socks that had been ordered by a physician.
Consistently provide treatment to prevent urinary tract infections in two
of nine residents. In both cases, the nursing home had not updated its
assessment of the need for catheters that required frequent reinsertion.
Follow up on two of eight residents who were nutritionally at risk. One
resident’s weight dropped from 98.5 to 84 pounds in seven months; the other
resident’s weight dropped from 174.5 pounds to 160.5 pounds in seven months.
Practice techniques to reduce the potential spread of infection. Open sores
on one resident’s feet were not completely wrapped; a nurse’s aide was seen
walking down a hall carrying a soiled undergarment; the facility did not have
a procedure for monitoring identified or possible infections.