Anda di halaman 1dari 10

Pennsylvania Department of Health

WESLEY ENHANCED LIVING MAIN LINE REHAB AND SKD


NURSING
Patient Care Inspection Results
Information About Nursing Home Patient Care Inspections

Note: If you need to change the font size, click the "View" menu at the top of the page,
place the mouse over the "Text Size" menu item, and select the desired font size.

Severity Designations

Minimal Citation -
Minimal Harm Actual Harm Serious Harm
No Harm
WESLEY ENHANCED LIVING MAIN LINE REHAB AND SKD NURSING
Inspection Results For: 9/18/2017 Print Current Report View Previous Reports
There are 41 surveys for this facility. Please select a date to view the survey results.

Surveys don't appear on this website until at least 41 days have elapsed since the
exit date of the survey.

WESLEY ENHANCED LIVING Scope of Citation


MAIN LINE REHAB AND SKD Number of Residents Affected
NURSING - Inspection Results By Deficient Practice
Initial comments: Plan of Correction:

Based on an Abbreviated survey in


response to a complaint completed on
September 18, 2017, it was determined
that Wesley Enhanced Living Main Line
Rehabilitation and Skilled Nursing was
not in compliance with the following
requirements of 42 CFR 483, Subpart B,
requirements for Long Term Care and the
28 PA Code, Commonwealth of
Pennsylvania Long Term Care Licensure
Regulations.

483.24, 483.25(k)(l) REQUIREMENT


PROVIDE CARE/SERVICES FOR
HIGHEST WELL BEING:

483.24 Quality of life


Quality of life is a fundamental principle that applies to all care and services provided
to facility residents. Each resident must receive and the facility must provide the
necessary care and services to attain or maintain the highest practicable physical,
mental, and psychosocial well-being, consistent with the residents comprehensive
assessment and plan of care.

483.25 Quality of care


Quality of care is a fundamental principle that applies to all treatment and care
provided to facility residents. Based on the comprehensive assessment of a resident,
the facility must ensure that residents receive treatment and care in accordance with
professional standards of practice, the comprehensive person-centered care plan, and
the residents choices, including but not limited to the following:

(k) Pain Management.


The facility must ensure that pain management is provided to residents who require
such services, consistent with professional standards of practice, the comprehensive
person-centered care plan, and the residents goals and preferences.

(l) Dialysis. The facility must ensure that residents who require dialysis receive such
services, consistent with professional standards of practice, the comprehensive
person-centered care plan, and the residents goals and preferences.
Observations: Plan of Correction - To be completed:
11/08/2017
Based on clinical record review and staff
interview, it was determined the facility R2, residents chart cannot be altered.
failed to assess and monitor a resident With respect to how facility will identify
after experiencing a change in condition potential residents at risk:
which resulted in actual harm to one All residents with a changed in condition
resident who developed abnormal vital will have their charts audited for
signs, required oxygen and monitoring documentation and vital signs
hospitalization with diagnoses of documentation.
pneumonia, hypotension, sepsis and An audit of all residents' daily notes will
acute renal failure for one out of three be reviewed, at clinical meeting, for
residents reviewed (Resident R2). monitoring and documentation of
monitoring all residents with a change in
Findings include: condition, until resident is stable.
An audit of all resident' charts will be
Review of Resident R2's clinical record reviewed at clinical meeting, for monthly
revealed that the resident was admitted to documentation of vital signs and
the facility with diagnoses that included documentation of vital sign for all
dementia (long term and often gradual residents with a change in condition, until
decrease in the ability to think and resident is stable.
remember that is great enough to affect a All Professional Nursing Staff will be in-
person's daily functioning), delusions (a serviced on monitoring and documenting
belief that is held with strong conviction on residents with a change in condition
despite superior evidence to the contrary) via facilities updated "change in
and depression (state of low mood and condition" policy.
aversion to activity that can affect a All Professional Nursing Staff will be in-
person's thoughts, behavior, feelings, andserviced on monitoring residents' vital
sense of well-being). sign with a change in condition via
facilities updated "change in condition"
Review of the progress notes revealed a policy.
nursing entry on August 1, 2017, at 4:17 The DON or designee will audit weekly to
p.m. that stated Resident R2 had vomited ensure documentation of monitoring
once this morning and had a large residents with a changed in condition and
amount of loose stools twice and there documentation of vital signs, until
were no new orders at that time. resident is stable.
All finding from the audits will be
Further review of the progress notes reviewed at Quality of Care meeting until
revealed a nursing entry on August 2, 100 % compliance is achieved x three
2017, at 1:49 p.m. that stated the, months then a monthly audit will be
"resident vomited x1 (once) in the AM conducted for continued compliance x 3
and the physician was notified and there months.
was a new order for a CBC (complete The Quality Assurance committee meets
blood count- panel of test that break at least quarterly and is composed of
down the different cells in a person's NHA, DON, Unit manager, Social
blood) and a CMP (Comprehensive Services, Dietician, Medical Director,
Metabolic Panel- a rough check of Plant mgmt. The QA Committee will
kidney function, liver function, diabetic review the audits quarterly.
and thyroid status, and electrolyte and
fluid balance), lab draw pending at this
time."

Review of the physician's progress notes


revealed an entry on August 2, 2017, at
10:44 a.m., that stated Resident R2, "per
staff, has been having episodes of
vomiting." Further review of the
physician's progress notes revealed there
was a heart rate recorded of 62 and a
blood pressure of 137/82 (within normal
limits) with no date or time of when these
were obtained. Under the "Diagnosis,
Assessment and Plan" section of the
progress note, vomiting was noted and
the physician stated, "check LFT's (Liver
function test-panel of blood test to
determine the functionality of the liver)
and CBC."

Review of the physician's orders


confirmed an order for a CBC and a CMP
on August 2, 2017, was obtained.

Review of the laboratory results revealed


a CBC was drawn on August 3, 2017,
and had a result of 14.30 for the white
blood cell count (indicative of infection,
normal is 3.8-10.5). The lab results were
signed by a nurse indicating they were
communicated to the physician on
August 3, 2017, and signed by the
physician on August 4, 2017.

Further review of the nursing notes


revealed there was no nursing note
entered on August 3, 2017. The next
available nursing note was dated August
4, 2017, at 4:17 p.m. which revealed,
"nurse was checking on resident after
lunch secondary to 2 days of NVD
(nausea, vomiting, diarrhea). When nurse
started V.S (Vital Signs) and reached for
the resident, hand was cold and clammy,
resident V.S. were as follows T (temp)
100.5 HR (Heart rate) 160 B/P (Blood
Pressure) 100/50 R (respirations) 52
SPO2 (pulse oximetry- measure of
oxygen in the blood) 78 on RA (room air-
no supplementary oxygen). The nurse put
the resident on 2L/02 (2 liters per minute
of oxygen) nursing judgement, her son
was called and the resident was sent out
911." The resident was subsequently
transferred to the hospital.

Further review of the nursing notes


revealed a nurse entry on August 8, 2017,
at 11:03 p.m. stating that the resident
expired at the hospital.

Review of the resident's record revealed


there was a set of monthly vital signs in
March 2017. The Director of Nursing
was asked to provide vital signs for this
resident and presented a sheet of paper
with the title, July Monthly Vital Signs,
which was a list of every room number
and a set of vital signs for the resident in
the room. This was not a part of the
clinical record. Interview with the
Director of Nursing on September 13,
2017, at 1:00 p.m. confirmed that there
were no vital signs for this resident
documented in the clinical record by
nursing since March 2017.
Review of Resident R2's hospital records
revealed that the resident was admitted to
the hospital on August 4, 2017, at 3:51
p.m. Resident R2 was assessed with a
fever difficulty breathing, abdominal
pain, nausea, and vomiting. A laboratory
test completed at the time of admission to
the hospital revealed a white blood count
of 16.70. The resident's admitting
diagnoses included severe sepsis (a life-
threatening condition that arises when the
body's response to infection causes injury
to its own tissues and organs) pneumonia
with respiratory failure (an infection that
inflames air sacs in one or both lungs,
which may fill with fluid) and acute
kidney failure.

Further interview with the Director of


Nursing on September 13, 2017, at 2:45
p.m. revealed there was no evidence in
the clinical record that the facility
continued to monitor Resident R2 on
August 3 and August 4, 2017, after
Resident R2 had a change in condition
with a new onset of diarrhea and
vomiting on August 1, 2017, until the
resident was observed with vital signs
that were abnormal and needed to be
transferred to the hospital for emergency
care.

The facility failed to continue to assess


and monitor Resident R2 after
experiencing episodes of loose stools on
August 1, 2017, and after the last episode
of vomiting the morning of August 2,
2017, which resulted in actual harm to
Resident R2 developing abnormal vital
signs, requiring oxygen and
hospitalization with a diagnosis of
pneumonia (inflammatory condition of
the lung), hypotension (low blood
pressure), sepsis (infection of the blood
stream) and acute renal failure.

42 CFR 483.24 Provide Care/Services for


Highest Well Being
Previously cited 03/20/17
28 Pa. Code 201.14(a) Responsibility of
licensee
Previously cited 03/20/17

28 Pa. Code 201.18(b)(1) Management


Previously cited 03/20/17, 06/14/16,
04/15/16

28 Pa. Code 201.18(b)(3) Management


Previously cited 03/20/17

28 Pa. Code 201.18(e)(1) Management


Previously cited 03/20/17, 04/15/16

28 Pa. Code 211.5(f) Clinical records


Previously cited 03/20/17, 04/15/16

28 Pa. Code 211.5(g) Clinical records

28 Pa. Code 211.12(c) Nursing services


Previously cited 04/15/16

28 Pa. Code 211.12(d)(1)(3) Nursing


services
Previously cited 03/20/17, 04/15/16

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


services
Previously cited 03/20/17, 06/14/16
483.10(g)(14) REQUIREMENT
NOTIFY OF CHANGES
(INJURY/DECLINE/ROOM, ETC):

(g)(14) Notification of Changes.

(i) A facility must immediately inform the resident; consult with the residents
physician; and notify, consistent with his or her authority, the resident
representative(s) when there is-

(A) An accident involving the resident which results in injury and has the potential
for requiring physician intervention;

(B) A significant change in the residents physical, mental, or psychosocial status


(that is, a deterioration in health, mental, or psychosocial status in either life-
threatening conditions or clinical complications);

(C) A need to alter treatment significantly (that is, a need to discontinue an existing
form of treatment due to adverse consequences, or to commence a new form of
treatment); or

(D) A decision to transfer or discharge the resident from the facility as specified in
483.15(c)(1)(ii).

(ii) When making notification under paragraph (g)(14)(i) of this section, the facility
must ensure that all pertinent information specified in 483.15(c)(2) is available and
provided upon request to the physician.

(iii) The facility must also promptly notify the resident and the resident
representative, if any, when there is-

(A) A change in room or roommate assignment as specified in 483.10(e)(6); or

(B) A change in resident rights under Federal or State law or regulations as specified
in paragraph (e)(10) of this section.

(iv) The facility must record and periodically update the address (mailing and email)
and phone number of the resident representative(s).
Observations: Plan of Correction - To be completed:
11/08/2017
Based on clinical record review and staff
interview, it was determined the facility With respect to residents cited:
failed to notify the physician of a R1, residents chart cannot be altered.
resident's change in condition for one of With respect to how facility will identify
three residents reviewed (Resident R1). potential residents at risk:
An audit of all residents' daily notes will
Findings include: be reviewed, at clinical meeting, for
requests for follow up notification to the
Review of Resident R1's diagnosis sheet doctor.
revealed diagnoses that included Benign All Professional Nursing Staff will be in-
Prostatic Hyperplasia (BPH- a serviced in regards to all requests from the
noncancerous increase in size of the doctor for follow up will be documented
prostate) and urine retention (inability to via facilities updated "doctor notification"
completely empty the bladder). policy. Physician will continue to be
notified as per existing policy and updates
Review of Resident R1's August 2017 regarding resident clinical condition will
physician's orders revealed an order for a be provided as necessary.
Foley catheter (a flexible tube that is The DON or designee will audit weekly to
passed through the urethra and into the ensure doctors are notified. All finding
bladder to drain urine) to be changed from the audits will be reviewed at
every six months or as needed. Quality of Care meeting until 100 %
compliance is achieved x three months
Review of Resident R1's progress notes then a monthly audit will be conducted for
revealed a nursing entry on September 4, continued compliance x 3 months.
2017, at 3:35 p.m. that stated, "CNA The Quality Assurance committee meets
(Certified Nursing Assistant) reported to at least quarterly and is composed of
nurse of blood noted in resident's Foley NHA, DON, Unit manager, Social
catheter. Resident assessed and observed Services, Dietician, Medical Director,
with minimum bloody drainage in Foley Plant mgmt. The QA Committee will
catheter. Foley catheter changed and review the audits quarterly.
reinserted as per PRN (as needed)
Doctors orders; blood clot noted from
catheter during catheter change. On call
doctor notified; recommends continuous
observation and that she be notified
before end of evening shift if urine does
not clear."

Further review of the progress notes


revealed a nursing entry on September 4,
2017, at 11:05 p.m. that stated, "Resident
with hematuria (blood in the urine).
Foley Cath was changed 7-3." There was
no documented evidence that the
physician was notified about the blood in
the resident's urine as it was requested by
the physician on September 4, 2017, at
3:35 p.m.

Interview with the Director of Nursing on


September 13, 2017, at 1:00 p.m.
confirmed that there was no documented
evidence that the physician was notified
of Resident R1's continuing hematuria.

28 Pa. Code 201.14(a) Responsibility of


licensee
Previously cited 03/20/17

28 Pa. Code 201.18(b)(1) Management


Previously cited 03/20/17, 06/14/16,
04/15/16

28 Pa. Code 201.18(b)(3) Management


Previously cited 03/20/17

28 Pa. Code 201.18(e)(1) Management


Previously cited 03/20/17, 04/15/16

28 Pa. Code 211.5(f) Clinical records


Previously cited 03/20/17, 04/15/16

28 Pa. Code 211.5(g) Clinical records

28 Pa. Code 211.12(d)(1)(3) Nursing


services
Previously cited 03/20/17, 04/15/16

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


services
Previously cited 03/20/17, 06/14/16

Back to County Map

Home : Press Releases : Administration


Health Planning and Assessment : Office of the Secretary
Health Promotion and Disease Prevention : Quality Assurance

Copyright 2001 Commonwealth of Pennsylvania. All Rights Reserved.


Commonwealth of PA Privacy Statement