Emmanuel Center for Nursing

Inspectors wroteBased on a review of clinical records, facility policies, facility-provided investigative documentation, and staff interviews, it was determined the facility failed to protect one of five residents reviewed (Resident 5) from abuse and neglect by not implementing the individualized care plan intervention requiring two staff members for bed mobility assistance, resulting in actual harm in the form of a spiral fracture of the distal left femur. This deficiency is cited as past noncompliance.

Inspectors wroteBased on observations, staff interviews, review of clinical records, and the census of the designated Hospice Specialty Unit, it was determined the facility failed to ensure sufficient and appropriately deployed nursing staff to consistently provide timely quality of care, supervision, and services necessary to meet the physical and mental well-being of 10 residents receiving hospice services.

Inspectors wroteBased on observation and staff interview, it was determined the facility failed to maintain acceptable practices for the storage and service of food to prevent the potential for contamination and microbial growth in food, which increased the risk of food-borne illness in the dietary department and in the 100-Hall and 200-Hall medication room refrigerators.

Inspectors wroteBased on a review of clinical records, resident council meeting minutes, and resident and staff interviews, it was determined the facility failed to provide care in a manner that promotes each resident's quality of life by failing to respond timely to residents' requests for assistance, including experiences reported by two residents out of the 20 residents sampled (Residents 19 and 21) and experiences reported by five out of the six residents during a resident group interview (Residents 5, 12, 19, 21, and 42).

Inspectors wroteBased on review of clinical records and select facility policy, observations and staff interview, it was determined the facility failed to provide meal service in an environment that maintains each resident's dignity for three residents out of 6 sampled (Residents 26, 44, and 58), and failed to provide medication in a manner that respected the resident's dignity for one resident out of 20 sampled (Resident 31).

Inspectors wroteBased on a review of clinical records, observation, and resident and staff interviews, it was determined the facility failed to provide nursing services consistent with professional standards of practice by failing to thoroughly assess, obtain physician orders, and develop and implement a person-centered comprehensive care plan in accordance with standards of practice, for two residents out of 20 sampled residents (Residents 41 and 43).

Inspectors wroteBased on a review of clinical records, select facility policy, and staff interview, it was determined the facility failed to provide appropriate treatment and services to restore normal bladder function for one out of 20 residents sampled (Resident 21).

Inspectors wroteBased on review of clinical records and select facility policy, observation, and staff interview it was determined the facility failed to consistently provide respiratory care and supplemental oxygen, as ordered by the physician for one resident out of 20 sampled. (Resident 2) Additionally, the facility failed to store respiratory equipment in a sanitary manner for one resident out of three sampled receiving oxygen therapy (Resident 41).

Inspectors wroteBased on a review of clinical records and staff interviews, it was determined the facility failed to ensure a resident's drug regimen was free of unnecessary antibiotic drugs for one out of 20 residents sampled (Resident 19).

Inspectors wroteBased on the review of clinical records and staff interviews it was determined the facility failed to demonstrate coordination of services in the development of the comprehensive plan of care between the facility and a Hospice agency for two residents out of three sampled residents receiving hospice care (Resident 34 and 47).

Inspectors wroteBased on observation and staff interview it was determined the facility failed to ensure that staff followed proper infection control techniques while passing medications to one of three residents (Residents 38) on the 200 Hall nursing unit.

Inspectors wroteBased on a review of clinical records and staff interview it was determined the facility failed to provide residents or their representatives with written information of the facility's bed hold policy upon transfer to the hospital of one resident out of 20 residents sampled (Resident 10).

Inspectors wroteBased on observation and staff interview, it was determined that the facility failed to maintain acceptable practices for the storage and service of food to prevent the potential for contamination and microbial growth in food, which increased the risk of food-borne illness in the food and nutrition services department and one of two resident pantries.

Inspectors wroteBased on a review of clinical records, observation, and resident and staff interviews, it was determined that the facility failed to provide care in a manner respectful of each resident's dignity for one resident (Resident 1), and failed to provide care in a manner and environment that promotes each resident's quality of life by failing to respond timely to residents' request for assistance as reported by two residents out of 11 sampled (Residents 12 and 11).

Inspectors wroteBased on review of select facility policy and minutes from Resident Council meetings and resident and staff interviews it was determined that the facility failed to put forth sufficient efforts to promptly resolve continued resident complaints/grievances expressed during Resident Council Meetings including those voiced by five of five residents attending a resident group meeting (Residents 29, 46, 26, 49, and 16)

Inspectors wroteBased on a review of the facility's abuse prohibition policy and employee personnel files and staff interviews, it was determined that the facility failed to implement their established procedures for screening four of five employees for employment (Employee 1, 2, 3, and 4)

Inspectors wroteBased on review of clinical records and resident incident/accident reports, and staff interviews, it was determined that the facility failed to provide necessary staff supervision to monitor a resident's whereabouts to prevent an elopement from the facility for two residents (Resident 25 and 73) out of 18 reviewed.

Inspectors wroteBased on a review of clinical records and pharmacy recommendations and staff interview it was determined that the pharmacist failed to identify irregularities in the drug regimen of one resident (Resident 57) out of 18 residents reviewed.

Inspectors wroteBased on review clinical records and staff interviews, it was determined that the facility failed to ensure that a resident was free from unnecessary psychoactive medications by failing to attempt a gradual dose reduction, failing to ensure the presence of documented clinical rationale for the continued use of psychotropic medication and failing to monitor for potential adverse consequences of psychoactive drug use for two residents of 18 residents reviewed. (Resident 57 and 51)

Inspectors wroteBased on observations, test tray results, resident and staff interviews, and test tray results it was determined that the facility failed to serve meals at safe and palatable temperatures.

Inspectors wroteBased on review of select facility policy and the minutes from Residents' Council meetings, and resident and staff interviews, it was determined that the facility failed to routinely offer bedtime snacks to residents as desired.

Inspectors wroteBased on a review of clinical records, select facility policy, CDC and Pennsylvania Department of Health guidelines, observations, and staff interview it was determined that the facility failed to follow infection control practices designed to deter spread of RSV (Respiratory Syncytial Virus) infections in the facility.

Inspectors wroteBased on a review of clinical records, select facility incident reports, and the facility's abuse prohibition policy and staff interview it was determined that the facility failed to thoroughly investigate injuries of unknown origin to rule out abuse, neglect, or mistreatment as a potential cause of the injury sustained by one resident out of 18 sampled (Resident 19).

Inspectors wroteBased on a review of clinical records and staff interview, it was determined that the facility failed to develop person-centered comprehensive care plans to meet the current needs and problems of three out of 18 residents sampled (Residents 33, 64, and 22).

Inspectors wroteBased on review of select facility policies and clinical records it was determined that the facility failed to provide nursing services consistent with professional standards of quality by failing to demonstrate that licensed nurses evaluated and recorded the provision of necessary nursing care for a change in condition for one resident out of 18 sampled residents (Resident 39).

Inspectors wroteBased on resident interviews, clinical records, and staff interview, it was determined that the facility failed to timely provide prescribed respiratory care for one resident reviewed for one of 18 residents reviewed (Resident 49).

Inspectors wroteBased on observations, clinical record review and staff interviews, it was determined that the facility failed to ensure each resident received the necessary behavioral health care in a timely manner to attain or maintain the highest practicable mental and psychosocial well-being for one of 18 residents sampled (Resident 25).

Inspectors wroteBased on a review of clinical records and staff interview, it was determined that the facility failed to develop and implement an individualized person-centered plan to address a resident's dementia-related behavioral symptoms for one out of 18 residents reviewed (Resident 57).

Inspectors wroteBased on a review of clinical records and staff interviews it was determined that the facility failed to ensure that one resident's drug regimen was free of unnecessary antibiotic drugs for one out of 18 residents sampled (Resident 64).

Inspectors wroteBased on clinical record review and staff interview, it was determined that the facility failed to ensure that the necessary resident information was communicated to the receiving health care provider for four residents out of 18 residents sampled (Residents 10, 29, 39, and 3).

Inspectors wroteBased on clinical record review and staff interview, it was determined that the facility failed to send copies of the written notices of facility initiated transfers to a representative of the Office of the State Long Term-Care Ombudsman for three out of 18 residents sampled (Resident 10, 29 and 39).

Inspectors wroteBased on residents and staff interviews it was determined that the facility failed to provide care in an environment, which promotes each resident's quality of life by failing to respond timely to residents' request for assistance as reported by seven residents out of seven interviewed (Residents 24, 28, 32, 42, 43, 47, and 66).

Inspectors wroteBased on staff interview and a review of employee personnel records it was determined that the facility failed to ensure the qualified part-time professional activities director responsibilities included directing the development, implementation, supervision and ongoing evaluation of the activities program, which includes the completion and/or directing/delegating the completion of the activities component of the comprehensive assessment; and contributing to and/or directing/delegating the contribution to the comprehensive care plan goals and approaches that are individualized to match the skills, abilities, and interests/preferences of each resident.

Inspectors wroteBased on clinical record review, and staff interview, it was determined that the facility failed to provide restorative nursing services planned to maintain the functional abilities of two of seven sampled residents (Residents 34 and 43).

Inspectors wroteBased on a review of clinical records and select facility policy, resident and staff interview, it was determined that the facility failed to consistently attempt non-pharmacological interventions to alleviate pain prior to the administration of a narcotic pain medication prescribed on an as needed basis (PRN), failed to effectively manage a resident's consistent and repeated use of an opioid pain medication prescribed as needed (PRN), and had failed to administer pain medication as prescribed by the physician, for one resident out of four reviewed (Resident 23).

Inspectors wroteBased on observation, review of nurse staffing, the minutes from Resident Council Meetings and clinical records, observations and staff and resident interviews it was determined that the facility failed to provide and/or efficiently deploy sufficient nursing staff to consistently provide timely and quality of care to residents, including timely provision of assistance from the dining room back to the residents rooms and monitoring during meal service in the main dining room and timely response to requests for assistance to maintain resident safety and promote the physical and psychosocial well-being of residents, including Residents 24, 28, 43, 47, 66, 42 and 32.

Inspectors wroteBased on review of clinical records and staff interview, it was determined that the facility failed to offer routine annual dental services for four Medicaid payor sources out of 17 residents sampled (Residents 29, 33, 34 and 42).

Inspectors wroteBased on a review of clinical records and the Resident Assessment Instrument and staff interviews, it was determined that the facility failed to ensure that the Minimum Data Set Assessments (MDS - a federally mandated standardized assessment conducted at specific intervals to plan resident care) accurately reflected the status of two residents out of 17 sampled (Resident 29 and 42).

Inspectors wroteBased on clinical record review and staff interview, it was determined that the facility failed to complete a discharge summary, which included a recapitulation of the resident's stay, the course of illness, corresponding treatment, discharge instructions, and post-discharge care plan for one of three closed records reviewed (Resident 64).

Inspectors wroteBased on a review of clinical records and select facility policy and staff interview it was determined that the facility failed to implement planned fall prevention interventions and effective safety measures, including necessary staff supervision of two residents identified at risk for falls with known unsafe behaviors, to prevent falls with serious injuries, femur/hip fractures, for two residents out of four sampled (Resident 215 and Resident 19).

Inspectors wroteBased on a review of clinical records and staff interview, it was determined that the facility failed to develop and implement an individualized person-centered plan to address a resident's dementia-related behavioral symptoms for one out of 17 residents reviewed (Resident 48).

Inspectors wroteBased on observation, a review of clinical records and select facility policy and staff interview, it was determined that the facility failed to implement procedures to ensure acceptable storage and use by dates for multi-dose medications on one of two medication carts observed (B hall - 100's) and acceptable labeling of IV solutions for one of four residents reviewed (Resident 26).

Inspectors wroteBased on review of clinical records and staff interview, it was determined that the facility failed to timely offer and/or provide the pneumococcal immunization to one of 17 residents reviewed (Resident 32).