Gardens at Orangeville, the

Inspectors wroteBased on a review of clinical records, facility policy, facility-provided investigative documentation, and staff interviews, it was determined the facility failed to protect one of 23 residents reviewed (Resident 110) from neglect by failing to ensure staff implemented the resident's individualized care plan requiring the assistance of two staff members for transfers resulting in actual harm in the form of a fracture of the right distal tibia and fibula (the two bones of the lower leg located between the knee and ankle) that required hospital evaluation and treatment. This deficient practice is cited as past noncompliance.

Inspectors wroteBased on observations, a review of clinical records, physician orders, select facility policies, and staff interviews, it was determined that the facility failed to provide the necessary care and services to maintain residents' highest practicable physical well-being by failing to consistently implement physician-ordered treatments and care planned interventions to maintain skin integrity for two of 23 sampled residents (Residents 15 and 27).

Inspectors wroteBased on a review of clinical records, the Long-Term Care Facility Resident Assessment Instrument (RAI) User's Manual, select facility policy, resident interviews, and staff interviews, it was determined that the facility failed to consistently implement physician-ordered restorative nursing services in accordance with residents' physician orders and care plans to maintain or improve mobility for three of 23 residents reviewed (Residents 85, 15, and 64).

Inspectors wroteBased on a review of clinical records, select facility policy, and staff interviews, it was determined that the facility failed to implement, evaluate, and revise behavioral health interventions in response to persistent and escalating behavioral symptoms for one of 23 sampled residents reviewed for behavioral health services (Resident 63).

Inspectors wroteBased on a review of clinical records, select facility policy, observations, and staff interviews, it was determined that the facility failed to implement physician-ordered Enhanced Barrier Precautions and failed to maintain appropriate infection prevention and control practices for one resident (Resident 109) with an indwelling urinary Foley catheter out of 23 residents reviewed.

Inspectors wroteBased on a review of clinical records, employee records, the facility assessment, facility policies and procedures, and staff interviews, it was determined the facility failed to develop, implement, and maintain an effective training program, based on the facility assessment, to ensure licensed nursing staff demonstrated the knowledge, skills, and documented competencies necessary to provide care for a resident with a peripherally inserted central catheter (PICC) line for one of 23 residents reviewed (Resident 6).

Inspectors wroteBased on a review of clinical records, select facility policy, and staff interviews, it was determined that the facility failed to failed to promptly notify the attending physician of a significant change in condition for one out of three closed records reviewed (Resident 107).

Inspectors wroteBased on a review of clinical records, the facility's Abuse Policy, documentation provided by the facility, observations, and staff and resident interviews, it was determined that the facility failed to conduct a thorough internal investigation after receiving an allegation of possible misappropriation of resident property for one of 23 residents reviewed (Resident 63).

Inspectors wroteBased on review of select facility policy, Resident Council meeting minutes, grievance logs, and resident and staff interviews, it was determined the facility failed to thoroughly investigate a grievance, ensure prompt, ongoing efforts to resolve a grievance, provide timely status updates regarding the grievance resolution progress, and closed the grievance as resolved without providing a written decision or follow-up to the residents while the residents continued to experience severe delays in care for three of seven residents reviewed (Residents 2, 3, and 4).

Inspectors wroteBased on observations and staff interviews, it was determined the facility failed to provide services to maintain a clean and homelike environment for two out of two nursing units (Units East and West).

Inspectors wroteBased on clinical record review, grievance form review, and staff interview, it was determined that the facility failed to timely inform and update an interested family member regarding changes in condition, ongoing assessments, and changes in treatment for one of nine residents reviewed (Resident 1).

Inspectors wroteBased on a review of clinical records, observations, and resident and staff interviews, it was determined the facility failed to provide services to maintain a clean and homelike environment for two out of two nursing units (West and East Units), including experiences reported by one out of twenty-two residents sampled (Resident 43).

Inspectors wroteBased on a review of scheduled activities and resident and staff interviews, it was determined the facility failed to provide an ongoing program of activities to meet the interests of and support the physical, mental, and psychosocial well-being of residents including experiences expressed by four out of five residents during a resident group interview (Residents 7, 8, 26, and 37).

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 food and nutrition services department and one of two resident pantry areas (West Nursing Unit).

Inspectors wroteBased on review of clinical records, resident fund account information, facility admission documents, and staff and resident interviews, it was determined that the facility failed to protect the resident's personal funds by imposing charges against a resident's personal needs allowance (PNA) for a service for which payment is made under Medicaid for one of 22 sampled residents (Resident 7).

Inspectors wroteBased on observation, a review of clinical records and staff interviews, it was determined that the facility failed to develop a person-centered care plan to address a resident's limited range of motion to the left upper extremity and non-compliance with a therapeutic device to maintain skin integrity and prevent worsening range of motion for one resident out of 22 sampled (Resident 44).

Inspectors wroteBased on a review of clinical records and staff interviews, it was determined the facility failed to provide nursing services consistent with professional standards of practice by failing to obtain physician orders and develop and implement a person-centered comprehensive care plan in accordance with standards of practice for one resident out of 22 sampled residents (Resident 15).

Inspectors wroteBased on observation, clinical record review, select policy review, and staff interviews, it was determined the facility failed to ensure enteral feeding syringes in use were labeled and dated, and failed to provide direction on the maximum time such syringes may remain in service, to prevent contamination and other complications, for one resident receiving enteral nutrition out of 22 residents sampled (Resident 40).

Inspectors wroteBased on a review of select facility policy, observation, and staff interview, it was determined the facility failed to maintain respiratory equipment in a manner to promote optimal functioning for one resident out of 22 sampled residents. (Resident 9).

Inspectors wroteBased on observations and resident and staff interviews, it was determined the facility failed to provide services to maintain a clean and homelike environment for one out of two nursing units (West Unit), including issues reported by two of seven sampled residents (Residents 5 and 6) and one resident representative (Resident 2's representative).

Inspectors wroteBased on review of clinical records and staff interviews it was determined that the facility failed to provide nursing services consistent with professional standards of quality to ensure that licensed nurses properly evaluated and provided nursing care according to physician orders for one resident (Resident A1) out of 8 residents reviewed. According to the Pennsylvania Code, Title 49, Professional and Vocational Standards, State Board of Nursing, 21.11 (a)(1)(2)(4) indicates that the registered nurse was to collect complete ongoing data to determine nursing care needs, analyze the health status of individuals and compare the data with the norm when determining nursing care needs, and carry out nursing care actions that promote, maintain, and restore the well-being of individuals. [...]

Inspectors wroteBased on staff interview, a review of personnel files and employee credentials, it was determined the facility failed to ensure the full-time director of food and nutrition services, who was not a qualified dietitian or other clinically qualified nutrition professional, received frequently scheduled consultations from a qualified dietitian or other clinically qualified nutritional professional.

Inspectors wroteBased on a review of clinical records 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 one resident out of the 19 residents sampled (Resident 42) and experiences reported by four out of the five residents during a resident group interview (Residents 4, 15, 36, and 52).

Inspectors wroteBased on observations and resident and staff interviews, it was determined the facility failed to provide services to maintain a clean and homelike environment for two out of three nursing units (100 and 200 Halls).

Inspectors wroteBased on a review of clinical records and the Resident Assessment Instrument (RAI) and staff interview, it was determined the facility failed to ensure 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 19 sampled (Residents 53 and 70).

Inspectors wroteBased on a review of clinical records, select facility investigative reports, and staff interviews, it was determined the facility failed to implement effective safety measures to prevent an injury during transfer for one out of the 19 sampled residents (Resident 43).

Inspectors wroteBased on review of clinical records, select facility policy, and staff interview it was determined the facility failed to ensure that physician ordered intravenous (giving medication or fluid through a needle or tube inserted into a vein) antibiotics were administered as prescribed for two residents out of two sampled (Residents CR1 and 122).

Inspectors wroteBased on a review of clinical records and staff interview, it was determined the attending physician failed to act upon pharmacist identified irregularities in the medication regimen of one of 19 residents sampled (Resident 22).

Inspectors wroteBased on review of clinical records and staff interviews it was determined that the facility failed to provide nursing services consistent with professional standards of quality to ensure that licensed nurses properly evaluated and provided nursing care for one resident (Resident 1) out of 5 residents reviewed. According to the Pennsylvania Code, Title 49, Professional and Vocational Standards, State Board of Nursing, 21.11 (a)(1)(2)(4) indicates that the registered nurse was to collect complete ongoing data to determine nursing care needs, analyze the health status of individuals and compare the data with the norm when determining nursing care needs, and carry out nursing care actions that promote, maintain, and restore the well-being of individuals. [...]

Inspectors wroteBased on clinical record review and staff interview, it was determined that the facility failed to provide adequate supervision to monitor one resident's whereabouts and activities to prevent access to potential accident hazards for one of eight sampled residents. (Resident A1)

Inspectors wroteBased on observations, a review of facility's planned menus and concerns/grievances lodged with the facility and resident and staff interviews it was determined that the facility failed to plan menus that accommodate residents' food preferences, to the extent possible, to increase resident satisfaction with meals for residents which included four residents of 15 residents reviewed (Resident B2, B3, B4, and B5).

Inspectors wroteBased on clinical record review and staff interviews, it was determined that the facility failed to afford a resident the right to participate in the resident's treatment and health care decision making, including the right to refuse specific treatment, for one resident out of 15 reviewed. (Resident B1)

Inspectors wroteBased on a review of grievances lodged with the facility, observations and staff and resident interview, it was determined that the facility failed to provide housekeeping services to maintain a clean and orderly environment for residents, including Residents B2 and B3.

Inspectors wroteBased on a review of clinical records and the Resident Assessment Instrument and staff interview, 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 one resident out of 13 sampled (Resident 62).

Inspectors wroteBased on observation and staff interview it was determined that the facility failed to maintain an environment free of potential accident hazards and obstacles to safe mobility, assistance devices, on one of three nursing units (200 hall).