Homewood Living Williamsport

Inspectors wroteBased on observation and interview, it was determined that the facility failed to treat residents with respect and dignity, as evidenced by the failure to knock and request permission before entering a resident's room. This was evident for 1 (Resident #68) of 1 resident reviewed for dignity.

Inspectors wroteBased on record review, observations, and interviews, it was determined that the facility failed to ensure that call devices were kept within residents' reach. This was evident in 1 (Resident #9) of 24 residents reviewed in the initial pool of the survey.

Inspectors wroteBased on record review, observation, and interview, it was determined that the facility failed to ensure residents' grievances were identified, investigated, documented, and responded to. This was evident during the annual recertification survey when reviewing the facility resident council.

Inspectors wroteBased on review of Resident Council meeting minutes, grievance logs, facility policy, and staff interviews, the facility interfered with residents' right to file grievances by failing to maintain and implement a functional grievance process. This was evident during the annual recertification survey.

Inspectors wroteBased on record review and interviews, it was determined that the facility failed to provide activities to residents based on their comprehensive assessment to support the physical, mental, and psychosocial well-being. This was evident for 1 (Resident #3) of 3 residents reviewed for activities.

Inspectors wroteBased on observations, record reviews, and interviews, it was determined that the facility failed to follow an attending physician's order to administer oxygen to a resident. This was evident in 1 (Resident #94) of 1 resident reviewed for Respiratory Care during the survey.

Inspectors wroteBased on record reviews and interviews, it was determined that the facility failed to ensure pain management was provided to the resident based on professional standards of practice. This was evident for 1 (Resident #3) of 5 residents reviewed for unnecessary medications.

Inspectors wroteBased on interviews, observations, and record reviews, it was determined that the facility failed to develop and implement infection prevention and control policies and procedures, as evidenced by staff not wearing appropriate personal protective equipment (PPE) before providing direct care to residents. This was evident in 2 (Resident #13 and #12) of 4 residents reviewed for pressure ulcers.

Inspectors wroteBased on medical record review, administrative record review, and staff interview; it was determined that the facility failed to protect a cognitively impaired resident (resident #900) from physical abuse from a facility staff member. This was evident for 1 of 5 residents reviewed during a complaint survey. After the incident, the facility implemented effective and thorough corrective measures. The facility's plan and action were verified during this survey; therefore, this deficiency will be cited as past noncompliance. The date of correction is 2/20/23 The following terms are defined for comprehension of the investigative

Inspectors wroteBased on medical record review, administrative record review, policy review and staff interview; the facility failed to protect vulnerable residents (resident #901 & #174) from a significant medication error. This was evident for 2 of 30 residents reviewed during the survey. This deficient practice resulted in harm to resident # 901 who had a fall incident (accident) with major injury.

Inspectors wroteBased on record review, staff interview, and policy review, the facility's administration failed to implement its Resident Immunization policy related to current Centers for Disease Control (CDC) recommendations to provide residents the opportunity to receive the Prevnar (Pneumococcal conjugate vaccine (PCV) 20) or the PCV15. Eight out of eight residents ((R) 14, R21, R10, R32, R35, R2, R19, and R36) reviewed for immunizations were not offered pneumococcal vaccinations in compliance with CDC recommendations, the facility had never had PCV20 available, and the facility failed to identify the potential for deficient practice in quality assurance. These failures had the potential to increase the risk of residents contracting pneumonia.

Inspectors wroteBased on interviews, review of the facility documentation, and policy review, the Quality Assessment (QA) committee failed to identify quality deficiencies related to the facility's infection control program and take corrective action to ensure that Prevnar (PCV) 20 was offered and provided in accordance with recognized national standards. This failure had the potential to affect all residents who were eligible for the PVC20 vaccine who currently live in the facility.

Inspectors wroteBased on observation, interview, and review of facility policies, the facility failed to ensure protective equipment (PPE) was available for laundry staff in one of one laundry rooms while sorting soiled resident clothing and bed linens. This had the potential to infect the staff and/or residents with pathogens which could potentially lead to the development of infectious diseases.

Inspectors wroteBased on interview, record review, review of the Centers for Disease Control and Prevention (CDC) guidelines, and facility policy review, the facility failed to offer eight of eight residents (Resident (R) R14, R21, R10, R32, R35, R2, R19, and R36) reviewed for immunizations and/or their representatives the opportunity for the resident to be vaccinated in accordance with nationally recognized standards out of a current facility census of 69. This practice had the potential to increase the risk for the residents to contract pneumonia. (Cross Reference F835 and F867)

Inspectors wroteBased on record review, interview, and policy review, the facility failed to ensure five staff (Geriatric Nursing Assistant (GNA) 4, GNA5, and GNA6); (Licensed Practical Nurse (LPN) 9) and (Registered Nurse (RN) 3) of five random nursing staff reviewed for staffing were trained in the facility's Quality Assurance Performance Improvement (QAPI) Program.

Inspectors wroteBased on interview, record review, and Resident Assessment Instrument (RAI) Manual review, the facility failed to follow the RAI's transmission requirements, which indicate that within 14 days after a facility completes a resident's assessment a facility must electronically transmit encoded, accurate, and complete ''Minimum Data Set (MDS) data to the Center for Medicare & Medicaid Services (CMS) System, for one (Resident (R) 25) of one supplemental residents reviewed for Resident Assessment. Specifically, it had been over 120 days since the discharge ''MDS'' was completed and the ''MDS'' had not been transmitted to the CMS System.

Inspectors wroteBased on interview, record review, and policy review, the facility failed to provide education for two staff members to possess the competencies and skill sets necessary to ensure residents were free of medication errors for two of four residents (Resident (R) 174 and R15) reviewed for medications in a total sample of 26 residents. These failures resulted in the residents receiving the wrong dose of medications.

Inspectors wroteBased on record review and interview with staff it was determined the facility staff failed to ensure each residents drug regimen was free from unnecessary drugs. This was evident for 1 (#21) of 3 residents reviewed for unnecessary psychotropic drugs.

Inspectors wroteBased on observation, interview, record review, and review of facility policy, the facility failed to ensure a medication error rate below five percent. During medication administration two medication errors for two residents (Residents (R) 15 and R65) were made of 39 opportunities resulting in a medication error rate of 5.13 percent. These failures had the potential to increase or decrease the effectiveness of these medications.

Inspectors wroteBased on medical record review, administrative record review, and staff interview; the facility failed to protect a vulnerable resident (resident #901) from a fall with major injury when facility nursing staff failed to delete an incorrect order for sleep medication (Ambien) from the resident ' s medical record. This was evident for 1 of 4 residents reviewed during a complaint survey.

Inspectors wroteBased on medical record review, administrative record review, and staff interview; the facility failed to maintain an accurate resident (resident #901) medication order history. This was evident for 1 of 4 residents reviewed during a complaint survey.

Inspectors wroteBased on medical record review, administrative record review, and staff interview; the facility failed to ensure a resident's medication regimen was free from unnecessary PRN (as needed) medications (resident #901). This was evident for 1 of 4 residents reviewed during a complaint survey.

Inspectors wroteBased on medical record review, administrative record review, and staff interview; the facility failed to maintain an accurate resident (resident #901) medication order history. This was evident for 1 of 4 residents reviewed during a complaint survey.

Inspectors wroteBased on facility report review, medical record review, and staff interview, it was determined that the facility staff failed to ensure that safety interventions were followed and that the physician was provided sufficient notification regarding a recent fall with injury This is evident for 1 (#272) of 2 residents reviewed for provision of quality of care. These failures resulted in a finding of actual harm for Resident #272.

Inspectors wroteBased on medical record review, facility report review, and staff interview, it was determined that the facility failed to ensure the resident's right to be free of misappropriation of property. This was evident for 1 (#271) of 2 residents reviewed for abuse.

Inspectors wroteBased on record review, facility report review, and staff interview, it was determined that the facility staff failed to recognize and report an alleged misappropriation of property to Administration immediately. This was evident for 1(#271) of 2 investigated for abuse.

Inspectors wroteBased on record review and staff interview, it was determined that the facility failed to put a plan in place to ensure facility staff identify incidents of misappropriation of residents' property and report allegations immediately with administration. This was evident for 1 (#271) of 2 residents reviewed for abuse.

Inspectors wroteBased on review of the resident's record and interview with staff, it was determined the facility staff failed to provide and document sufficient preparation and orientation to residents to ensure safe and orderly transfer. This was evident for 2 (#47, #40) of 5 residents reviewed for Hospitalization.

Inspectors wroteBased on review of the medical record and interview with staff, it was determined the facility failed to ensure that the residents' medical record contained complete and accurately documented information. This was evident for 1 (#26) of 4 residents reviewed for Abuse.

Inspectors wroteBased on review of the medical record and interview with facility staff, it was determined that the facility staff failed to ensure irregularities reported to the attending physician by the pharmacist were acted upon for 1 (#41) of 5 residents reviewed for Unnecessary Medication review.