Manatawny Center for Rehabilitation and Nursing

Inspectors wroteBased on observation, and staff interview, it was determined that the facility failed to maintain the confidentiality of residents' medical information on one of three nursing units (Unit A Medication Cart).

Inspectors wroteBased on observations, and staff interviews it was determined that the facility failed to properly secure medications in two of two medication carts located in nursing unit A.

Inspectors wroteBased upon policy review and observation, it was determined that the facility failed to ensure infection control practices related to transmission-based precautions were implemented on one of four nursing units.

Inspectors wroteBased on clinical record reviews, observations, and staff interviews, it was determined that the facility failed to provide dignity for the use of an indwelling urinary catheter for one of 32 residents reviewed (Resident 80).

Inspectors wroteBased on clinical records review, and staff interviews, it was determined that the facility failed to implement the comprehensive care plan intervention to prevent alteration in nutrition and/or hydration for one of eight residents reviewed (Resident 89).

Inspectors wroteBased on review of clinical records, medication regimen review, and staff interview, it was determined the facility failed to ensure the physician's medication order was followed for one of the eight residents reviewed (Resident 86).

Inspectors wroteBased on facility policy review, clinical record review, and staff interview, it was determined that the facility failed to ensure proper monitoring of fluid restrictions for two of eight residents reviewed for nutrition/hydration needs (Resident 3 and Resident 9).

Inspectors wroteBased on clinical record review, and staff interview, it was determined that the facility failed to ensure that necessary treatments were provided for two of five residents with a pressure ulcer (Residents 71 and 177).

Inspectors wroteBased on observations and staff interviews, it was determined that the facility failed to provide a safe and homelike environment for one of the four units observed (Milestone Unit).

Inspectors wroteBased on review of clinical records and staff interview, it was determined that the facility failed to develop a comprehensive care plan for two of 25 residents reviewed (Residents 22 and 108).

Inspectors wroteBased upon clinical record review, it was determined the facility failed to revise a care plan to reflect changes in nutrition for a resident with weight loss for one of 25 residents reviewed (Resident 84).

Inspectors wroteBased on clinical record review and staff interview it was determined the facility failed to develop baseline care plans for two of 24 residents reviewed. (Resident 182 and 183) Findings Include: Review of Resident 182's clinical record revealed the resident was admitted to the facility on [DATE]. Review of Resident 182's Nursing admission screener, dated February 2, 2024 revealed the resident should have had a basic care plan for Activities of Daily living, Allergies, Communication, Discharge planning, falls, neurological, oral/nutrition, skin, sleep pattern, and smoking cessation. Review of Resident 182's care plan revealed the only care plan initiated in the 48 hours after admission was a nutrition care plan. All other care plans were initiated between February 5th and February 12, 2024. [...]

Inspectors wroteBased on clinical record review and staff interview it was determined the facility failed to provide care and services for pressure ulcer for one of six residents reviewed. (Resident 21) Findings Include: Review of Resident 21's admission Nursing Assessment, dated January 16, 2024 revealed there was a stage 1 pressure ulcer (intact reddened skin), measuring 3 centimeter (cm), 1cm wide and 1cm deep on the coccyx (small triangular bone at the base of the spinal column). Review of Resident 21's physician orders on admission revealed there was no order for wound care to this wound. Review of Resident 21's wound consult note, dated January 24, 2024 revealed the resident had a stage 3 pressure ulcer (extend through the skin into deeper tissue and fat but do not reach muscle, tendon, or bone) measuring 2cm long, 1cm wide, and 0.2cm deep. [...]

Inspectors wroteBased on observations, review of clinical records and facility documentation, and interviews with residents and staff, it was determined that the facility failed to provide proper continence care for one of one resident reviewed (Resident 70).

Inspectors wroteBased on review of facility policy, clinical record review, and staff interview, it was determined that the facility failed to adequately monitor and address weight loss in a timely manner for two of four residents reviewed for nutrition (Residents 105 and 112).

Inspectors wroteBased on clinical record review and staff interview it was determined that the facility failed to ensure that the pharmacy provided medications timely for one of two residents reviewed (Resident 80) and failed to provide record of disposition of a controlled drug for one of three closed records reviewed (Resident 130).

Inspectors wroteBased on clinical record review and staff interview it was determined the facility failed to obtain laboratory services as ordered for one of 24 residents reviewed. (Resident 21) Findings Include: Review of Resident 21's physician orders revealed an order dated January 25, 2024 for a PT/INR (blood test to determined how fast blood clots) every Thursday for monitoring Coumadin (blood thinner). Review of the clinical record revealed there was no PT/INR drawn on Thursday February 8, 2024. Interview with the Director of Nursing on February 14, 2023 at 11:30 a.m. confirmed resident 21 did not have a PT/INR drawn on Thursday February 8th, 2024 as ordered. 28 Pa. Code 211.12(c)(d) (1)(3)(5) Nursing services

Inspectors wroteBased on clinical record review and staff interview it was determined the facility failed to report results of laboratory studies to the physician for one of 24 residents reviewed. (Resident 21) Findings Include: Review of Resident 21's progress notes revealed a nursing entry dated January 23, 2024 at 9:43 p.m. stating INR 5.5 (lab resulting indicating how long it takes for blood to clot) new order obtained to hold warfarin (blood thinner) dose and recheck on January 25, 2024. Review of Resident 21's labs revealed a PT/INR was drawn on January 25th 2024 and the results were reported to the facility on the same day. Review of Resident 21's clinical record revealed the results of the PT/INR drawn on January 25, 2024 were not reported to the physician until January 29, 2024. Interview with the Director of Nursing on February 14, 2023 at 11:30 p.m. [...]

Inspectors wroteBased on clinical record, facility policy and procedure, hospital record reviews and staff interview, it was determined the facility failed to monitor and assess a pressure ulcer present upon readmission causing actual harm to Resident 1 when the wound deteriorated and became infected causing septic shock for one of three residents reviewed. (Resident 1) Findings Include: Review of facility policy and procedure titled Prevention of Pressure Ulcer/Injuries, revised July 2017, revealed conduct a comprehensive skin assessment upon admission, including skin integrity- any evidence of existing or developing pressure ulcers or injuries. Skin assessments should be done weekly by a licensed nurse. Inspect the skin on a daily basis when performing or assisting with personal care or ADLs. Review of Resident 1's clinical progress notes revealed nursing entry dated August 17, 2023 at 7:15 p.m. [...]