SCRANTON, PA - A July 2024 inspection at Marywood Heights nursing home on Adams Avenue revealed significant violations related to medication management, behavioral health services, and resident care documentation that put vulnerable residents at risk.
Psychiatric Care Denied Due to Transportation Issues
The most concerning violation involved a resident with major depressive disorder who was denied essential mental health services. Resident 27 had been experiencing daily episodes of persistent yelling that were difficult to redirect - a clear indication of untreated psychiatric symptoms requiring professional intervention.
The facility had scheduled a crucial psychiatrist appointment for May 28, 2024, but canceled the appointment because they could not provide transportation for the resident. As of the July 25 inspection date, nearly two months later, this critical appointment had not been rescheduled, leaving the resident without proper psychiatric care.
This failure represents a fundamental breach of care standards. Residents with behavioral health needs require consistent psychiatric follow-up to manage symptoms, adjust medications, and prevent deterioration. When nursing homes fail to ensure access to these services, residents can experience worsening depression, increased agitation, and declining quality of life. The daily yelling episodes documented in this case suggest the resident's mental health condition was inadequately managed.
Dangerous Medication Oversight Failures
Inspectors uncovered serious problems with medication management that could have resulted in harmful drug interactions or overdoses. A resident receiving treatment for anxiety and depression was prescribed three separate anti-anxiety medications simultaneously: Remeron, Ativan, and Buspar. This combination created unnecessary duplication of effects and increased the risk of serious side effects.
The facility's consultant pharmacist identified this dangerous pattern and made three separate recommendations between January and June 2024 to reduce or discontinue some of these medications. The pharmacist specifically noted that gradual dose reduction must be attempted annually for psychotropic drugs unless clinically contraindicated, and requested documentation if the physician believed the risks of reduction outweighed the benefits.
The facility failed to provide any evidence that the attending physician responded to any of these pharmacy recommendations. This breakdown in the medication review process is particularly dangerous for elderly residents, who are more susceptible to adverse drug reactions and falls from over-sedation.
Unnecessary Antibiotic Treatment Without Clinical Justification
In another medication-related violation, Marywood Heights administered a 10-day course of the antibiotic Keflex to a resident without proper clinical justification. The resident had been sent to the emergency room after a fall and dizziness, where they received a diagnosis of "possible urinary tract infection" and a prescription for antibiotics.
However, the hospital never completed the necessary urine culture and sensitivity testing to confirm the infection. When facility staff called the hospital three days later, they learned that no culture had been performed - only a basic urinalysis. Despite this lack of diagnostic confirmation and the absence of any documented UTI symptoms, the facility continued administering the antibiotic for the full 10-day course.
Unnecessary antibiotic use contributes to the growing problem of antibiotic resistance and can cause serious side effects in elderly residents, including digestive problems, secondary infections, and allergic reactions. Proper infection control protocols require confirmed bacterial infections before initiating antibiotic therapy.
Expired Medications Found on Active Medication Carts
During the inspection, surveyors discovered expired insulin medications on an active medication cart that should have been removed and discarded. Two multidose insulin vials - Lantus and Admelog - were found with expiration dates of July 17, 2024, eight days past their safe use period.
Expired insulin can lose its effectiveness, leading to unpredictable blood sugar control in diabetic residents. This puts residents at risk for both dangerous high blood sugar episodes and potentially life-threatening low blood sugar reactions if the medication's potency has diminished unpredictably.
Critical Documentation Failures Compromise Care Quality
The inspection revealed systemic problems with maintaining accurate and complete medical records, a violation that affected three residents. Proper documentation is essential for coordinating care, tracking treatment outcomes, and ensuring continuity when staff changes occur.
In one case, a resident attended both an in-person psychology appointment and a telehealth visit, but no documentation of either visit was found in the medical record. During an interview, the resident expressed frustration that "the facility did not provide an electronic device to conduct the visit and his daughter had to scramble to get my son to bring in a device."
Another resident's medical record was missing critical hospital documentation from an emergency room visit that resulted in antibiotic treatment. The missing records prevented proper evaluation of whether the treatment was appropriate.
These documentation failures violate professional nursing standards that require accurate, timely recording of all care provided. Without complete records, healthcare providers cannot make informed decisions about ongoing treatment needs.
Industry Standards and Required Protocols
Federal and state regulations require nursing homes to provide necessary behavioral health services, maintain proper medication management protocols, and keep accurate medical records. Facilities must ensure residents can access required medical appointments, even if this means arranging appropriate transportation or telehealth alternatives.
Medication management protocols require pharmacist reviews, physician responses to identified problems, and proper storage and disposal of expired drugs. The Joint Commission and Centers for Disease Control emphasize that antibiotic use must be based on confirmed infections to prevent resistance and adverse effects.
Documentation standards established by the American Nurses Association require real-time recording of all assessments, treatments, communications, and care outcomes to support informed decision-making and care continuity.
Additional Issues Identified
The inspection also found that the facility failed to offer routine dental services to a Medicaid resident as required, and identified infection control problems including improper storage of irrigation equipment used for catheter care.
These violations collectively demonstrate systemic problems with care coordination, medication safety, and quality assurance processes that are fundamental to nursing home operations and resident safety.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Marywood Heights from 2024-07-25 including all violations, facility responses, and corrective action plans.
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