Lock Haven Rehabilitation And Senior Living

transfer to the emergency department, and unfortunately while they were enroute the resident was

alert for a patient in cardiac arrest) was called as the patient was a known do not resuscitate/do not

There was no evidence the PA or the resident's physician was made aware Resident CR1's nausea and vomiting had actually started as documented late on [DATE] into the early morning hours of [DATE], as the PA referenced in the note as symptoms started on [DATE], per staff, or that the either was aware the resident had loose stools identified in bowel records also beginning [DATE], and significantly decreased intakes of meals due to nausea and vomiting beginning [DATE], not one day before on [DATE].

The PA's note did not reflect being made aware of the resident's significant decrease in blood pressure as it was obtained on [DATE], in the morning at 8:49 AM as the PA's note reflected the resident's blood pressure from the day before ([DATE]) in normal range in the visit on [DATE].

The PA did not reference being made aware of any low blood pressure until the later encounter with the registered nurse on [DATE], as noted above when the resident rapidly declined in the afternoon.

Facility staff were not able to provide any evidence to the surveyor to indicate Resident CR1's providers were made aware the resident's change in condition began late on [DATE], greater than 24 hours prior, and not [DATE], as indicated in provider reports.

Additional diagnostics were not ordered until [DATE], after the PA visited the resident.

There was no evidence of any follow up to the resident's condition on [DATE], as emesis was noted in the very early morning hours, the resident had loose stools documented, and the resident's meal intakes reflected significant decline for the day with refusal of dinner, until emesis was documented on [DATE].

Resident CR1 expired on [DATE], at 2:20 PM prior to any of the ordered diagnostic testing being completed.

The above information was reviewed with the Nursing Home Administrator and Director of Nursing on [DATE], at 3:45 PM.

Cross Refer F-F578 483.25 Quality of Care Previously cited deficiency [DATE] 28 Pa.

Code 211.12(d)(1)(3)(5) Nursing services

395616 01/09/2025

Lock Haven Rehabilitation and Senior Living 22 Cree Drive Lock Haven, PA 17745

January 9, 2025, at 3:45 PM. 28 Pa.

Code 211.9(a)(1)(k) Pharmacy services 28 Pa.

Code 211.10(c) Resident care policies 28 Pa.

Code 211.12 (d)(1)(3) Nursing services

Review of Resident CR1's medication administration record for January 2024, revealed Resident CR1's evening dose of routine insulin glargine noted above for January 3, 2025, was identified as not administered.

A corresponding medication administration record note dated January 3, 2025, at 8:26 PM noted the insulin was not administered as it was unavailable.

Review of Resident CR1's vital sign blood sugar check on January 3, 2025, at 8:23 PM revealed the resident's blood sugar was documented as 227 milligrams (mg)/deciliter (dL), which was flagged as a high level as it exceeded 99 mg/dL in the vital check system.

In an interview with the Director of Nursing on January 9, 2025, at 1:22 PM it was revealed the insulin glargine was marked unavailable due to not arriving from the pharmacy in time for administration.

There was no evidence any facility staff contacted Resident CR1's physician regarding not being able to administer the resident's evening dose of insulin due to unavailability on January 3, 2025, and the resident's blood sugar level was high at 227 mg/dL.

There was no evidence the resident received any alternative to the missed dose of the insulin glargine.

A nursing note dated January 4, 2025, at 4:59 AM (the next morning) noted the resident's blood sugar level had significantly increased and was 449 mg/dL and the on-call physician was notified and ordered a one-time dose of rapid/fast acting insulin to be administered to the resident. A recheck of the resident's blood sugar level at 7:46 AM was decreased to 95 mg/dL.

Clinical record review for Resident 2 revealed a physician's order dated September 11, 2024, for the resident to have a lidocaine external patch (pain reliever) applied to the right hip topically daily in the morning for pain.

395616

Form Approved OMB

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.

Building 395616 B.

Wing 01/09/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Lock Haven Rehabilitation and Senior Living 22 Cree Drive Lock Haven, PA 17745

Review of Resident CR1's closed clinical record revealed a nursing note dated [DATE], at 8:25 PM noting the resident had complaints of nausea and not feeling well. A nursing note followed dated [DATE], at 2:38 AM noting no further emesis, and a clear liquid tray was ordered for breakfast.

There was no further documentation identified between the notes identified above between the evening of [DATE], through the night to [DATE], regarding the number of times emesis occurred or any other details.

A review of meal intakes for Resident CR1 for [DATE], revealed the resident was documented as only consuming ,d+[DATE] percent of breakfast and lunch and had refused dinner on that day.

Review of meal intakes for the resident prior to [DATE], back to [DATE], revealed the resident had normally consumed at least 51% of meals and mostly ,d+[DATE] percent of meals.

Resident CR1's meal intakes for [DATE], breakfast continued to be low for the resident at ,d+[DATE] percent, with lunch slightly better at ,d+[DATE] percent and dinner ,d+[DATE] percent.

Resident CR1 was also documented on his bowel record of having a loose/diarrhea bowel movement on the evening of [DATE].

The resident was documented as having normal stools almost daily for several days leading up to [DATE].

There were no further nursing notes for Resident CR1 for [DATE], reflecting the decrease in meal intakes, whether his nausea had subsided, if there was any further emesis during the day of [DATE], or that the resident had a loose/diarrhea bowel movement since nausea and vomiting has been recently documented.

The next nursing note for the resident was dated [DATE], at 2:13 PM, which noted the resident had emesis twice during the shift with coffee ground appearance, very foul odor, and the resident complaining overall of not feeling well. It was noted the registered nurse supervisor was notified and observed the emesis, and the resident would be monitored for increased emesis and vital sign changes.

A late entry note documented by the registered nurse on [DATE], at 9:54 AM for [DATE], at 2:51 PM noted the resident was having multiple emesis during the shift, it was liquid brown in color, there was no concern for gastrointestinal (GI) bleeding, and the emesis had no coffee brown texture noted upon assessment.

The note indicated GI illness was circulating around the building and the resident's provider was aware with Zofran (an anti-nausea medication) ordered and fluids encouraged.

395616

Form Approved OMB

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.

Building 395616 B.

Wing 01/09/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Lock Haven Rehabilitation and Senior Living 22 Cree Drive Lock Haven, PA 17745