Lehigh Valley Hospital Tsu

Penalty

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to assess a resident's capability to self-administer medication for one sampled resident, identified in the report as Resident 48. The facility policy stated that self-administration of medications could occur only under direct observation by licensed staff for residents determined to be fully alert, oriented, and able to follow instructions, and that nursing staff were to instruct the patient in proper medication use and document the education in the interdisciplinary teaching record. Resident 48 had diagnoses including a recent left femur fracture from a fall that was surgically repaired, chronic pain, and difficulty walking. A physician ordered lidocaine 4% pain patches to be applied daily to the resident's left lower extremity and left in place for 12 hours. The medication was refused one morning because the resident wanted to shower, and later that day surveyors observed an open, unused lidocaine patch on the resident's bedside table, dated and initialed by the RN assigned to the resident for day shift. There was no documentation that the facility assessed the resident for the ability to self-administer the lidocaine patch, and the medication was not secured. The DON confirmed that the resident was not assessed to self-administer the medication and that it should not have been left on the bedside table.

Penalty

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to maintain safe hot water temperatures in the Transitional Skilled Unit (TSU), resulting in water temperatures at resident hand sinks and shower rooms significantly exceeding the allowable range of 95 to 110 degrees Fahrenheit as specified by facility policy and state regulations. Observations revealed hot water temperatures ranging from 122.5 to 134.2 degrees Fahrenheit in multiple resident rooms. The thermostatic mixing valves, which are responsible for regulating water temperature, were also found to be set between 120 and 130 degrees Fahrenheit, above the required maximum. Facility documentation showed that water temperature logs for March and April were not completed, indicating a lack of ongoing monitoring. Multiple residents reported that the hot water from their hand sinks was too hot, and several stated they were able to independently use the sinks. Staff interviews confirmed that the hot water temperatures in the shower rooms had been too high for several weeks to two months, and that there were no thermometers available to check water temperature prior to providing showers. The occupational therapist also confirmed the absence of thermometers in resident shower rooms, further indicating a lack of proper monitoring and safeguards. The combination of unmonitored and excessively high water temperatures, lack of temperature checks before resident use, and absence of documentation or corrective action placed residents at risk for serious injury from thermal burns. These findings led to the determination of Immediate Jeopardy to resident safety on the TSU, as the facility failed to ensure that hot water temperatures were maintained within safe limits.

Removal Plan

• The facility identified that a bypass valve was left in the open position which prevented the hot and cold water from mixing. The valve was closed and high temperatures were reset. A lockout tag was installed on the bypass valve to prevent the bypass valve from being placed in the open position.
• The water temperatures were rechecked after the bypass valve was closed and temperatures were noted to be 106 degrees F.
• The facility checked the sink water temperature in all resident rooms and shower rooms on the TSU after a lockout tag was placed on the bypass valve. All temperatures were noted to be below the 110-degree F threshold. There were no additional high temperatures identified.
• A policy for the TSU was to be developed to address water temperature safety and monitoring.
• Employees were educated on the water temperature policy, including acceptable hot water temperature ranges, appropriate methods to check hot water temperatures, and measures to take if temperatures were outside acceptable parameters. All staff were to be educated.
• Water temperatures will be checked using a thermometer that is accessible and available on the unit prior to assisting a resident in the shower.
• Facilities Management or designee will conduct random audits of a minimum of ten sinks daily for four weeks. Water temperatures will be recorded.
• Facilities Management or designee will complete a log with visual inspection of the lockout tags being in place.
• The logs (temperature and visual inspection) will be audited by the Nursing Home Administrator or designee. The team will review the findings with the Quality Assurance Performance Improvement Committee for recommendations.
• Facilities Management will educate maintenance staff on temperature monitoring required for random water temperature audits and on documentation of temperatures.
• Staff will be re-educated on temperature monitoring required for showers by the Nursing Home Administrator or designee and documented on a sign-in sheet.
• If the water feels or measures out of range, engineering will be contacted for immediate correction.
• The Medical Director was updated on the Correction and Removal-Abatement Plan, as well as occurrences of which this plan pertains. Monitoring will be initiated and completed by the Administrator and/or designee as indicated above.