pennsylvania OFFICE 0= LONG-TERM LIVING 06/15/2012 Brandi Williard Administrator The Hill at Whitemarsh 4000 Fox Hound Drive Lafayette Hill, PA 19444 RE: The Hill at Whitemarsh License # 460110 - Regular Dear Ms. Williard: As a result of the Office of Long Term Living's Licensing Inspection on 04/24/2012, two areas of non-compliance were identified. Your Plan of Correction has been approved. During the next on-site inspection, the licensing representative will ensure that the Plan of Correction was implemented accordingly. We have found the above named residence to be in compliance with 55 PA Code Chapter 2800 (relating to Assisted Living Residences). Therefore, your Regular License remains in.effect. Thank you for your efforts to provide Assisted Living Residential services. If you have any questions, please contact the Division of Licensing at (717) 772-2570. Sincerely, Kevin Longenecker Director Bureau of Provider Support I Division of Licensing 1555 Walnut Street, 5 th FI. I Harrisburg, PA 17101 1717.772.2570 I www.ltlinpa.pa.qov
OFFICE OF LONG TERM LIVING PRINTED: 05/11/2012 FORM APPROVED STATEMENT OF DEFICIENCIES (XI)PROVIDER LICENSE NUMBER: (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION COMPLETED A. BUILDING 460110 B. WING _ 04/24/2012 NAME OF PROVIDER OR SUPPLIER The Hill at Whitemarsh STREET ADDRESS, CITY, STATE, ZIP CODE 4000 FOX HOUND DRIVE LAFAYETTE IDLL, PA 19444 (X4)ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5) PREFIX (EACH DEFICIENCY MUST BE PRECEEDED BY FULL REGULATORY OR PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE TAG LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) DATE If team member E returns to the Facility all trainings will be comp eted by AL Administrator, Manager, ot' A three-month state licensure visit was conducted on April 24, 2012. It was determined that The Hills at Nursing Home Administrator. Al Whitemarsh was not in compliance with the following required training will be completed requirements of 55 Pa Code, Chapter 2800, Assisted by July 1 2012 Living Residences: 2 000 Initial Comments 2 000 A chart audit for remaining staff providing direct care has been completed as of 5/9/2012 and this tool will Direct care staff persons may not provide unsupervised be used going forward to ensure all new assisted living services until completion of 18 hours of hires providing direct care since sl art of training in the following areas: (1) Training that includes a demonstration ofjob duties, AL license are in compliance wid followed by supervised practice. regulation 2800.65 and 2800.69 (2) Successful completion and passing the 21900 65(g) Staff/direct care staff training/orientation 21900 Department-approved direct care training course and passing of the competency test. All Directors and Managers have Ibeen (3) Initial direct care staff person training to include the trained on education training regulation following: \ and have been provided the audit ILOOl. (i) Safe management techniques. Every Manager and/or Director will be (ii) Assisting with ADLs and IADLs. (iii) Personal hygiene. (iv) Care of residents with mental illness, neurological responsible for ensuring their tearll meets the required training per rebulation impairments, mental retardation and other mental 2800.65 and 2800.69 disabilities. (v) The normal aging-cognitive, psychological and functional abilities of individuals who are older. (vi) Implementation ofthe initial assessment, annual assessment and support plan. (vii) Nutrition, food handling and sanitation. (viii) Recreation, socialization, community resources, social services and activities in the community. (ix) Gerontology. (x) Staff person supervision, if applicable. (xi) Care and needs of residents with special emphasis All core competency trainings ha~e been scheduled and will be completed y July 1 2012, an audit tool has bee generate< and shared with all Management/ irector teams to monitor their teams atter dance to core competency in-servicing. AUTHORIZED PROVIDER REPRESENTATIVE'S SIGNATURE TITLE (X6)D ATE <::
OFFICE OF LONG TERM LIVING PRINTED: 05/11/2012 FORM APPROVED STATEMENT OF DEFICIENCIES (XI)PROVIDER LICENSE NUMBER: (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION COMPLETED A. BUILDING B. WING _ 460110 04/24/2012 NAME OF PROVIDER OR SUPPLIER The Hill at Whitemarsh STREET ADDRESS, CITY, STATE, ZIP CODE 4000 FOX HOUND DRIVE LAFAVETTE IDLL, PA 19444 (X4)ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5) PREFIX (EACH DEFICIENCY MUST BE PRECEEDED BY FULL REGULATORY OR PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE TAG LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) DATE 21900 Continued From page 1 21900 on the residents being served in the residence. (xii) Safety management and hazard prevention. (xiii) Universal precautions. (xiv) The requirements ofthis chapter. (xv) The signs and symptoms of infections and infection control. (xvi) Care for individuals with mobility needs, such as prevention of decubitus ulcers, incontinence, malnutrition and dehydration, if applicable to the residents served in the residence. (xvii) Behavioral management techniques. (xviii) Understanding ofthe resident I s assessment and how to implement the resident I s support plan. (xix) Person-centered care and aging in place. This STANDARD is not met as evidenced by: Upon review of staff records, it was discovered Direct care staff person B, hired on 10/24/11, has not yet received training in person -centered care, communication, problem solving and relationship skills, nutrition support according to resident preference and Dementia specific training. Upon review of staff records it was also discovered that the training hours ofdirect care staffperson C, hired on 3/20/12, cannot not be determined although the staff person provides unsupervised direct care. Upon review ofstaff records it was discovered that Direct care staffe, hired on 5/25/11, did not have record of completing direct care training. 22090 69 Additional dementia-specific training 22090 Administrative staff, direct care staff persons, ancillary staff persons, substitute personnel and ATG6899 002Tll If continuation sheet 2 of 3
OFFICE OF LONG TERM LIVING STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (XI)PROVIDER LICENSE NUMBER: (X2) MULTIPLE CONSTRUCTION A. BUILDING PRINTED: 05/11/2012 FORM APPROVED (X3) DATE SURVEY COMPLETED 460110 B. WING _ 04/24/2012 NAME OF PROVIDER OR SUPPLIER The Hill at Whitemal'sh STREET ADDRESS, CITY, STATE, ZIP CODE 4000 FOX HOUND DRIVE LAFAYETTE IDLL, PA 19444 (X4)ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) ID PREFIX TAG PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) (X5) COMPLETE DATE 22090 Continued From page 2 volunteers shall receive at least 4 hours of dementia-specific training within 30 days ofhire and at least 2 hours of dementia-specific training annually thereafter in addition to the training requirements ofthis chapter. 22090 This STANDARD is not met as evidenced by: Upon review ofstaff records, it was discovered Direct care staff person B, hired on 10/24/11, has not yet received dementia specific training. ATG6899 002Tll If continuation sheet 3 of 3
Brandi Williard From: Susan McMenamin ~I Sent: Friday, May 11, 2012 1:16 PM To: Anita DeCaro; B.J. DeMelo; Brandi Williard; Briana Egan; Diane Jiles; Diane Kijak; Don Martin; Ed Birkmire; Frank Garrity; Judy McGruther; Kiesha Edwards; Nicole Bennett; Patrick Brooks; Peter Fleming; Peter von Mechow; Robert Levengood; Sarah Jolles; Sharon Budman; Sharon Javier; Stephanie Peter; Susan McMenamin; Susan Park Subject: Agenda Managers Meeting MAY 2012 Attachments: Agenda Managers Meeting MAY 2012.doc Happy Friday! Attached is the Agenda for Monday's meeting! See you then! Susan 1
J. McGruther I. Financial Update P. Fleming 1. Budget 2. Turnover 3. Movie Tickets II. Healthcare Update 1. CQI/Survey 2. Occupancy II. Marketing Update P. Von Mechow S. Jolles III. MOD Highlights F. Garrity IV. Safety Committee Highlights F. Garrity V.Microsoft Training R. Levengood P. vonmechow B. Williard Dragon Spirit Day -Junel S. McMenamin Amp up Your Impact with your Team Webinar S. McMenamin
The following employees have been identified as needing core competency training a copy of the training schedule has been provided to identify Activities: William Firman Michael McDevitt Dietary: Don Martin Chef Alyssa Catagnus Nadiyah Cooper Rachel Ginsburg Margaret Tucker Maintenance: Fran Giles All core competency training will be completed by July 1 2012
New Hire orientation audit. Direct Care Staff Name 1-9 Initial Date of Hire Direct Care Dementia Training All staff AL Orientation-all staff/volunteers 18 hours list dates and time Within 30 days of hire :t;~ ( rna "T' J"1..A J../J Jq Ittj'Z4- '-It 30 U 5/1 5)2.. J4J:J~,}j '1
Oakley Hall Assisted living Residence Record of Employee Orientation ~~~~~~~~~~~~~~~D~eclH~~ De pt. ---li.-+,,,,",,,,,,-~--ji,...!'-t-',,,=,,,""-"'-"----,,,=r-------- Position: LhiA ~-Iq-~I~ Shift: 200\ Status: FT PT PRN Fire Safety and Emergency Training (First day training) Required for all staff and volunteers: Date Subject Employee's Trainer's,Initials Initials Evacuation Procedures Staff duties-fire drills, emergency evacuation., transportation, and at emergency location Designated mtg. place Smoking safety & policies Location & use of fire extinguishers Smoke detectors and fire alarms Telephone & notification of emergency services 40 Hour Orientation Required for all staff and volunteers: Date. Subject Employee's Trainer's l':litic;lls r""\lnitial~ lj I) (t rl Resident rights (,C \!Y}.JU U Bj C( '1'1 Emergency medical plan c L ~LA') Y1ft It Mandatory reporting of abuse & neglect (OAPSA) <" L fk i A1 -I' {. Y t C Reportable incidents and conditions. '" ~J<1- J? '1 I l \C( 'l'l Safe Management Techniques L 'UJ~j J "-" Core competency: person-centered care; communication, y\ 1 4 1\1 problem-solving and relationship skills; nutrition support 1ijt0 / il '"'--'" Dementia Training 2 hours; ~ed for all staff and volunteers: Trained b~ W~ C3 Date: Ancillary Staff: Orientation to specific job duties 4' 2..& Jz.. Hours of Training: --Y-..;----- Trained by: _ Position; Date: _ Date employee assumed job duties: _ Direct Care Staff-must complete orientation items on pages 2 and 3 before providing unsupervised care~ Pagel 0/3 (all employees)
Oakley Hall Assisted Living Residence Record of Direct Care Qualifications and Training / Employee: \_) 0"-/ Date of Hire: _Lf--:...r~Il--+-.:...-J:=:2=- _ Dept. AL CJ Position: L_'_,_I'\_"_-A_ _ Shift: 3~ (l Status: ~ FT PT PRN ---- ---- s'...,~'~ J!tk,rJ, QuaIifications: High School Diploma GED V- Certified Nursing Assistant LPN RN Date certificates complete: O/I,/hyZst AifJ~CPR 1.t(1!ii 'Jr.-line training (DPW course) Date Subject Employee's Trainer's Hours In.itials Initials, Safe management techniques cj L ~_0, 1--1 /:JiJ120J'2. Assisting with ADLs and IADLs cjl.r 1-1 / 1f~ I"'U:J 17.~ Personal hygiene cj L (, I Care of residents with mental illness, neurological J Y/30/Z,:> 17." impairments, developmental disabilities 0 L \ Normal aging-cognitive, psychological & functional ( Lj I?"h/'7f)17-d abilities,.) l.. I II l?yb J"'lL)/i 'l.- and support plane ~ I ~J-.,~ '\ "-.j L \ Implementation of initial and annual assessment, Lj /1ieJ LO) '2 Nutrition, food handling and sanitation ~J!-f!l~i:. \ l JL. I,,. Recreation, socialization, community resource~' \\,~ )~ L (.~ 12/201 'L I social services, community \ si//2017 Gerontology \J ( -/ / I 5i I~/ 2017 Staff person supervision " 1./ \ I Si, J7-'>1 '7 Care & needs of residents 10 v ) I hi I '1 Q..D}') Safety management & hazard prevention :... ) L ( I \Sf I /1r))7 Universal Precautions J --" \ I c: }f. j?o j ') Chapter 2800 requirements { \ L ) J ~d Ii /?AJ? Signs & symptoms of infections & infection control. ~\./ I J ~I! ~\L C-l 1 /-'? /';17 Care for persons with mobility needs v ".. \ l (t::;/l,' ),?I'-"'} ') Behavior management \. lr \ I ' rr!j fj~..',~ Understanding assessments & how to implementj' J ( \ J <. 20/21-- support plans "'-., V ifl.-;oj 2J:> 17 Person-centered care & aging in place' ( )( J \ Total Hours (must =18) --- l ), f{ecord demonstratipn and supervised practice on page 3. l'.fi {CJ( r~l ~1 J ':ZJ~ {11 Lj 10 0 1/7. ~. 5{lJIl. f5(~2-iil Page 2 of3 (direct care staff)
Oakley Hall Assisted Living Residence Record of Direct Care Qualifications and Training Employee: ~l ~~ Date of Hire: 4_'_~_i_g_,_'-sZ"""-- Dept. Be A L C--~ Position: ----=--'--------------- Shift: 3 - II Status: /_. FT PT PRN Employee demonstrated job duties on these dates: Task demonstrated Trainer's Trainer's Comments Initials Employee completed supervised practice on these date(s): Date Task supervised Employee's Trainer's Trainer's Comments Initials Initials,-5J~ '~/j f\\r, ~l '. _~r> 0 j f)/, 1\ ;AO ~ ) ( -' 'C< \(l\[...~ 1O...lA. ) (~ ::5JCJ... r-!o. 0' -, L /'>....\.-, ~,n=>. (1:2i r-r ) 'Cs \r: \( CC1QA A ) 6).2-0/\r~c C'- 3(x~ C,)/"~'" ~~ l~ \r~ \r~\1 ~d..l.a ). l) \ Supervisor's statement: The above employee completed initial orientation and training on,t:)!( ) 1/2.. I S' /l/./z The employee began providing unsupervised care on: Su pervisor's signature: _1'...;;;..:j_~~..~2;:...)~("..l;;U:::l_i...1'~'(... ~,l",l "...:.-~\~.;;::::;L;;;::~;...\.::::L.b::..::: :~::;;;,..\:.:.::.'=...:o:e.a,:::,:;::;::.;;~~-.~-;~-) '-~ _ Attach copy of employee's schedule during orientation that identifies who provided supervision prior to employee's completion of orientation requirements. Page 3 of3 (direct care staff)
DATE of INSERVICE: l+. l.c.o. I L TOTAL TIME il Hours OF TRAINING PRESENTATION: -- 'I Minutes TOPIC: Uv~di0\\\o;"-u,~ s, i... Lt PRINT NAME SIGNATURE POSITION (
Direct Care Staff Training: CERTIFICATE Page 1 of 1 Certificate of Completion Direct Care Staff Training Course and Competency Test Joy Lowery 4/26/2012 ce838f7d7fc546a2b5ba2205bfdd81f7 This certificate certifies that the above named individual has successfuuy colllpleted the Department~approvedpersonal care home dire'ct care training course and conlpetency test in accordance with 55 Pa.Code 2600.65(d)(2). http://services.dpw.state.pa.us/pch_comptest/certificate.aspx 4/26/2012