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Based on review of facility policy, medical record review (MR) and interview with staff (EMP), it was determined that the facility failed to ensure that verbal orders were signed by a physician within 24 hours for six of 56 applicable medical records reviewed (MR44, MR47, MR49, MR50, MR51 and MR52).

Findings include:

Review on April 28, 2011, of the facility's "Rules and Regulations of The Medical, Dental, and Podiatric Staff of Muncy Valley Hospital," last reviewed December 2010, revealed "... II. Health Records A. General - Practitioners with the support of the health records staff shall be responsible for the preparation of a complete and legible health record for each patient. Its contents shall be pertinent and current. This record shall include, but not be limited to: identification data, chief complaint, personal history, family history, history of present illness, physical examination, special reports ... condition on discharge, discharge note, case summary, and autopsy report when performed. Each entry to the health record shall be dated and signed. For the purpose of authenticating health records, electronic signatures are acceptable. ... N. Verbal Orders All orders for treatment shall be in writing. A verbal order shall be considered to be in writing if dictated by a member of the Medical Staff or by a physician extender to a duly authorized person ... All orders dictated over the telephone shall be signed by the appropriately authorized person to whom dictated, with the name of the physician, and his or her name with the date and time documented. Medication verbal orders must be read back to the prescriber to ensure the order was clearly communicated. The responsible physician shall authenticate such orders by signing them at the next visit, which is to be within twenty-four (24) hours. ..."

Review on April 28, 2011, of MR44, MR47, MR49, MR50, MR51 and MR52, revealed multiple verbal orders for medications and treatments that were not cosigned by the physician within 24 hours.

Interview with EMP4 at 1:00 on April 28, 2011, confirmed that MR44, MR47, MR49, MR50, MR51, and MR52 contained multiple verbal orders for medications and treatments that were not cosigned by the physician within 24 hours.

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Based on review of facility documents, medical records (MR) and interview with staff (EMP), it was determined that the facility failed to ensure that patient records were completed within 30 days following discharge for five of 67 applicable medical records reviewed (MR74, MR75, MR76, MR77, and MR78).

Findings include:

Review on April 26, 2011, of the facility's "Rules and Regulations of The Medical, Dental, and Podiatric Staff of Muncy Valley Hospital," last reviewed December 2010, revealed "... II. Health Records ... K. Delinquency - Records not completed within two (2) weeks of discharge shall be considered delinquent. Physicians who have been delinquent for a given health records for a period of one (1) week shall be deemed to have voluntarily relinquished elective admitting privileges including scheduled admissions. Continuance of delinquency for a given health record for a period of two (2) weeks shall result in the voluntary relinquishment of all admitting and other related privileges ... Each week, physicians with responsibility for medical record completion will receive written communication form the Health Records Department communicating any delinquency and also the date which will result in a limitation of privileges ... a list of all incomplete charts, deficient reports ... and deficiency type ... After (30) days of suspension of admitting and other related privileges, Medical Staff membership shall be terminated unless otherwise determined by the Medical Executive Committee. ..."

Review on April 26, 2011, of facility document "Current Delinquency Detail Report Muncy Valley," dated April 26, 2011, revealed MR74 was not completed 31 days from discharge; MR75 was not completed 95 days from discharge; MR76 was not completed 93 days from discharge; MR77 was not completed 65 days from discharge; and MR78 was not completed 33 days from discharge. The physicians responsible for two of these delinquent records received weekly notices of their delinquencies and the date of suspension of privileges from the Health Records Department.

Interview with EMP15, at 1:00 PM on April 26, 2011, confirmed that MR74, MR75, MR76, MR77, and MR78 were not completed within 30 days of discharge.

Based on review of facility policies, medical records (MR) and interview with staff (EMP), it was determined that the facility failed to perform a history and physical examination within twenty-four hours of admission as per facility policy for four of 55 applicable medical records reviewed (MR44, MR48, MR50 and MR55).

Findings include:

Review on April 28, 2011, of the facility's "Rules and Regulations of The Medical, Dental, and Podiatric Staff of Muncy Valley Hospital," last reviewed December 2010, revealed "... II. Health Records A. General - Practitioners with the support of the health records staff shall be responsible for the preparation of a complete and legible health record for each patient. Its contents shall be pertinent and current. This record shall include, but not be limited to: identification data, chief complaint, personal history, family history, history of present illness, physical examination, special reports ... condition on discharge, discharge note, case summary, and autopsy report when performed. Each entry to the health record shall be dated and signed. For the purpose of authenticating health records, electronic signatures are acceptable. ... B. History & Physical - A complete admission history and physical examination shall be recorded within twenty-four (24) hours of admission by the attending physician or designated alternate such as covering physician or credentialed Allied Health Professional. The report shall include all pertinent findings resulting from an assessment of the systems of the body. If a complete history has been recorded and a physical examination performed or thoroughly updated within thirty (30) days prior to the patient's admission to the Hospital, a copy of these may be used in lieu of the admission history and physical examination if accompanied by an admission interval note. At the time of admission, a note indicating the reason for admission and immediate diagnostic or therapeutic plans shall be documented. The health record must contain the pertinent history and physical exam information prior to the performance of any scheduled procedure. ..."

Review on April 28, 2011, of MR44, MR48, MR50 and MR55 revealed that a complete admission history and physical examination, or an update to a previous history and physical, were not recorded in the medical records within twenty-four (24) hours of admission.

Interview with EMP4, at 1:00 PM on April 28, 2011, confirmed that MR44, MR48, MR50 and MR55 did not have a complete admission history and physical examination within twenty-four (24) hours of admission.

Based on review of facility documents, medical records (MR), and staff interview (EMP), it was determined that the facility failed to have a designated activity program for the swing bed resident, and the facility failed to provide an ongoing program of activities to meet the needs of 18 of 18 swing bed medical records reviewed (MR12, MR57, MR58, MR59, MR60, MR61, MR62, MR63, MR64, MR65, MR66, MR67, MR68, MR69, MR70, MR71, MR72 and MR73).

Findings include:

1) Review on April 29, 2011, of the facility's "Manager Resident Activities/Assistant Nursing Home Administrator" job description, last reviewed October 27, 2009, revealed "... Major Tasks, Duties and Responsibilities ... Oversees the activity and TR [Therapeutic Recreation] programs on the SNU [Skilled Nursing Unit], Swing Bed ... units. ..."

Review on April 29, 2011, of the facility's "Activity Calendar" for February, March and April 2011 revealed that the calendar was labeled Muncy Valley Hospital Skilled Nursing Unit. Further review of the activity calendars revealed all activities were scheduled on the skilled nursing units. There was no documentation that any activity on the calendars were scheduled specifically for the swing bed resident or that the calendar reflected activities for the swing bed program.

Interview with EMP3, on April 29, 2011, at approximately 10:00 AM revealed the activity calendar was specifically for the hospital based skilled nursing unit. EMP3 confirmed there was no separate activity calendar for the facility's swing bed program. EMP3 also confirmed the swing bed residents may go to the facility's skilled nursing unit for activities, and there was an activity cart available for the residents in the facility's swing bed program.

2) Review on April 29, 2011, of the facility's "MVH Swing Bed Initial Recreation Assessment Form," no review date, revealed information that the facility used to obtain information from the resident through interview questions of current and past activity interests. These activities included: "Cards, games, arts/crafts, exercise, sports, music, reading/writing, spiritual activities, shopping, walking, watching TV, gardening, talking, helping others, parties, special events, animals, cooking, watching movies, hobbies and other activities. The resident's previous occupation was asked and where the resident preferred the activity setting: In Room, Out of Room. The form also included resident preferences of individual/1:1 Activities, group activities, both Individual/1:1 and group activities and an interview summary of an individualized activity program ..."

Review on April 29, 2011, of MR12, MR58, MR59, MR60, MR61, MR62, MR63, MR66, MR67, MR68, MR69, MR70, MR71, MR72 and MR73 revealed that the facility completed an initial recreation assessment following admission to the swing bed program.

Review of MR12, MR58, MR59, MR60, MR61, MR62, MR63, MR66, MR67, MR68, MR69, MR70, MR71, MR72 and MR73 on April 29, 2011, revealed the facility assessed their current and past activity interests which included: cards, games, arts/crafts, exercise, sports, music, reading and writing, spiritual and religious activities, trips/shopping, walking and wheeling outdoors, watching TV, gardening and planting, talking/conversing, helping others/volunteering, parties/socials, special events and entertainment, animals, cooking, watching movies and hobbies. The facility documented that MR12, MR58, MR59, MR60, MR61, MR62, MR63, MR66, MR67, MR68, MR69, MR70, MR71, MR72 and MR73 all preferred in room activities, individual one on one activities, that their leisure interests and preferences were identified and that they would have multidisciplinary supportive visits at least once a week.

Continued review of MR12, MR58, MR59, MR60, MR61, MR62, MR63, MR66, MR67, MR68, MR69, MR70, MR71, MR72 and MR73 revealed no documentation that the facility individualized their activity programs, that the facility met their activity interests, leisure interests and preferences, that the facility provided supportive visits once a week, or that these patients attended and/or participated in swing bed program activities.

Interview with MR59 and MR61, on April 29, 2011, at approximately 11:30 AM, confirmed that the facility did not provide them with activities of their interests and that the facility did not offer any activities to MR59 and MR61 during their stay in the swing bed program.

Interview with EMP3, on April 29, 2011, at approximately 11:45 AM, revealed that the swing bed residents can go to the facility's skilled nursing unit for activities and that there was an activity cart available for swing bed program residents who are looking for something to do.

Interview with EMP3 and EMP4, on April 29, 2011, at approximately 11:50 AM, confirmed that the facility completed initial recreation assessments on MR12, MR58, MR59, MR60, MR61, MR62, MR63, MR66, MR67, MR68, MR69, MR70, MR71, MR72 and MR73 following admission to the swing bed program. EMP3 and EMP4 confirmed that the facility documented that these patients all preferred in room activities, individual one on one activities, that their leisure interests and preferences were identified, and that they would have multidisciplinary supportive visits at least once a week. Further interview with EMP3 and EMP4 confirmed that the facility did not individualized the patients' activity programs, that the facility did not met their activity interests, leisure interests and preferences, that the facility did not provide supportive visits once a week, and that these patients did not participate in any swing bed program activities.

3) Review on April 29, 2011, of MR57, MR64 and MR65 revealed that these patients were admitted to swing bed status. Further review of MR57, MR64 and MR65 revealed no documentation that the facility completed an initial recreation assessment. There was no documentation that the facility met with MR57, MR64 and MR65 to identify any activity interests, leisure interests, or activity preferences.

Interview with EMP3, on April 29, 2011, at approximately 11:55 AM, confirmed that MR57, MR64 and MR65 were admitted to swing bed status, that the facility did not complete an initial recreation assessment, and there was no documentation in MR57, MR64 and MR65 indicating activity interests, leisure interests or activity preferences.

Based on review of facility documentation, medical records (MR) and interview with staff (EMP), it was determined that the facility failed to ensure routine and 24-hour emergency dental care was available for 18 of 18 swing bed program medical records reviewed (MR12, MR57, MR58, MR59, MR60, MR61, MR62, MR63, MR64, MR65, MR66, MR67, MR68, MR69, MR70, MR71, MR72 and MR73).

Findings include:

Review on April 29, 2011, of the facility's "Policy and Procedure" manual for swing bed program revealed no swing bed program policy or procedure for providing routine and 24-hour emergency dental care services to swing bed residents.

Review on April 29, 2011, of MR12, MR57, MR58, MR59, MR60, MR61, MR62, MR63, MR64, MR65, MR66, MR67, MR68, MR69, MR70, MR71, MR72 and MR73 revealed no documentation of routine dental care since admission or documentation that the patients refused dental care.

Interview with EMP3 and EMP4, on April 29, 2011, at approximately 12:00 PM, confirmed that MR12, MR57, MR58, MR59, MR60, MR61, MR62, MR63, MR64, MR65, MR66, MR67, MR68, MR69, MR70, MR71, MR72 and MR73 did not contain documentation of routine dental care since admission or documentation that the patients refused dental care. Further interview with EMP3 confirmed that the facility did not have a policy or procedure to provide routine and 24-hour emergency dental care for residents in the swing bed program.