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Inspection visit

Health inspection

BUCKINGHAM VALLEY REHABILITATION AND NURSINGCENTERCMS #3951881 citation on this visit
1 citation recorded

Inspector’s narrative

What the inspector wrote

This survey cited 1 deficiency. The full statement and the facility’s plan of correction follow, verbatim from the federal record.

395188 03/01/2024 Buckingham Valley Rehabilitation and Nursingcenter 820 Durham Road Buckingham, PA 18912
F 0759 Ensure medication error rates are not 5 percent or greater. Level of Harm - Minimal harm or potential for actual harm Based on facility policy review, clinical record review, observation, and staff interview, it was determined that the facility failed to maintain a medication error rate less than five percent on one of three nursing units. (West Unit) Residents Affected - Few Findings include: A review of the facility policy entitled, Medication Administration, last reviewed January 30, 2024, revealed that staff were to administer medications as ordered by the physician. Medications were to be administered 60 minutes prior to or after the scheduled times unless otherwise specified by the physician. Clinical record review revealed that Resident 1 had diagnoses that included stroke, hypertension (HTN), and arthritic pain. A review of physician's orders dated January 5, 2024, and February 8, 2024, revealed that staff were to administer the following medications at 8:00 a.m. daily: tramadol (a pain medication) 50 mg, and metoprolol (a blood pressure medication) 25 mg. Observation of the medication pass on March 1, 2024, revealed that licensed practical nurse (LPN) 1 administered Resident 1's medications at 9:40 a.m. Clinical record review revealed that Resident 2 had diagnoses that included gastroesophageal reflux disease (GERD), anxiety, seizures, and diabetes. A review of physician's orders dated January 8, 2023, March 14, 2023, June 16, 2023, December 11, 2023, and January 10, 2024, revealed that staff were to administer the following medications at 8:00 a.m. daily: lamotrigine (an anticonvulsant medication) 150 mg, levetiracetam (an anticonvulsant medication) 500 mg, Ativan (an antianxiety medication) 0.5 mg, Novolog (insulin) based on sliding scale parameters, Novolog 70/30 14 units, and omeprazole (a stomach acid reducing medication) 20 mg. Observation of the medication pass on March 1, 2024, revealed that LPN 1 administered Resident 2's medications at 10:00 a.m. The Novolog based on sliding scale parameters was administered at 10:18 a.m. Clinical record review revealed that Resident 4 had diagnoses that included HTN, GERD, urinary retention, and depression. A review of physician's orders dated October 14, 2022, revealed that staff were to administer the following medications at 8:00 a.m. daily: amlodipine (a medication for high blood pressure) 5 mg, and lisinopril (a medication for high blood pressure) 10 mg. A review of physician's orders dated October 14, 2022, July 28, 2023, and January 19, 2024, revealed that staff were to administer the following medications at 9:00 a.m. daily: ferrous sulfate (iron) 325 mg, finasteride (a medication for enlarged prostate) 5 mg, Prozac (an antidepressant medication) 20 mg, and famotidine (a stomach acid reducing medication) 20 mg. Observation of the medication pass on March 1, 2024, revealed that LPN 1 administered Resident 4's medications at 10:36 a.m. Page 1 of 2 395188 395188 03/01/2024 Buckingham Valley Rehabilitation and Nursingcenter 820 Durham Road Buckingham, PA 18912
F 0759 In an interview on March 1, 2024, at 9:35 a.m., LPN 1 confirmed that the medication pass was late. Level of Harm - Minimal harm or potential for actual harm Observation during the medication pass on March 1, 2024, from 9:40 a.m. through 10:36 a.m., revealed 24 medication opportunities with 15 medication errors which resulted in a medication error rate of 62.5%. Residents Affected - Few 28 Pa. Code 211.12(d)(1)(5) Nursing services. 395188 Page 2 of 2

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Citations

1 citation recorded*CMS

What do CMS severity letters mean?

Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.

General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.

Each letter combines severity with scope: how many residents the deficiency affected.

  • 0759GeneralS&S Dpotential for harm

    F759 - Medication Errors

    Ensure medication error rates are not 5 percent or greater.

FAQ · About this visit

Common questions about this visit

What happened during the March 1, 2024 survey of BUCKINGHAM VALLEY REHABILITATION AND NURSINGCENTER?

This was a inspection survey of BUCKINGHAM VALLEY REHABILITATION AND NURSINGCENTER on March 1, 2024. The surveyor cited 1 deficiency, recorded on the federal Form 2567 statement of deficiencies.

Were any deficiencies cited at BUCKINGHAM VALLEY REHABILITATION AND NURSINGCENTER on March 1, 2024?

Yes, 1 deficiency was cited, each with a CMS Scope and Severity grade. The first was: "Ensure medication error rates are not 5 percent or greater."

What type of survey was this?

This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.

SourceView on CMS Care Compare

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Next steps

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Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.