Based on clinical record review, resident interview, and observation, it was determined that the facility failed to provide timely assistance with care in a manner that maintained dignity for two of 24 sampled residents. (Residents 30, 86) Findings include: Clinical record review revealed that Resident 30 had mild cognitive impairment and required assistance from staff to get out of bed. According to the care plan, she also had depressed mood and would call out at times. The care plan indicated that staff was to respond to her requests for care and allow the resident to make decisions about her activities. On June 4, 2024, at 10:09 a.m., the resident was observed in bed and her call light was on. The resident stated, I want to get out of bed. Between 10:09 and 10:38 a.m., the call light remained on, and several staff members walked by the room without assisting the resident. At 10:38 a.m., a staff member turned off the call light and left the room without assisting the resident. The resident began to call out, Help me! until staff assisted her at 11:07 a.m. Clinical record review revealed that Resident 86 was incontinent of urine, was able to communicate her needs, and required assistance to use the toilet. According to the care plan, staff was to assist the resident to the toilet frequently and upon request. On June 5, 2024, at 10:49 a.m., the resident turned on her call light. At that time she stated, I need to use the bathroom. At 10:52 a.m., a nurse entered the room and turned off her call light without assisting her to the bathroom. Staff did not assist the resident until 11:30 a.m. 28 Pa. Code 211.12(d)(1)(5) Nursing services.

Based on clinical record review and observation, it was determined that the facility failed to implement physician's orders for one of 24 sampled residents. (Resident 45) Findings include: Clinical record review revealed that Resident 45 had diagnoses that included muscle weakness, dementia, and Parkinson's disease. Review of the Minimum Data Set assessment, dated May 15, 2024, revealed that the resident had cognitive impairment. Review of the care plan revealed the resident has a potential for impaired skin integrity and staff was to apply Dermasaver gloves (gloves for skin protection) to both arms while the resident was in the wheelchair. On June 18, 2023, a physician ordered that staff to apply a Tubigrip (an elastic bandage for support) to the right hand under the Dermasaver glove. On June 4, 2024, at 1:12 p.m. and 2:07 p.m., and again on June 5, 2024, at 10:47 a.m. and 12:25 p.m., Resident 45 was observed in a wheelchair without the Dermasaver gloves or Tubigrip in place. There was no documented evidence that the resident had refused application of the Dermasaver gloves or Tubigrip. 28 Pa. Code 211.12(d)(1)(5) Nursing services.

Based on review of the LPN (Licensed Practical Nurse) Act, clinical record review and staff interviw, it was determined that the facility failed to ensure that professional standards of quality regarding the administration of physician prescribed medications was followed for one of four residents that received medication. (Resident 1) Findings include: Pa. Code Title 49 Professional and Vocational Standards Department of State Chapter 21, State Board of Nursing 21.145 Function of the Licensed Practical Nurse states that the LPN is prepared to functions as a member of the health care team based on preparation, knowledge, skills and understanding of past experiences in nursing situations and the LPN administers medications and carries out the therapeutic treatments ordered for the patient. Clinical record review revealed that Resident 1 had diagnoses that included COPD (chronic obstructive pulmonary disease), anxiety and hypotension. Clinical record review revealed that on January 31, 2024, at 9:40 p.m. LPN 1 failed to identify Resident 1 by name band identification, photo identification or verbal confirmation prior to the administration of medications. As a result, Resident 1 received another resident's medications in error including a medication to treat hypertension (Lisinopril),a medication for schizophrenia (Quetiapine), a medication for tremors (Ropinirole) and a medication for depression (Mirtazapine). In an interview on February 6, 2024, at 11:10 a.m., the Director of Nursing confirmed that LPN 1 failed to follow the accepted standard of identifying a resident prior to the administration of medication. 28 Pa. Code 211.12(d)(1)(5) Nursing services.

Based on clinical record review, observation, and staff interview, it was determined that the facility failed to ensure physician's orders were implemented for one of 24 sampled residents. (Resident 20) Findings include Clinical record review revealed that Resident 20 had diagnoses that included spina bifida, paraplegia, muscle weakness, and debility. A physician's order dated November 1, 2019, directed staff to apply a knee abduction cushion and check for alignment throughout the day. Review of the care plan revealed that the resident was at risk for skin breakdown. The intervention was for staff to apply a knee abduction cushion per the orders. Multiple observations on July 19, 2023, between 11:10 a.m., and 1:28 p.m., revealed Resident 20 sitting in a wheelchair, the knee abduction cushion was not in place. In an interview on July 20, 2023, at 8:20 a.m., the Director of Nursing confirmed that staff did not apply the knee abduction cushion and that it should have been applied per the care plan and physician's order. 28 Pa. Code 211.12(d)(1)(5) Nursing services.

Based on facility policy review, clinical record review, and observation, it was determined that the facility failed to ensure that proper care was provided for one of two sampled residents who used a urinary catheter (a flexible tube that drains urine from the bladder). (Resident 20) Findings include: Review of facility policy entitled, Urinary Catheters, last reviewed January 2023, revealed that a catheter drainage bag was never to be elevated to or above bladder level. Clinical record review revealed that Resident 20 had diagnoses that included paraplegia, spina bifida, dementia, and dysfunction of the bladder. Review of the care plan revealed that the resident had an indwelling catheter. The intervention was for staff to position the catheter bag and tubing below the level of the bladder. Multiple observations on July 18, 2023, between 11:30 a.m. and 1:13 a.m., revealed Resident 20 was seated in a wheelchair. The tubing of the catheter was arranged such that it extended down the resident's pants leg and out the bottom to the drainage bag. The catheter bag was positioned inside the seat of the wheelchair, between the arm rest and the resident's hip. Neither the tubing nor the drainage bag were maintained below the level of the resident's bladder. Urine was observed in the tubing. 28 Pa. Code 211.10(d) Resident care policies. 28 Pa. Code 211.12(d)(1)(5) Nursing services.