Based on observations and staff interviews, it was determined that the facility failed to label multi-dose containers of Tuberculin solution (used to test for the disease tuberculosis) with the date they were opened in one of two medication storage rooms. Findings include: Observation on 9/10/25, at 10:15 a.m. of a medication storage refrigerator revealed an opened and undated multi-dose vial of Tuberculin solution. During an interview on 9/10/25, at 10:20 a.m. Licensed Practical Nurse Employee E1 confirmed that the multi-dose vials of Tuberculin solution should have been labeled with the date it was opened. During an interview on 9/10/25, at 10:35 a.m. the Director of Nursing confirmed that the multi-dose vials are labeled to discard after 30 days opened and that staff would not be able to determine when to discard the vials due to the lack of an opened date. 28 Pa. Code 201.18(b)(1) Management 28 Pa. Code 211.9(a)(1) Pharmacy services 28 Pa. Code 211.12(d)(1)(5) Nursing services

Based on review of the hospice/facility agreement and clinical records, and staff interview, it was determined that the facility failed to maintain current information related to Hospice services for one of three residents reviewed (Closed Record Resident CR1). Findings include: A Hospice Care Services Agreement dated 2/08/06, indicated that, Hospice shall communicate with facility to ensure coordination of patient care services; Hospice Health Aides shall provide a copy of the completed assignment form to the facility; facility and Hospice each shall prepare and maintain records concerning patients receiving services under this agreement; and such records shall be available for review and inspection by each party as necessary for the treatment of patients under this agreement. Resident CR1's clinical record revealed an admission date of 1/12/21, with diagnoses that included senile degeneration of the brain (irreversible memory loss, behavioral and cognitive decline, personality changes, and a decreasing ability to cope with everyday life), encounter for palliative care (indicates that a patient's goals are comfort-oriented), mood disorder, difficulty swallowing. A care plan initiated 9/01/23, indicated the need for Hospice care due to the terminal condition of senile degeneration of the brain. Further review of Resident CR1's clinical record revealed a revocation of Hospice services dated 8/19/24, and a provider progress note dated 8/20/24, that indicated the discontinue of Hospice services. Resident CR1's clinical record contained Hospice communication documents with a visit date of 6/18/24, and there was no evidence of Hospice communication sheets beyond 6/18/24. During an interview on 1/06/25, at 12:06 p.m. the Director of Nursing confirmed there was no evidence of Hospice communication documents for Resident CR1 between 6/18/24, and 8/19/24, (date Hospice services were revoked). 28 Pa. Code 201.14(a)(b) Responsibility of licensee 28 Pa. Code 201.18(b)(1)(3) Management 28 Pa. Code 211.5(f)(iii)(viii)(ix) Medical records 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services

Based on review of facility policies and clinical records, observations, and staff and resident interviews, it was determined that the facility failed to follow physician's orders in accordance with standards of practice regarding respiratory care equipment for one of 18 residents reviewed (Resident R11). Findings include: Review of a facility policy entitled Oxygen Administration dated 5/23/23, revealed, O2 [oxygen] tubing is to be changed weekly, Sunday on 11pm-7 am shift by nursing and as needed humidifier bottle changed weekly. Review of a facility policy entitled Administering Medications Through a Small Volume (Handheld) Nebulizer [medical device to administer medications for respiratory conditions] dated 5/23/23, revealed, Nurse to change equipment and tubing every Sunday (11pm - 7am shift). Review of Resident R11's clinical record revealed an admission date of 2/28/23, with diagnoses that included Chronic Obstructive Pulmonary Disease (COPD-a condition that obstructs air flow in the lungs with symptoms of difficulty breathing, coughing and shortness of breath), Congestive Heart Failure (CHF - a progressive heart disease that weakens the pumping action of the heart muscles, causing fatigue and shortness of breath in the resident), and Permanent Atrial Fibrillation (A-Fib - a type of abnormal, rapid heartbeat that is present all the time, causing shortness of breath, heart palpitations, weakness and can lead to development of blood clots). Review of R11's clinical record revealed physician's orders dated 11/18/23, that identified the use of oxygen through a nasal canula (tubing with prongs inserted to the nostrils that deliver oxygen into the resident's nostrils) and physician's orders for nebulizer treatments as needed for shortness of breath, wheezing. Observation on 11/28/23, at 10:25 a.m. revealed that Resident R11's oxygen nasal canula and oxygen humidifier bottle did not have dates identified to indicate when they were last changed. Further observation revealed Resident R11's slow-volume (handheld) nebulizer device that also did not have a date when it was last changed. During an interview on 11/28/23, at 10:30 a.m. Resident R11 indicated that staff have not replaced the oxygen humidifier, nasal canula, or nebulizer device and tubing weekly. During an interview on 11/29/23, at 10:02 a.m. the Infection Control Nurse confirmed that Resident R11's oxygen nasal canula, humidifier bottle, nebulizer device, and tubing all did not have a date to identify when they had been changed according to physician's orders and that all the items should be dated when changed by staff. 28 Pa. Code 211.10(c)(d) Resident care policies 28 Pa. Code 211.12(d)(1)(5) Nursing services

Based on review of PAHAN 694, and resident and staff interviews, it was determined that the facility failed to provide care in a manner that maintained the resident's psychosocial well-being for six of 24 residents reviewed (Residents R68, R26, R53, R56, R57, and R65). Findings include: Review of the 2023 PAHAN 694 5-11-UPD UPDATE encourages the use of masks until no new cases of SARS-CoV-2 infection have been identified for 14 days. From 11/27/23, through 11/28/23, during resident interviews, the following residents complained of an inability to communicate with masked staff members: During interview on 11/27/23, at 11:10 a.m. Resident R68 expressed frustration with difficulties communicating with staff members as their masks inhibited the resident's ability to hear what the staff were saying to them. During interview on 11/27/23, at 1:35 p.m. Resident R26 complained that on several occasions they avoided communicating with staff as it was too hard to understand what the staff were saying while they were wearing masks and wasn't worth the trouble. During interview on 11/27/23, at 2:15 p.m. Resident R53 disclosed that it was difficult to communicate with the staff due to their wearing masks and that they were made to feel as though the staff were afraid that they had some sort of a disease. During interview on 11/28/23, at 11:20 a.m. Resident R56 indicated he/she could not hear conversation and was noted with confusion about the mask being worn; making motion to remove mask. During interview on 11/27/23, at 2:30 p.m. Resident R57 indicated he/she asks staff to repeat themselves several times and eventually requests staff to pull the mask down so he/she can understand conversation. During interview on 11/27/23, at 3:00 p.m. Resident R65 indicated he/she has a difficult time hearing staff and consistently asks them to repeat themselves and/or pull the mask down to understand and hear what they are saying. During interview on 11/27/23, at 4:00 p.m. Nursing Staff Employee E5 revealed that it was very difficult' to communicate with residents while wearing a mask. During interview on 11/28/23, at 1:20 p.m. Nursing Staff Employee E6 confirmed that the residents had a difficult time understanding the staff while wearing masks. During interview on 11/30/23, at approximately 11:50 a.m. the facility's President, Nursing Home Administrator (NHA) and Director of Nursing (DON) confirmed that the staff were made to wear masks at all times in the resident areas. They also indicated that they were using the 2023 PAHAN 694 5-11-UPD UPDATE (PENNSYLVANIA DEPARTMENT OF HEALTH 2023 PAHAN 694 5-11-UPD UPDATE: Interim Infection Prevention and Control Recommendations for COVID-19 in Healthcare Settings) to determine whether staff should be made to wear masks. During interview on 11/30/23, at approximately 11:50 a.m. the facility's President, NHA, and DON confirmed that there had been no new cases of SARS-CoV-2 infection for at least 35 days, revealing that the last case had been identified on 10/26/23. 28 Pa. Code 201.29(a) Resident rights