Based on review of facility policy, observation, and staff interview, it was determined that the facility failed to safely secure medications on one of five nursing unit medication carts (Neighborhood Three medication cart). Findings include: A facility policy entitled Storage of Medications dated 2/03/25, indicated that unlocked medication carts are not left unattended. Observation on 5/20/25, at 11:10 a.m. revealed Neighborhood Three medication cart observed unlocked and unattended in a resident accessible hallway. During an interview at that time Licensed Practical Nurse Employee E3 confirmed that he/she should have locked the medication cart before leaving it unattended. 28 Pa. Code 211.9(a)(1) Pharmacy services 28 Pa. Code 211.12(d)(1)(5) Nursing Services

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of clinical records, facility documentation, and staff interview, it was determined that the facility failed to maintain complete and accurate records for one of 21 residents reviewed (Resident R44). Findings include: Resident R44's clinical record revealed an admission date of 9/08/23, with diagnoses that included stroke with left-sided weakness, arthritis of the hips, migraine headaches, nausea, and major depression. Review of Resident R44's medical diagnoses revealed a diagnosis of Schizophrenia (a serious mental health condition that affects how people think, feel and behave, and may result in a mix of hallucinations, delusions, and disorganized thinking and behavior) added to the clinical record on 12/15/23. Continued review of Resident R44's diagnosis reports signed by the physician on 6/11/24, 9/04/24, 11/15/24, revealed the Schizophrenia diagnosis remained on his/her clinical record. Review of Resident R44's Pennsylvania Preadmission Screening Resident Review (federal requirement to help ensure that individuals with serious mental illness are not inappropriately placed in nursing facilities for long term care) dated 9/08/23, lacked evidence of a history of Schizophrenia prior to admission. Review of Resident R44's Order Summary Reports signed by the physician on 3/04/25, and 4/15/25 revealed a diagnosis of Schizophrenia listed. Review of Resident R44's Neuropsychology assessments dated 9/21/23, 12/07/23, and 7/11/24, lacked evidence of a diagnosis of Schizophrenia, and a Psychiatric Evaluation dated 12/30/24, that indicated Resident R44 had a psychiatric history of Schizophrenia. Review of Resident R44's Minimum Data Sets (MDS- a standardized assessment tool that measures health status in nursing home residents) revealed the Quarterly MDS dated [DATE], Annual MDS dated [DATE], Quarterly MDS dated [DATE], and Quarterly MDS dated [DATE], Section I-Active Diagnoses were coded to indicate that Schizophrenia was an active diagnosis. A departmental progress note dated 5/22/25, at 8:52 a.m. revealed that upon conversation with Resident R44, his/her physician, and family it was determined that Resident R44 did not have a history of Schizophrenia and that adding the diagnosis to the clinical record was a clerical error. During an interview on 5/22/25, at 9:05, a.m. the Director of Nursing confirmed that there is no evidence that Resident R44 had a history of schizophrenia and that the inclusion of the diagnosis in the clinical record was inaccurate. 28 Pa. Code 211.5(f)(iv) Medical records 28 Pa. Code 211.12(d)(1)(5) Nursing services

Based on review of Minimum Data Sets (MDS - federally mandated standardized assessment conducted at specific intervals to plan resident care), clinical records and staff interviews, it was determined that the facility failed to ensure that MDS assessments accurately reflected the status of three of 22 residents reviewed (Residents R2, R35, and R109). Findings include: Review of MDS instructions for Section O Special Treatments, Procedures, and Programs subsection O0110 K1 Hospice was to be checked if treatments, procedures, and programs were performed while a resident of this facility and within the last 14 days. Review of MDS instructions for Section A Identification Information subsection A2105 Discharge Status revealed to select the two-digit code that corresponds to the residents discharge status. Resident R2's clinical record revealed an admission date of 6/26/15, with diagnoses that included malignant neoplasm of prostate, (a cancer in a man's prostate), depression (condition characterized by persistent feeling of sadness loss of interest in activities once enjoyed), and high blood pressure. Resident R2's clinical record revealed a physician's order dated 9/25/24, to admit to Hospice Services. Resident R2's quarterly MDS with an Assessment Reference Date (ARD) of 3/19/25, Subsection O0100 K1 Hospice was not checked, although Resident R2 received hospice services while a resident of the facility during the fourteen-day look-back period. Resident R35's clinical record revealed an admission date of 5/10/24, with diagnoses that included senile degeneration of the brain (a group of neurological disorders that cause a gradual decline in cognitive function), acquired coagulation factor deficiency (blood clotting disorder is an inherited or acquired issue that makes you tend to form blood clots too easily), and an enlarged heart. Resident R35's clinical record revealed a physician's order dated 9/03/24, to admit to Hospice Services on 8/30/24. Resident R35's quarterly MDS with an ARD of 2/25/25, Subsection O0100 K1 Hospice was not checked, although Resident R2 received hospice services while a resident of the facility during the fourteen-day look-back period. During an interview on 5/21/25, at 11:10 a.m. Registered Nurse Assessment Coordinator (RNAC) confirmed that Resident R2's 3/19/25, MDS and Resident R35's 2/25/25, MDS were coded inaccurately and should have been checked for receiving Hospice while a resident for Residents R2 and R35. Resident R109's clinical record revealed an admission date of 1/23/25, with diagnoses that included aspiration pneumonia (a type of lunch infection that occurs when food, liquid, saliva, or vomit is inhaled into the lungs), Benign Prostatic Hyperplasia (BPH - a noncancerous enlargement of the prostate gland, which can result in frequent urination, difficulty starting or stopping urination and a weak urine stream) and high blood pressure. Resident R109's clinical record revealed a progress note dated 2/20/25, indicating Resident R109 was transferred to the Emergency Room. Further review revealed a physician's order dated 2/20/25, indicating to send Resident R109 to the emergency room for evaluation of his/her right lower extremity. Resident R109's Discharge Return Anticipated MDS with an ARD of 2/20/25, Section A Identification Information subsection A2105 Discharge Status was coded as 01. Home / Community. During an interview on 5/22/25, at 9:54 a.m. the RNAC confirmed that Resident R109 was discharged to the hospital on 2/20/25, and the Discharge Return Anticipated MDS with an ARD or 2/20/25, was coded inaccurately and should have been coded as 04. Short-Term General Hospital (acute hospital, IPPS). 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 211.5(f)(ix) Medical Records

Based on review of facility policy, observations and staff interviews, it was determined that the facility failed to maintain dishwashing machine water temperatures in accordance with manufacturer recommendations for food service safety for the kitchen dishwasher and failed to ensure that food was stored in accordance with standards for food safety in one of five unit refrigerators reviewed (Neighborhood 4). Findings include: A facility policy entitled, Dishwashing Machine Use dated 2/3/25, revealed, The operator will check temperatures using the machine gauge with each dishwashing machine cycle, and will record the results in a facility approved log. Review of dishwasher temperature log for the kitchen for the dates of April 1, 2025, through May 18, 2025, revealed that the kitchen dishwashing machine temperatures were not logged for each of the dishwashing wash and rinse cycles. During an interview on 5/19/25, at 10:10 a.m. the Dietary Manager confirmed that the dishwashing machine wash and rinse temperatures were not being recorded with each cycle and should be recorded on the dishwasher temperature log with each dishwashing machine cycle. Observation on 5/19/25, at 10:15 a.m. and again at 2:00 p.m. of the Neighborhood 4 freezer revealed several ice packs that are used for treatments on resident's bodies stored next to popsicles and ice cream cups. During an interview on 5/19/25, at 2:00 p.m. Licensed Practical Nurse Employee E1 confirmed that the ice packs used as treatments for residents were in the freezer with food and he/she confirmed that ice packs that are used on resident's bodies should not be stored in the resident freezer with food. 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 201.18(b)(1) Management

Based on review of facility policy, observations, and staff interview, it was determined that the facility failed to provide resident privacy during medication administration for one of four residents reviewed (Resident R22). Findings include: Review of facility policy entitled Confidentiality of Information and Personal Privacy dated 1/5/24, indicated The facility will safeguard the personal privacy and confidentiality of all resident personal and medical records. and Access to resident personal and medical records will be limited to authorized staff . During observation of medication administration for Resident R22 on 6/26/24, at 8:01 a.m. Registered Nurse (RN) Employee E1 prepared medications for a resident from the Neighborhood 400 medication cart parked sideways in the hallway with the computer open sitting on top of the medication cart. RN Employee E1 then proceeded into the resident room to administer medications to a resident in the room. RN Employee E1 did not cover/protect resident/medication information that was revealed on the computer on top of the medication cart and was visible to those walking in the hallway. During the medication administration, RN Employee E1 was unable to view the computer on top of the medication cart parked sideways in the hallway outside of the resident room. During an interview on 6/26/24, at 8:15 a.m. RN Employee E1 confirmed that he/she left the medication cart with the computer open and did not cover/protect resident/medication information that was on the computer on top of the medication cart from anyone walking through the hallway. RN Employee E1 also confirmed that resident information is to be covered when not within view. 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 211.12(d)(1)(5) Nursing services

Based on review of facility policies, manufacturer's guidelines, observations, and staff interviews, it was determined that the facility failed to prevent the opportunity for potential unauthorized access of medications and to appropriately discard outdated medications for two of two medication carts reviewed (Neighborhood 300 and Neighborhood 400). Findings include: Review of facility policy entitled Medication Storage in the Facility dated 1/5/24, indicated Medication rooms, carts and medication supplies are locked or attended by persons with authorized access. and Outdated, contaminated or deteriorated medications . are immediately removed from stock, disposed of according to procedures for medication disposal . Review of manufacturer's guidelines revealed that an open Insulin Lantus vial must be used within 28 days after opening or be discarded, even if the vial still contains insulin. Review of facility policy entitled Medication Administration - General Guidelines dated 1/5/24, indicated During administration of medications, the medication cart is kept closed and locked when out of sight of the medication nurse . Observation of drug storage on 6/25/24, at 3:22 p.m. of the Neighborhood 400 medication cart revealed an open bottle Insulin Lantus with an open date written on it of 5/20/24. Additional observations of Neighborhood 400 medication cart revealed an open bottle of Iron Gluconate (an over the counter supplement that helps increase red blood cells) with a best-by date of 4/2024, and an open date of 6/10/24, which was beyond the best by date. During an interview on 6/25/24, at 3:22 p.m. with Licensed Practical Nurse (LPN) Employee E2 he/she confirmed that the open date on the Insulin Lantus was beyond the 28 days and should have been discarded. He/she also confirmed that the open bottle of Iron Gluconate had a manufacturer best-by date of 4/2024, which should have not been opened after the best-by date and should have been discarded. Observation of drug storage on 6/25/24, at 3:30 p.m. of the Neighborhood 300 medication cart revealed an open bottle of Iron Gluconate with a best-by date of 4/2024, and an open date of 6/1/24, which was beyond the best by date. During an interview on 6/25/24, at 3:30 p.m. with Registered Nurse (RN) Employee E3, he/she confirmed that the open bottle of Iron Gluconate had a manufacturer best-by date of 4/2024, which should not have been opened after the best-by date and should have been discarded. During observation of medication administration on 6/26/24, at 8:10 a.m. RN Employee E1 walked away and left the medication cart unattended while it was unlocked with a resident sitting approximately one foot away from the unlocked medication cart. RN Employee E1 then proceeded to walk down the hall and entered a resident room two rooms away from the medication cart, which remained unlocked. During an interview on 6/26/24, at 8:13 a.m. RN Employee E1 confirmed that he/she left the medication cart unlocked that was out of his/her view when he/she was in a resident room. RN Employee E1 also confirmed that the medication cart was to be locked when out of view. 28 Pa. Code 201.18(b)(1) Management 28 Pa. Code 211.9(a)(1) Pharmacy services 28 Pa. Code 211.12(d)(1) Nursing services

Based on review of clinical records, facility policy, and facility documentation, and staff interview it was determined that the facility failed to maintain complete and accurate documentation as related to bathing and meal intake for 13 of 14 residents reviewed (Residents R1, R2, R4, R5, R6, R7, R12, R13, R14, R15, R16, R17, and R18). Findings include: Review of facility policy dated 1/5/24, entitled Bed Bath, Shower / Tub indicated that staff documentation was to include the date and time shower/tub, or bed bath was performed and if resident refused the reason why and what interventions were taken. Review of facility policy dated 1/5/24, entitled Assisting the Resident with In-Room Meals indicated that staff documentation was to include how much of the meal the resident consumed and if the resident refused the reason why and what interventions were taken. Review of Resident R1's clinical record revealed an admission date of 12/2/22, with diagnoses that included diabetes, high blood pressure, and breast cancer. The clinical record revealed that Resident R1was to have a shower on Sunday and Wednesday on day shift. Resident R1's clinical record lacked documentation indicating if he/she received a shower or bath on five (2/21/24, 2/28/24, 3/3/24, 3/6/24, and 3/17/24) of eight scheduled showers in the past 30 days. Resident R1's clinical record lacked documentation indicating if he/she consumed their breakfast meal and what percent was consumed on 14 (2/21/24, 2/23/24, 2/26/24, 2/27/24, 2/28/24, 3/1/24, 3/2/24, 3/3/24, 3/4/24, 3/6/24, 3/9/24, 3/11/24, 3/16/24, and 3/17/24) of 30 breakfast meals in the past 30 days. Resident R1's clinical record lacked documentation indicating if he/she consumed their lunch meal and what percent was consumed on 15 (2/21/24, 2/23/24, 2/26/24, 2/27/24, 2/28/24, 3/1/24, 3/2/24, 3/3/24, 3/4/24, 3/5/24, 3/6/24, 3/9/24, 3/11/24, 3/16/24, and 3/17/24) of 30 lunch meals in the past 30 days. Resident R1's clinical record lacked documentation indicating if he/she consumed their supper meal and what percent was consumed on two (3/11/24, and 3/15/24) of 30 supper meals in the past 30 days. Resident R2's clinical record revealed an admission date of 8/17/23, with diagnoses that included high blood pressure, anemia, and arthritis. The clinical record revealed that Resident R2 was to have a shower on Tuesday and Friday on evening shift. Resident R2's clinical record lacked documentation indicating if he/she received a shower or bath on three (2/20/24, 2/29/24, and 3/14/24) of nine scheduled showers in the past 30 days. Resident R2's clinical record lacked documentation indicating if he/she consumed their supper meal and what percent was consumed on 3 (2/20/24, 3/1/24, and 3/15/24) of 30 supper meals in the past 30 days. Resident R4's clinical record revealed an admission date of 6/14/23, with diagnoses that included high blood pressure, anemia, and diabetes. The clinical record revealed that Resident R4 was to have a shower on Wednesday and Saturday on evening shift. Resident R4's clinical record lacked documentation indicating if he/she received a shower or bath on one (3/16/24) of eight scheduled showers in the past 30 days. Resident R4's clinical record lacked documentation indicating if he/she consumed their breakfast meal and what percent was consumed on five (2/23/24, 2/25/24, 2/29/24, 3/1/24, and 3/10/24) of 30 breakfast meals in the past 30 days. Resident R4's clinical record lacked documentation indicating if he/she consumed their lunch meal and what percent was consumed on five (2/23/24, 2/25/24, 2/29/24, 3/1/24, and 3/10/24) of 30 lunch meals in the past 30 days. Resident R4's clinical record lacked documentation indicating if he/she consumed their supper meal and what percent was consumed on three (2/27/24, 3/16/24, and 3/17/24) of 30 supper meals in the past 30 days. Resident R5's clinical record revealed an admission date of 6/26/15, with diagnoses that included high blood pressure, anemia, and dysphagia (difficulty in swallowing food and/or liquids). Resident R5's clinical record lacked documentation indicating if he/she consumed their breakfast meal and what percent was consumed on one (2/25/24) of 30 breakfast meals in the past 30 days. Resident R5's clinical record lacked documentation indicating if he/she consumed their lunch meal and what percent was consumed on one (2/25/24) of 30 lunch meals in the past 30 days. Resident R5's clinical record lacked documentation indicating if he/she consumed their supper meal and what percent was consumed on seven (2/23/24, 2/26/24, 2/27/24, 3/3/24, 3/9/24, 3/11/24, and 3/17/24) of 30 supper meals in the past 30 days. Resident R6's clinical record revealed an admission date of 9/12/22, with diagnoses that included high blood pressure, anemia, and venous insufficiency (a condition that affects the blood flow to your legs resulting in swelling, pain, and changes in your skin). The clinical record revealed that Resident R6 was to have a shower on Sunday and Wednesday on day shift. Resident R6's clinical record lacked documentation indicating if he/she received a shower or bath on one (2/25/24) of eight scheduled showers in the past 30 days. Resident R6's clinical record lacked documentation indicating if he/she consumed their breakfast and what percent was consumed on one (2/25/24) of 30 breakfast meals in the past 30 days. Resident R6's clinical record lacked documentation indicating if he/she consumed their lunch and what percent was consumed on one (2/25/24) of 30 lunch meals in the past 30 days. Resident R6's clinical record lacked documentation indicating if he/she consumed their supper and what percent was consumed on ten (2/20/24, 2/23/24, 2/25/24, 2/26/24, 2/27/24, 3/7/24, 3/8/24, 3/13/24, 3/18/24, and 3/19/24) of 30 supper meals in the past 30 days. Resident R7's clinical record revealed an admission date of 2/22/24, with diagnoses that included high blood pressure, anemia, and a stroke. The clinical record revealed that Resident R7 was to have a shower on Tuesday and Saturday on day shift. Resident R7's clinical record lacked documentation indicating if he/she received a shower or bath on three (3/9/24, 3/12/24, and 3/19/24) of eight scheduled showers in the past 30 days. Resident R7's clinical record lacked documentation indicating if he/she consumed their breakfast and what percent was consumed on eight (2/22/24, 2/26/24, 3/4/24, 3/6/24, 3/9/24, 3/12/24, 3/14/24, and 3/18/24) of 30 breakfast meals in the past 30 days. Resident R7's clinical record lacked documentation indicating if he/she consumed their lunch and what percent was consumed on eight (2/26/24, 2/29/24, 3/4/24, 3/6/24, 3/9/24, 3/12/24, 3/14/24, and 3/18/24) of 30 lunch meals in the past 30 days. Resident R7's clinical record lacked documentation indicating if he/she consumed their supper and what percent was consumed on one (2/22/24) of 30 supper meals in the past 30 days. Resident R12's clinical record revealed an admission date of 2/15/22, with diagnoses that included high blood pressure, anemia, and peripheral vascular disease (when arteries become narrow affecting blood supply most commonly in the legs). The clinical record revealed that Resident R12 was to have a shower on Sunday and Wednesday on day shift. Resident R12's clinical record lacked documentation indicating if he/she received a shower or bath on three (2/21/24, 2/28/24, and 3/3/24) of eight scheduled showers in the past 30 days. Resident R12's clinical record lacked documentation indicating if he/she consumed their breakfast and what percent was consumed on 12 (2/21/24, 2/26/24, 2/27/24, 2/28/24, 3/3/24, 3/4/24, 3/5/24, 3/7/24, 3/8/24, 3/9/24, 3/11/24, and 3/19/24) of 30 breakfast meals in the past 30 days. Resident R12's clinical record lacked documentation indicating if he/she consumed their lunch and what percent was consumed on 14 (2/21/24, 2/23/24, 2/25/24, 2/26/24, 2/27/24, 2/28/24, 3/3/24, 3/4/24, 3/5/24, 3/7/24, 3/8/24, 3/9/24, 3/11/24, and 3/19/24) of 30 lunch meals in the past 30 days. Resident R12's clinical record lacked documentation indicating if he/she consumed their supper and what percent was consumed on two (3/4/24, and 3/12/24) of 30 meals in the past 30 days. Resident R13's clinical record revealed an admission date of 7/28/22, with diagnoses that included diabetes, arthritis, and high blood pressure. The clinical record revealed that Resident R13 was to have a shower on Monday and Thursday on day shift. Resident R13's clinical record lacked documentation indicating if he/she received a shower or bath on six (2/22/24, 2/26/24, 2/29/24, 3/4/23, 3/14/24, and 3/18/24) of eight scheduled showers in the past 30 days. Resident R13's clinical record lacked documentation indicating if he/she consumed their breakfast meal and what percent was consumed on eight (2/26/24, 2/28/24, 3/3/24, 3/4/24, 3/5/24, 3/14/24, 3/18/24, and 3/19/24) of 30 breakfast meals in the past 30 days. Resident R13's clinical record lacked documentation indicating if he/she consumed their lunch meal and what percent was consumed on ten (2/22/24, 2/25/24, 2/26/24, 2/28/24, 3/3/24, 3/4/24, 3/5/24, 3/14/24, 3/18/24, and 3/19/24) of 30 lunch meals in the past 30 days. Resident R13's clinical record lacked documentation indicating if he/she consumed their supper meal and what percent was consumed on two (3/4/24, and 3/12/24) of 30 supper meals in the past 30 days. Resident R14's clinical record revealed an admission date of 5/27/23, with diagnoses that included high blood pressure, anemia, and dementia (a condition that affects the brains' ability to think, remember things, and function). The clinical record revealed that Resident R14 was to have a shower on Monday and Thursday on day shift. Resident R14's clinical record lacked documentation indicating if he/she received a shower or bath on seven (2/22/24, 2/26/24, 2/29/24, 3/4/24, 3/11/24, 3/14/24, and 3/18/24) of eight scheduled showers in the past 30 days. Resident R14's clinical record lacked documentation indicating if he/she consumed their breakfast meal and what percent was consumed on eight (2/26/24, 2/28/24, 3/4/24, 3/5/24, 3/6/24, 3/14/24, 3/18/24, and 3/19/24) of 30 breakfast meals in the past 30 days. Resident R14's clinical record lacked documentation indicating if he/she consumed their lunch meal and what percent was consumed on 11 (2/22/24, 2/25/24, 2/26/24, 2/28/24, 3/3/24, 3/4/24, 3/5/24, 3/6/24, 3/14/24, 3/18/24, and 3/19/24) of 30 lunch meals in the past 30 days. Resident R14's clinical record lacked documentation indicating if he/she consumed their supper meal and what percent was consumed on two (3/4/24, and 3/12/24) of 30 supper meals in the past 30 days. Resident R15's clinical record revealed an admission date of 12/26/23, with diagnoses that included diabetes, dementia, and high blood pressure. The clinical record revealed that Resident R15 was to have a shower on Tuesday and Saturday on day shift. Resident R15's clinical record lacked documentation indicating if he/she received a shower or bath on four (2/27/24, 3/5/24, 3/9/24, and 3/12/24) of nine scheduled showers in the past 30 days. Resident R15's clinical record lacked documentation indicating if he/she consumed their breakfast meal and what percent was consumed on 14 (2/21/24, 2/26/24, 2/27/24, 2/28/24, 3/3/24, 3/4/24, 3/5/24, 3/7/24, 3/8/23, 3/9/24, 3/10/24, 3/11/24, 3/12/24, and 3/17/24) of 30 breakfast meals in the past 30 days. Resident R15's clinical record lacked documentation indicating if he/she consumed their lunch meal and what percent was consumed on 15 (2/21/24, 2/23/24, 2/26/24, 2/27/24, 2/28/24, 3/3/24, 3/4/24, 3/5/24, 3/7/24, 3/8/24, 3/9/24, 3/10/24, 3/11/24, 3/12/24, and 3/17/24) of 30 lunch meals in the past 30 days. Resident R15's clinical record lacked documentation indicating if he/she consumed their supper meal and what percent was consumed on two (3/4/24, and 3/11/24) of 30 supper meals in the past 30 days. Resident R16's clinical record revealed an admission date of 7/1/22, with diagnoses that included dementia, high blood pressure, and anxiety. The clinical record revealed that Resident R16 was to have a shower on Tuesday and Friday on evening shift. Resident R16's clinical record lacked documentation indicating if he/she received a shower or bath on one (3/12/24) of nine scheduled showers in the past 30 days. Resident R16's clinical record lacked documentation indicating if he/she consumed their breakfast meal and what percent was consumed on 12 (2/21/24, 2/26/24, 2/27/24, 2/28/24, 3/3/24, 3/4/24, 3/5/24, 3/8/24, 3/9/24, 3/11/24, 3/18/24, and 3/19/24) of 30 breakfast meals in the past 30 days. Resident R16's clinical record lacked documentation indicating if he/she consumed their lunch meal and what percent was consumed on 15 (2/21/24, 2/23/24, 2/25/24, 2/26/24, 2/27/24, 2/28/24, 3/3/24, 3/4/24, 3/5/24, 3/8/24, 3/9/24, 3/10/24, 3/11/24, 3/18/24, and 3/19/24) of 30 lunch meals in the past 30 days. Resident R16's clinical record lacked documentation indicating if he/she consumed their supper meal and what percent was consumed on five (2/29/24, 3/4/24, 3/11/24, 3/12/24, and 3/16/24) of 30 supper meals in the last 30 days. Resident R17's clinical record revealed an admission date of 3/2/21, with diagnoses that included high blood pressure, arthritis, and peripheral vascular disease. Resident R17's clinical record lacked documentation indicating if he/she consumed their breakfast meal and what percent was consumed on 15 (2/26/24, 2/27/24, 2/28/24, 3/3/24, 3/4/24, 3/5/24, 3/7/24, 3/8/24, 3/9/24, 3/10/24, 3/11/24, 3/12/24, 3/16/24, 3/17/24, and 3/18/24) of 30 breakfast meals in the past 30 days. Resident R17's clinical record lacked documentation indicating if he/she consumed their lunch meal and what percent was consumed on 16 (2/23/24, 2/26/24, 2/27/24, 2/28/24, 3/3/24, 3/4/24, 3/5/24, 3/7/24, 3/8/24, 3/9/24, 3/10/24, 3/11/24, 3/12/24, 3/16/24, 3/17/24, and 3/18/24) of 30 lunch meals in the past 30 days. Resident R17's clinical record lacked documentation indicating if he/she consumed their supper meal and what percent was consumed on four (2/20/24, 2/22/24, 3/4/24, and 3/11/24) of 30 supper meals in the last 30 days. Resident R18's clinical record revealed an admission date of 7/4/23, with diagnoses that included high blood pressure, peripheral vascular disease, and epilepsy (neurological disorder that cause seizures). The clinical record revealed that Resident R18 was to have a shower on Monday and Friday on evening shift. Resident R18's clinical record lacked documentation indicating if he/she received a shower or bath on one (3/4/24) of eight scheduled showers in the past 30 days. Resident R18's clinical record lacked documentation indicating if he/she consumed their breakfast meal and what percent was consumed on 13 (2/21/24, 2/26/24, 2/27/24, 2/28/24, 3/3/24, 3/4/24, 3/5/24, 3/7/24, 3/8/24, 3/9/24, 3/11/24, 3/18/24, and 3/19/24) of 30 breakfast meals in the past 30 days. Resident R18's clinical record lacked documentation indicating if he/she consumed their lunch meal and what percent was consumed on 16 (2/21/24, 2/23/24, 2/25/24, 2/26/24, 2/27/24, 2/29/24, 3/3/24, 3/4/24, 3/5/24, 3/7/24, 3/8/24, 3/9/24, 3/10/24, 3/11/24, 3/18/24, and 3/19/24) of 30 lunch meals in the past 30 days. Resident R18's clinical record lacked documentation indicating if he/she consumed their supper meal and what percent was consumed on two (3/4/24, and 3/12/24) of 30 supper meals in the last 30 days. During an interview on 3/21/24, at 9:00 a.m. the Nursing Home Administrator confirmed that Residents R1, R2, R4, R5, R6, R7, R12, R13, R14, R15, R16, R17, and R18 lacked documentation indicating if a shower or bath was given as directed and / or meal intake in the last thirty days. 28 Pa. Code 211.5(f)(ii)(ix) Medical records 28 Pa. Code 211.12(d)(1)(5) Nursing services

Based on observations, review of clinical records, and staff interview, it was determined that the facility failed to promote cleanliness and help prevent the spread of infection regarding respiratory care equipment according to physician's orders for two of 24 residents reviewed (Residents R50 and R38). Findings include: Review of Resident R50's clinical record revealed an admission date of 4/14/22, with diagnoses that included hypertension (high blood pressure), pulmonary hypertension, (a condition that affects the blood vessels in the lungs and in the heart causing high blood pressure), and Chronic Obstructive Pulmonary Disease (COPD-a condition that obstructs air flow in the lungs with symptoms of difficulty breathing, coughing and shortness of breath). Additional review of the physician's orders revealed an order to change oxygen tubing and canister, label and date all tubing every night shift every Sun [Sunday]. Review of Resident R38's clinical record revealed an admission date of 5/17/22, with diagnoses that included hypertension, diabetes, and COPD. Additional review of the physician's orders revealed an order to change oxygen tubing and canister, change nebulizer tubing if in use, label and date all tubing every night shift every Sun. Observation on 7/11/23, at 3:25 p.m. revealed Resident R50's nasal cannula (oxygen tubing that has prongs that go into the nostrils and loops around the ears to secure in place to ensure adequate oxygen delivery) had a piece of tape wrapped around the oxygen tubing dated 7/3/23. It was also noted that the oxygen water canister was dated 7/3/23. There was no evidence of oxygen equipment changed on Sunday 7/9/23. Additional observations on 7/12/23, at 9:18 a.m. and again at 1:00 p.m. revealed Resident R50's nasal cannula remained with the same and had a piece of tape wrapped around the oxygen tubing dated 7/3/23. It was also noted that the oxygen water canister remained as dated 7/3/23. Observations on 7/12/23, at 9:18 a.m. and 1:00 p.m. revealed Resident R38's nasal cannula had a piece of tape wrapped around the oxygen tubing dated 6/6/23. There was no evidence of the oxygen equipment being changed according to physician's orders During an interview on 7/12/23, at 1:18 p.m. the Director of Nursing confirmed that the oxygen tubing was dated 7/3/23, on R50's oxygen tubing and canister and the oxygen tubing on R38 was dated 6/6/23, and that the oxygen tubing was to be changed weekly and dated when it is changed. 28 Pa. Code 211.12(d)(1)(5) Nursing services

Based on review of clinical records, observations, and staff interview, it was determined that the facility failed to prevent the potential for cross contamination during a dressing change for one of two residents with pressure ulcers requiring wound care reviewed (Resident R88). Findings include: Review of Resident R88's clinical record revealed an admission date of 10/27/22, with diagnoses that included bipolar disorder, pressure ulcer of the left hip, severe protein calorie malnutrition, dehydration and high blood pressure. Review of Resident R88's physician's orders dated July 2023, included an order to cleanse the coccyx wound and apply a wound vac (vacuum machine used to remove drainage from a wound). Observation of wound care on 7/13/23, at 10:30 a.m. revealed that upon entrance to Resident R88's room the wound vac machine and tubing were resting directly on the floor. During an interview on 7/14/23, at 9:45 a.m. the Director of Nursing confirmed that the wound vac machine and tubing should not be resting on the floor. 28 Pa. Code 201.18 (b)(2) Management 28 Pa. Code 211.12(d)(1)(2)(5) Nursing services

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations and staff interviews, it was determined that the facility failed to maintain a safe, clean, homelike environment by not monitoring for safe temperatures and cleanliness of residents' personal refrigerators and ensuring their electrical safety for use for three of six resident refrigerators observed (rooms [ROOM NUMBER]). Findings include: Observations on 7/14/23, at approximatley 9:20 a.m. revealed a personal resident refrigerator in room [ROOM NUMBER]. There was no identification tag observed on the refrigerator indicating that it was checked by maintenance for electrical safety for usage. It was also observed that there was no thermometer in the refrigerator and no temperature log sheet identifying that the refrigerator was monitored for safe temperatures to store food and beverage items. Observations of room [ROOM NUMBER] and room [ROOM NUMBER], revealed personal resident refrigerators present in the rooms. There was no identification tags on the refrigerators indicating that they were checked by maintenance for electrical safety for usage. It was also observed that there was no thermometer in either refrigerator or temperature log sheets identifying that the refrigerators were monitored for safe temperatures to store resident food and beverage items. During an interview on 7/14/23, at 10:00 a.m. the Director of Maintenance confirmed that the facility has not tagged the refrigerators showing that they were checked for electrical safety prior to use in the resident rooms, that there are no thermometers in the resident's personal refrigerators, and temperatures are not monitored for safety of resident personal food and beverage items in personal refrigerators. During an interview with the Nursing Home Administrator on 7/14/23, at approximately 10:30 a.m. it was confirmed that the facility does not have a policy for monitoring residents' personal refrigerators. 28 Pa. Code 201.14 (a) Responsibility of Licensee

Based on review of facility documents, and staff and resident interviews it was determined that the facility failed to ensure that residents received timely resolution to Resident Council concerns for two of three resident council meetings (November 2022, and December 2022). Findings include: Review of Resident Council meeting minutes revealed: On 10/06/22, residents attending the meeting reported that foul language use was a big concern with aides and nurses and the Administrator's response was that the concern would be discussed in the staff-managers meeting this month. On 11/30/22, residents attending the meeting reported that foul language was still a major issue, and that some aides and nurses were still swearing, and that they believed no consequences are being issued to staff. The Administrator's response was for residents to let him/her know who the staff was, and the facility will continue to educate staff. On 12/14/22, residents attending the meeting reported that foul language was still a major issue, and that some aides and nurses were still swearing, and that they believed no consequences are being issued to staff. The Social Worker responded he/she would let the Administrator know, and that the facility will continue to re-educate staff. Review of a facility document entitled, General Staff Meeting Agenda dated 10/19/22, lacked evidence that the topics of concern reported by the Resident Council were included in the employee education. Interviews on 2/02/23, between 9:15 a.m. and 3:00 p.m. revealed that Residents R1, R2, and R3 confirmed that they are still hearing staff swear and having inappropriate conversations daily, and Resident R5 confirmed that the swearing is better than it was, but that he/she still hears it. Residents R2 and R3 also confirmed that they are not sure who is responsible because they can't see the staff in the hallways and the masks make it worse. During an interview on 2/02/23, at approximately 3:15 p.m. the Nursing Home Administrator (NHA) confirmed that the General Staff Meeting Agenda dated 10/19/22, lacked topics specific to Resident Council concerns of staff language, and negative staff interactions with residents. During a phone interview on 2/03/23, at approximately 3:30 p.m. the NHA confirmed that the November and December Resident Council meetings lacked evidence of facility follow-up to resident concerns and how the facility responded to resident concerns. The concerns reported in the October Resident Council meeting continued to be reported in the November and December Resident Council meetings and in resident interviews on 2/02/23, and there was no evidence that the NHA reported to the Resident Council how the facility was going to monitor the facility response. The employee education provided to staff was not specific to concerns reported from the Resident Council and there was no evidence that the facility reported how they resolved the issue. 28 Pa. Code 201.14 (a) Responsibility of licensee 28 Pa. Code 201.18 (e)(1)(4) Management 28 Pa. Code 201.29(j) Resident rights