Based on review of clinical records and staff interview, it was determined that the facility failed to provide evidence that non-pharmacological interventions (interventions attempted to calm a resident other than medication) were attempted prior to the administration of a PRN (as needed) psychotropic (affecting the mind) medication for one of five residents reviewed for unnecessary medications (Resident R114). Findings include: Upon request, the facility was unable to provide a policy regarding non-pharmacological interventions prior to the administration of psychotropic medications. Resident R114's clinical record revealed an admission date of 9/18/23, with diagnoses that included dementia (loss of cognitive functioning affecting a person's memory and behaviors), gastroesophageal reflux disease (GERD - happens when stomach acid flows back up into the esophagus and causes heartburn), and high blood pressure. Resident R114's clinical record revealed a physician's order dated 5/18/25, with a discontinuation date of 11/18/25, that identified to administer Lorazepam (anti-anxiety medication) 0.5 milligrams (mg) by mouth daily PRN for increased behaviors / anxiety. Resident R114's May 2025 Medication Administration Record (MAR) revealed that the PRN Lorazepam was used five times (5/20/25, 5/21/25, 5/22/25, 5/27/25, and 5/28/25). Review of May MAR and clinical record progress notes revealed that there was no evidence of non-pharmacological interventions being attempted prior to the administration of the PRN Lorazepam four of the five times it was used. Resident R114's June 2025 MAR revealed that the PRN Lorazepam was used four times (6/3/25, 6/10/25, 6/12/25, and 6/23/25). Review of June MAR and clinical record progress notes revealed that there was no evidence of non-pharmacological interventions being attempted prior to the administration of the PRN Lorazepam three of the four times it was used. Resident R114's July 2025 MAR revealed that the PRN Lorazepam was used six times (7/3/25, 7/8/25, 7/18/25, 7/28/25, 7/30/25, and 7/31/25). Review of July MAR and clinical record progress notes revealed that there was no evidence of non-pharmacological interventions being attempted prior to the administration of the PRN Lorazepam six of the six times it was used. Resident R114's August 2025 MAR revealed that the PRN Lorazepam was used one time (8/5/25). Review of August MAR and clinical record progress notes revealed that there was no evidence of non-pharmacological interventions being attempted prior to the administration of the PRN Lorazepam one of one time it was used. During an interview on 8/7/25, at 1:47 p.m. the Director of Nursing confirmed that the facility lacked evidence of non-pharmacological interventions being attempted prior to the administration of a PRN anti-anxiety medication for each time it was administered. 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, review of dishwashing machine manufacturer's instructions, 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 on three of three kitchenettes observed ([NAME], Gardens, and Springs). Findings include: Review of manufacturer's instructions for the facility dishwashing machine revealed that the hot water sanitizing mode minimum wash temperature and recommended wash temperature was 150 degrees Farenheit (F). Review of the Dishwashing/Warewashing machine temperature log sheet revealed that the temperature requirements for the wash cycle was: Wash 150 degrees F. If temperatures were not met per standard, fill out work order and notify management. Observations of the dishwashing machine operation on 10/11/2023, at 1:10 p.m. on the [NAME] unit, in the presence of the Dietary Aide Employee E1, revealed a dishwasher temperature of 144.2 degrees F during the wash cycle. Dietary Aide Employee E1 confirmed, at the time of observation, that the wash cycle was lower than the required 150 degrees F. Observations of the dishwashing machine operation on 10/11/2023, at 1:12 p.m. on the Gardens unit, in the presence of the Dietary Aide Employee E2, revealed a dishwasher temperature of 147.6 degrees F during the wash cycle. Dietary Aide Employee E2 confirmed, at the time of observation, that the wash cycle was lower than the required 150 degrees F. Observations of the dishwashing machine operation on 10/11/2023, at 1:15 p.m. on the Springs unit, in the presence of the Dietary Aide Employee E3, revealed a dishwasher temperature of 146.3 degrees F during the wash cycle Dietary Aide Employee E3 confirmed, at the time of observation, that the wash cycle was lower than the required 150 degrees F. Review of Dishwashing/Warewashing machine temperature logs for the Springs, [NAME], and Gardens kitchenettes revealed that Springs kitchenette dishwashing machine logged wash temperatures below 150 degrees F for multiple days and shifts in the months of September and October 2023. During an interview on 10/11/2023, at 1:30 p.m. the Dining Manager confirmed that dishwashing machine temperatures are supposed to meet the 150 degrees F during the wash cycle. Staff recording and observing the dishwashing machine temperatures are to inform management and maintenance if the dishwashing machines do not meet the required temperatures for wash and rinse cycles. The facility did not produce a policy on monitoring and documenting dishwashing machine temperatures. 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 201.18(b)(1) Management

Based on review of facility policy and clinical records, observation, and staff interview, it was determined that the facility failed to ensure physician's orders were accurate and reflected the status and care provided to one of 24 residents reviewed (Resident R8). Findings include: Review of a facility policy entitled, Special Locking Arrangement (SLA) and Secure Care Systems, dated 1/27/22, indicated that With a signed consent and a physician's order, residents considered at risk for elopement, will be properly fitted with an ankle transmitter to be worn . Resident R8's clinical record revealed an admission date of 8/31/21, with diagnoses that included dementia (group of symptoms affecting memory, thinking and social abilities severely enough to interfere with your daily life), muscle weakness, and anemia. Review of Resident R8's clinical record revealed an elopement risk assessment completed on 11/6/22, at 3:23 p.m. that identified a transmitter was fitted to the resident on 11/6/22, due to history of wandering and making statement that they are leaving or seeking to find someone/something. Further review of Resident R8's clinical record revealed there was not a physician's order for the secure band/ankle transmitter. Observation of Resident R8 on 11/9/22, at 10:11 a.m. revealed a secure band/ankle transmitter to his/her left ankle. During an interview on 11/9/22, at 2:35 p.m. Registered Nurse (RN) Employee E1 and Licensed Practical Nurse (LPN) Employee E2 confirmed that Resident R8 had a secure band/ankle transmitter to his/her left ankle. On 11/9/22, at 2:40 p.m. RN Employee E1 and LPN Employee E2 confirmed that there was no physician's order for use of the secure care/ankle transmitter band for Resident R8. 28 Pa. Code 211.5(f) Clinical Records 28 Pa. Code 211.12 (d)(1)(5) Nursing Services