Based on facility policy review, observations, clinical record review, and staff interviews, it was determined that the facility failed to maintain adequate personal hygiene and grooming of residents dependent on staff for assistance with these activities of daily living for two of two residents reviewed (Residents 6 and 64).Findings include: Review of facility policy, titled Activities of Daily Living (ADLs), with a last review date of January 2025, revealed Care and services will be provided for the following activities of daily living: 1. Bathing, dressing, grooming and oral care; and 3. A resident who is unable to carry out activities of daily living will receive the necessary services to maintain good nutrition, grooming, and personal and oral hygiene. Review of Resident 6's clinical record revealed diagnoses that included dementia (a chronic disorder of the mental processes caused by brain disease, and marked by memory disorders, personality changes, and impaired reasoning), Parkinson's disease (long term degenerative disorder of the central nervous system that mainly affects the motor system), and lack of coordination. Review of Resident 6's care plan revealed a focus for ADL Care Plan: Alteration in self-care related to Parkinson's, limited mobility, cognitive deficit with a last revised date of March 3, 2023. Interventions included, but were not limited to, Grooming: Dependent with shampoo, shave, nail care with a last revision date of November 30, 2024. Observation of Resident 6 on August 18, 2025, at 12:25 PM, revealed that she was up in her chair in the unit common area. She had visual facial hair noted on her upper lip. Follow-up observations of Resident 6 on August 19, 2025, at 9:53 AM, in the unit common area; August 20, 2025, at 12:12 PM, in the unit dining room; and August 21, 2025, at 9:37 AM, in the unit common area, all revealed that she was well-groomed with visual facial hair noted on her upper lip. During a staff interview with Employee 7 (Nurse Aide assigned to Resident 6) on August 21, 2025, at 9:42 AM, Employee 7 indicated that residents are usually shaved on shower days and that residents and/or their families can ask between showers if needed. Review of facility provided documentation revealed that Resident 6's bath/shower schedule was Monday and Thursday on day shift. Review of Resident 6's August care task documentation revealed that she had received personal hygiene every shift and failed to reveal any documentation of refusals of care. Review of Resident 64's clinical record revealed diagnoses that included hemiplegia (paralysis of one side of body) and hemiparesis (muscle weakness on one side of the body) following a cerebral infarction (CVA-a stroke-damage to the brain from interruption of its blood supply) affecting right dominant side, dementia, and generalized muscle weakness. Review of Resident 64's care plan revealed a focus for ADL Care Plan: Alteration in self-care related to weakness, dementia, CVA with hemiplegia with a last revision date of August 8, 2024. Interventions included, but were not limited to, Grooming: Assistance required with shampoo, shave, nail care with an initiated date of November 27, 2024. Observation of Resident 64 on August 19, 2025, at 10:50 AM, revealed that she was up in her chair in the unit common area. She had visual facial hair noted on her chin. Follow-up observations of Resident 64 on August 20, 2025, at 9:15 AM, in the unit common area; and August 21, 2025, at 9:38 AM, in the unit common area, revealed that she was well-groomed with visual facial hair noted on her chin. Review of facility provided documentation revealed that Resident 64's bath/shower schedule was Wednesday and Saturday on evening shift. Review of Resident 64's August care task documentation revealed that she had received personal hygiene every shift and failed to reveal any documentation of refusals of care. During a staff interview with the Nursing Home Administrator, the Assistant Nursing Home Administrator (ANHA), and the Director of Nursing (DON) on August 21, 2025, at 11:36 AM, the DON confirmed that Residents 6 and 64 should have been shaved on their shower days, or at least offered and documented if they refused. The ANHA indicated that Residents 6 and 64 had now been shaved. 28 Pa. Code 211.10(d) Resident care policies28 Pa. Code 211.12(d)(1)(2)(5) Nursing services

Based on review of facility policy, observations, and staff interviews, it was determined that the facility failed to maintain an effective infection control program related to the preparation and administration of medications for two Residents observed (Residents 3 and 55).Findings include: Review of facility policy, titled IIB2: Oral Medication Administration, with a last review date of January 2025, revealed C. For solid medications: 1) Pour or push the correct number of tablets or capsules into the souffle cup, taking care to avoid touching the tablet or capsule, unless wearing gloves. During a medication pass observation on August 20, 2025, between 9:22 AM and 9:30 AM, Employee 6 was observed preparing and administering medications to Residents 3 and 55. When preparing medications, Employee 6 was observed using an ink pen to poke a hole in the back of the pill pouch on each blister pack, and then used the ink pen to poke the pill through from the front of the blister pack into the medication cup. She prepared and administered six medications to Resident 3, and 10 medications to Resident 55. During a staff interview with Employee 6 on August 20, 2025, at 9:40 AM, Employee 6 confirmed that she had used the pen to poke the back of the blister pack and could not be sure that the pen did not touch the pills. She said that the pills are hard to push through the blister pouches sometimes, and sometimes the back of the blister pack falls into the medication cup. During a staff interview with the Nursing Home Administrator, the Assistant Nursing Home Administrator, and the Director of Nursing (DON) on August 20, 2025, at 2:00 PM, the DON confirmed that Employee 6 should not have been using her ink pen to poke holes into the back of the medication blister packs to remove medications. 28 Pa. Code 211.10(d) Resident care policies28 Pa. Code 211.12(d)(1)(2)(5) Nursing services

Based on facility policy review, clinical record reviews, and staff interviews, it was determined that the facility failed to provide the highest practical well-being by not following physician orders for three of 22 residents reviewed (Residents 3, 8, and 84).Findings include: Review of Resident 3's clinical record revealed diagnoses that included dependence on renal dialysis (an artificial process for removing waste products and excess fluids from the body that is needed when the kidneys are not functioning properly), hypertension (high blood pressure), and weakness. Review of Resident 3's physician orders revealed an order for Midodrine HCl Oral Tablet 5 mg, Give 2 tablets by mouth every 8 hours as needed for hypotension (low blood pressure), give for SBP (systolic blood pressure) less than 120, with a start date May 5, 2025. Review of Resident 3's clinical record revealed a document titled Physician Orders with an order dated May 5, 2025, that read, Change Midodrine to 10 mg PRN (as needed) for SBP <120. Further review of Resident 3's clinical record revealed her SBP measure was below 120 on May 27; June 6, 25, 29; July 8; and August 13, 2025. Review of Resident 3's May-August 2025 MAR (Medication Administration Record- documentation for treatments/medication administered or monitored), revealed she did not receive any doses of the PRN midodrine order on May 27; June 6, 25, 29; July 8; and August 13, 2025. Interview with Employee 2 (Registered Nurse) on August 21, 2025, at 11:04 AM, she revealed the midodrine should have been given on the aforementioned dates and those were medication errors. During an interview with the Director of Nursing (DON) on August 21, 2025, at 11:39 AM, she revealed she would expect medications to be given per physician orders. Review of Resident 8's clinical record revealed diagnoses that included hemiplegia (paralysis of one side of body) and hemiparesis (muscle weakness on one side of the body) following a cerebral infarction (a stroke-damage to the brain from interruption of its blood supply) affecting left non-dominant side, enterocolitis (inflammation of the digestive tract) due to clostridium difficile (a bacteria that causes an infection of the colon, the longest part of the large intestine), and dementia (a chronic disorder of the mental processes caused by brain disease, and marked by memory disorders, personality changes, and impaired reasoning). Review of Resident 8's clinical record revealed that her medication regimen was reviewed by the facility pharmacist on April 28, 2025. Review of the facility provided Consultant Pharmacist's Medication Regimen Review form revealed that the pharmacist noted that according to the MAR [Medication Administration Record] in PCC [Point Click Care-the facility's electronic health record] no vancomycin doses are scheduled to be administered on 5/9/2025, 5/17/25-5/24/25 or 6/1/2025-6/7/2025. There was a written notation in the Follow-Through section on this report that indicated transcribed correctly in PCC with no signature or date noted. Review of Resident 8's physician order history revealed the following orders dated April 14 2025: vancomycin 50mg/ml give 2.5 ml via PEG every 6 hours for 10 days (start on April 15, 2025 and stop on April 25, 2025); then give 2.5 ml every 8 hours for 7 days (start on April 25, 2025, and stop on May 2, 2025); then give 2.5 ml every 12 hours for 7 days (start on May 2, 2025, and stop on May 9, 2025); then give 2.5 ml daily for 7 days (start on May 10, 2025, and stop on May 17, 2025); then give 2.5 ml every 48 hours (start on May 25, 2025, and stop on June 1 , 2025); then give 2.5ml every 72 hours (start on June 8, 2025, and stop on June 15, 2025). There was no order entered for the week of May 17-24, 2025. Review of Resident 8's May 2025 MAR revealed that she received no doses of vancomycin on May 9, 2025. In addition, there was no entry for vancomycin to be delivered between May 17-May 24, 2025. During a staff interview with Employee 3 and Employee 4 on August 21, 2025, at 10:20 AM, Employee 3 confirmed that she had transcribed the order incorrectly and therefore Resident 8 did not receive all ordered doses of the vancomycin. She confirmed that Resident 8 did not receive any vancomycin on May 9, 2025, a total of 2 missed doses. She further indicated that during the week of May 18-24, 2025, Resident 8 should have started the every 48 hour dose and that the week of June 1-8, 2025, Resident 8 should have started the every 72 hour dose. She confirmed that Resident 8 missed a dose on May 19 and 21, 2025, a total of 2 missed doses as Resident 8 was transferred to the hospital for an acute illness on May 22, 2025, and did not return to the facility until June 3, 2025, at which time Resident 8's medication orders changed. During a staff interview with the Nursing Home Administrator, the Assistant Nursing Home Administrator, and the DON on August 21, 2025, at 11:36 AM, the DON confirmed that she would have expected Resident 8's medication order to have been transcribed correctly so that Resident 8 would have received her ordered doses of medications. Review of Resident 84's clinical record revealed diagnoses that included chronic kidney disease (when damaged kidneys cannot filter blood properly) and diabetes (a disease causing high blood sugar due to insufficient insulin production or ineffective insulin use). Review of the facility policy, titled Insulin Administration with a last revised and reviewed date of January 2025, revealed 1. All insulins will be administered in accordance with physician's orders. Review of Resident 84's clinical record revealed a physician's order for Basaglar KwikPen Subcutaneous Solution Pen injector, 100 unit per milliliter (ml) (insulin glargine), inject 36 unit subcutaneously in the morning related to type 2 diabetes mellitus, give half dose if not eating or blood sugar is less than 100; with a start date of May, 19, 2024. Review of Resident 84's July 2025 Medication Administration Record (MAR) revealed that on July 1, 2025, at 9:00 AM, Resident 84 had a blood sugar level of 98, and it was documented that 36 units of insulin was administered. On July 23, 2025, at 9:00 AM, Resident 84 had a blood sugar level of 108, and 18 units of insulin was administered. On July 25, 2025, at 9:00 AM, Resident 84 had a blood sugar level of 114, and 18 units of insulin was administered. Further review of Resident 84's clinical record revealed a physician's order for Novolog solution 100 unit per ml (insulin aspart), inject 8 unit subcutaneously with meals related to type 2 diabetes mellitus, give 4 units if blood sugar is less than 110; hold if less than 90; with a start date of January 4, 2024. Review of Resident 84's July 2025 MAR, revealed that on July 26, 2025, at 8:00 AM, Resident 84 had a blood sugar level of 103, and 8 units of insulin was administered. On July 26, 2025, at 5:00 PM, Resident 84 had a blood sugar level of 131, and it was documented that they were administered 0 units of insulin. On July 30, 2025, Resident 84 had a blood sugar level of 96, and 6 units of insulin was administered. During an interview with the DON and Nursing Home Administrator on August 21, 2025, at 11:35 AM, they revealed they would have expected Resident 84 to have been administered the correct dosage of insulin as per physician's order. 28 Pa. Code 201.18(b)(1) Management28 Pa. Code 211.12(c)(d)(1)(3)(5) Nursing services

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review, observation, and resident and staff interviews, it was determined that the facility failed to ensure that the resident assessment accurately reflected the resident's status for two of 19 residents reviewed (Residents 28 and 66). Findings Include: Review of Resident 28's clinical record revealed diagnoses that included chronic kidney disease (CKD - when a disease or condition impairs kidney function, causing kidney damage to worsen over several months or years) and heart failure (when the heart muscle doesn't pump blood as well as it should). Observation of Resident 28 on September 9, 2024, at 10:09 AM, revealed Resident 28 sitting in her room with a CPAP (continuous positive airway pressure - a machine that uses mild air pressure to keep breathing airways open while you sleep) on her bedside table. Resident 28 revealed she uses it daily. Review of Resident 28's clinical record revealed a progress note dated July 27, 2024, at 7:23 AM, indicating Resident 28 slept with her CPAP on throughout the night. Review of Resident 28's clinical record revealed a progress note dated July 28, 2024, at 6:44 AM, indicating Resident 28's CPAP functioning and in place. Review of Resident 28's MDS (Minimum Data Set is part of the federally mandated process for clinical assessment of all Medicare and Medicaid certified nursing homes) dated August 2, 2024, revealed that Section O0110. G1. Non-invasive Mechanical Ventilator was marked No. During an interview with the Director of Nursing (DON) on September 12, 2024, at 9:30 AM, revealed that the facility was unaware of Resident 28 having a CPAP, and that a modification MDS has been initiated to reflect that Resident 28 was using a non-invasive mechanical ventilator during the look back period on the MDS, dated [DATE]. Review of Resident 66's clinical record revealed diagnoses that included dementia (a chronic disorder of the mental processes caused by brain disease, marked by memory disorders, personality changes, and impaired reasoning), pressure ulcer of sacral region (a wound that occurs from prolonged pressure on your skin), and hypertension (high blood pressure). Review of Resident 66's physician orders revealed an order for Diabetic Supplement three times a day for skin support, with a start date of June 19, 2024, and discontinued on August 15, 2024. Review of Resident 66's Quarterly MDS with ARD (assessment reference date- last day of assessment period) of July 5, 2024; Modification of Quarterly MDS with ARD of July 5, 2024; and Significant Change MDS with ARD of August 7, 2024; revealed Resident 66 was marked no for nutrition or hydration intervention to manage skin problems on all three assessments. Interview with Employee 3 (Registered Nurse Assessment Coordinator) on September 11, 2024, at 1:06 PM, revealed the aforementioned MDS assessments were coded inaccurately and they have now been modified. Interview with the DON on September 11, 2024, at 1:48 PM, revealed she would expect resident MDS assessments to be coded accurately. 28 Pa. Code 211.5(f) Medical Records 28 Pa Code 211.12 (d)(3)(5) Nursing Services

Based on facility policy review, clinical record review, and resident and staff interviews, it was determined that the facility failed to ensure residents with limited mobility received appropriate services, equipment, and assistance to maintain or improve mobility for two of nine residents reviewed for limited range of motion (Residents 30 and 40). Findings include: Review of facility policy, titled Restorative Nursing Programs, dated April 16, 2022, read, in part, It is the policy of this facility to provide maintenance and restorative services designed to maintain or improve a resident's abilities to the highest practicable level. Restorative aides will implement the plan for a designated length of time, performing the activities, and documenting on the Restorative Aide Documentation Form. Review of Resident 30's clinical record revealed diagnoses that included cerebrovascular accident (CVA- poor blood flow to the brain that causes cell death), hemiplegia (one-sided paralysis or weakness caused by brain or spinal cord problems), and muscle weakness. Interview with Resident 30 on September 9, 2024, at 10:03 AM, revealed he had been in therapy before, but he was not sure if he is on a restorative nursing program (RNP). Review of Resident 30's care plan revealed a focus area ADL Care Plan: Alteration in self-care r/t [related to] CVA with left hemiplegia and ambulatory dysfunction, last revised January 9, 2024, with an intervention for Restorative - Passive ROM Program- [Resident 30] is at risk for decline in functional mobility, joint flexibility and contracture development. Goal: To help maintain participation in functional mobility, maintain flexibility and prevent contractures. Maintain comfort level and quality of life, initiated on October 30, 2023. Review of Resident 30's PROM nurse aid task documentation from January 2024 to September 10, 2024, failed to reveal documentation to indicate the RNP program was implemented 25 times on day shift and 11 times on evening shift. Review of Resident 40's clinical record revealed diagnoses that included muscle weakness, chronic pain, and major depressive disorder (a mood disorder that causes a persistent feeling of sadness and loss of interest in things). Review of Resident 40's nurse aide task documentation on September 10, 2024, revealed the following tasks: Restorative - Transfer Program- [Resident 40] is at risk for decline in functional mobility skills and tasks and at risk for contracture development. GOAL: To help prevent decline in functional mobility skills and tasks. Maintain flexibility as much as possible. Restorative - Splint Assistance Program - [Resident 40] is to wear palm protector to left hand. Goal: [Resident 40] will not develop a contracture of left hand or limited range of motion. Review of Resident 40's nurse aid task documentation from January 2024 to September 10, 2024, failed to reveal documentation to indicate the Transfer RNP program was implemented 51 times on day shift and 73 times on evening shift. Review of Resident 40's nurse aid task documentation from January 2024 to September 10, 2024, failed to reveal documentation to indicate the Splint RNP program was implemented 44 times on day shift and 81 times on evening shift. Review of Resident 40's care plan on September 10, 2024, failed to reveal the current splint RNP program on her care plan. During an interview with the Director of Nursing (DON) on September 11, 2024, at 1:46 PM, the surveyor questioned the missing RNP documentation for Residents 30 and 40. Email correspondence with the DON on September 11, 2024, at 5:36 PM, revealed The RNP programs on [Resident 30] and [Resident 40] were documentation errors that should have stated refused. During an interview with the DON on September 12, 2024, at 10:40 AM, the surveyor revealed the concern with the inaccurate and lack of documentation for Resident 30's and 40's RNP programs, and that Resident 40's care plan was not updated with her current RNP program. The DON revealed her expectation for documentation in the clinical record to be accurate. 28 Pa. Code 211.10(d)(a) Resident care policies 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services

Based on observation, clinical record review, and staff interviews, it was determined that the facility failed to ensure that the resident assessment accurately reflected the resident's status for two of 21 residents reviewed (Residents 70 and 85). Findings include: Review of Resident 70's clinical record revealed diagnoses that included Alzheimer's with early onset (gradually progressive brain disorder that causes problems with memory, thinking, and behavior) and anxiety disorder (mental disorder characterized by feelings of worry about future events and/or fear in reaction to current events). Observation of Resident 70 on October 30, 2023, at 9:39 AM, revealed her wandering throughout the nursing unit. Review of Resident 70's current plan of care revealed that she had a care plan for elopement, where it was noted that she is a wanderer and wanders aimlessly. This information was updated to Resident 70's care plan on October 2, 2023. Review of Resident 70's behavior tracking documentation revealed that she exhibited wandering behavior on October 4, 2023. Review of Resident 70's October 6, 2023, quarterly MDS (Minimum Data Set - an assessment tool to review all care areas specific to the resident such as a resident's physical, mental, or psychosocial needs) revealed that this assessment was not coded to indicate that Resident 70 exhibited wandering behavior during the look back period (seven day period prior to the assessment date). During an interview with the Nursing Home Administrator (NHA) on November 2, 2023, at 1:28 PM, he agreed that the MDS assessment should have been coded to indicate that Resident 70 exhibited wandering behavior. Review of Resident 85's clinical record revealed diagnoses that included Parkinson's disease (long-term movement disorder where the brain cells that control movement start to die and cause changes in how one moves, feels, and acts) and dementia (loss of memory, language, problem-solving, and other thinking abilities that are severe enough to interfere with daily life). Review of nursing progress note dated July 28, 2023, revealed Resident 85 experienced a fall on that date, where she obtained a laceration to her right pointer finger and a hematoma (localized collection of blood outside the blood vessels, due to either disease or trauma including injury or surgery, and may involve blood continuing to seep from broken capillaries) to her left forehead. Review of Resident 85's August 23, 2023 quarterly MDS revealed that it was not coded to indicate that Resident 85 experienced any fall with injury since the prior assessment was completed. Review of Resident 85's assessment submissions revealed that the prior applicable assessment was completed on May 26, 2023. During an interview with the NHA on November 2, 2023, at 11:58 AM, he confirmed that Resident 85's August 23, 2023, MDS was coded incorrectly. 28 Pa. Code 211.12(d)(1)(5) Nursing services

Based on observation, facility policy review, clinical record review, and staff interviews, it was determined that the facility failed to ensure that residents receive necessary treatment and services, consistent with professional standards of practice, to promote healing and prevent infection of a pressure ulcer for one of two residents reviewed for pressure ulcers (Resident 16). Findings Include: Review of facility policy, titled Wound Care and Dressing Change, revised January 2020, revealed Clean portion of surface before placing supplies on table. Wash hands and don gloves .Undress wound, assess area and cleanse and appropriately dispose of soiled dressing. Remove gloves and sanitize hands. [NAME] new gloves. Apply new treatment as ordered. Review of Resident 16's clinical record revealed diagnoses that included dementia (a group of thinking and social symptoms that interferes with daily functioning) and stage 4 pressure ulcer of the sacrum (localized damage to the skin and/or underlying soft tissue usually over a bony prominence; stage 4 is full-thickness skin and tissue loss). Review of Resident 16's current physician orders revealed a treatment order dated October 21, 2023, to cleanse the sacral pressure ulcer with sea cleanse (a saline-based solution for cleansing and irrigating acute and chronic wounds), apply Mesalt to wound (a type of dressing used for wound healing), and cover with foam. Observation of Resident 16's wound care on November 1, 2023, at 8:12 AM, revealed Employee 2 (Registered Nurse) cleansed Resident 16's bedside table. Employee 2 then applied gloves. Employee 2 did not perform hand hygiene prior to applying the gloves. Employee 2 then removed Resident 16's old dressing and discarded it. Next, Employee 2 removed her gloves and applied new gloves. Employee 2 did not perform hand hygiene after removing her old gloves and prior to applying new gloves. Employee 2 then cleansed Resident 16's wound with sea cleanse, removed her gloves, and applied new gloves. Employee 2 did not perform hand hygiene after removing her old gloves and prior to applying new gloves. Employee 2 then applied Mesalt to Resident 16's wound bed and applied the foam dressing. At the conclusion of the wound care, Employee 2 removed her gloves and performed hand hygiene. During an interview with the Nursing Home Administrator and Director of Nursing (DON) on November 2, 2023, at 1:28 PM, the DON stated that hand hygiene should have been performed between glove changes. 28 Pa. Code 211.12(d)(1)(2)(3)(5) Nursing services

Based on observations, facility policy review, clinical record review, and staff interviews, it was determined that the facility failed to maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the transmission of communicable diseases and infections for three of 21 residents reviewed (Residents 13, 16, and 61). Findings include: Review of facility provided policy, titled Homeland Center Infection Prevention and Control Manual, Transmission-Based Precaution, dated 2021, revealed, It is essential both to communicate transmission-based precautions to all health care personnel and for personnel to comply with requirements. Pertinent signage (i.e., isolation precautions) and verbal reporting between staff can enhance compliance with transmission-based precautions to help minimize the transmission of infections within the facility. Review of Resident 13's medical record revealed diagnoses that included urinary tract infection (UTI - an infection in any part of the urinary system) and Chronic obstructive pulmonary disease (COPD - a common, preventable, and treatable disease that is characterized by persistent respiratory symptoms like progressive breathlessness and cough). Review of Resident 13's medical record revealed a urine culture and sensitivity result that was positive for Escherichia coli (E. coli- a bacterial infection) that was reported on October 29, 2023, at 10:48 AM. Observation of Resident 13's room on October 30, 2023, at 1:27 PM, revealed a PPE (personal protective equipment) caddie being hung on the Resident's door. Further observation revealed that no signage was hung with instructions on what type of precautions needed to be followed or what PPE should be used. Further observation of Resident 13's room on October 31, 2023, at 8:15 AM, revealed that no signage was hung with instructions on what type of precautions needed to be followed or what PPE should be used at that time. Review of Resident 13's physician's orders on November 1, 2023, revealed a current physician order for contact isolation for seven days to start on October 30, 2023, at 4:00 PM. Interview with the Director of Nursing (DON) on November 2, 2023, at 1:31 PM, revealed that the facility should have had signage hanging outside of Resident 13's room indicating what type of PPE needed to be used. Review of Resident 16's clinical record revealed diagnoses that included dementia (a group of thinking and social symptoms that interferes with daily functioning) and stage 4 pressure ulcer of the sacrum (localized damage to the skin and/or underlying soft tissue usually over a bony prominence; stage 4 is full-thickness skin and tissue loss). Observation of Resident 16's wound care on November 1, 2023, at 8:12 AM, revealed Employee 2 (Registered Nurse) removing Resident 16's old, soiled dressing and placing it in the trashcan. Observation of the old dressing revealed wound drainage present. At the conclusion of the dressing change, Employee 2 left the room, but did not remove the trash, with the soiled dressing in it, from Resident 16's room. During an interview with Employee 3 (Registered Nurse, Infection Preventionist) on November 2, 2023, at 9:33 AM, Employee 3 stated that, at the conclusion of wound care, the nurse should tie the trash bag shut, remove it from the room, and take it to the soiled utility room. During an interview with the Nursing Home Administrator (NHA) and DON on November 2, 2023, at 1:28 PM, the DON stated that the trash bag with the soiled dressing should have been removed from Resident 16's room at the conclusion of the dressing change. Review of Resident 61's clinical record revealed diagnoses that included UTI and hypertension (elevated blood pressure). Review of Resident 61's nursing progress notes revealed a note on October 27, 2023, stating that the Resident's urine culture returned positive for UTI and VRE (vancomycin-resistant Enterococcus; an infection with bacteria that are resistant to the antibiotic called vancomycin), and that Resident 61 was placed on contact isolation. Review of Resident 61's physician orders revealed an order dated October 27, 2023, to write a progress note every shift related to antibiotic usage for UTI VRE and contact isolation. Observation of Resident 61's room on October 30, 2023, at 11:29 AM and again at 1:56 PM, revealed a PPE caddy hanging just inside Resident 61's room. Further observations failed to reveal any signage on the outside of Resident 61's room stating that Resident 61 was on contact precautions. Observation of Resident 61's room on October 31, 2023, at 9:03 AM, revealed the PPE caddy present, but no signage present. Observation on October 31, 2023, at 9:46 AM, revealed a contact precautions sign had been placed on the outside of Resident 61's room. During an interview with the NHA and DON on November 1, 2023, at approximately 1:15 PM, they were made aware of Resident 61 not having contact precaution signage outside of his room until October 31, 2023, at 9:46 AM. During an interview with Employee 3 on November 2, 2023, at 9:31 AM, Employee 3 stated that signage should be placed at the same time the PPE caddy is placed. During a follow up interview with the NHA and DON on November 2, 2023, at 12:06 PM, they were again made aware of the surveyor's concern with the lack of contact precautions signage for Resident 61's room. The NHA stated he had a concern with that as well. 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services