Based on clinical record review, observations, and staff interview, it was determined that the facility failed to implement physicians' orders for two of 18 sampled residents. (Residents 25, 219) Findings include: Clinical record review revealed that Resident 25 had diagnoses that included Parkinson's disease and hypotension (low blood pressure). A physician's order dated February 18, 2025, directed staff to administer a medication (midodrine hydrochloride) three times a day for hypotension. The medication was to be held if the resident's systolic blood pressure (SBP, the first measurement of blood pressure when the heart beats and the pressure is at its highest) was greater than 140 millimeters of mercury (mm/Hg). Review of Resident 25's medication administration record revealed that staff administered the medication one time in April 2025, once in May 2025, and once in June 2025, when the resident's SBP was greater than 140 mm/Hg. The medication was withheld and should have been administered twice in May 2025 when the resident's SBP was below 140 mm/Hg. Clinical record review revealed that Resident 219 had diagnoses that included heart failure and diabetes. A review of a nursing note from June 30, 2025, revealed the resident was alert, oriented, and able to make his needs know. A physician's order dated June 30, 2025, directed staff to apply compression stockings in the mornings and take them off at bedtime. A nutrition note dated June 30, 2025, indicated that Resident 219 had mild edema in his bilateral lower extremities, was prescribed a diuretic medication, and had orders to wear the compression stockings to his lower extremities. Observations on July 1, 2025, at 11:18 a.m., from 12:15 p.m. to 12:45 p.m., and at 1:45 p.m., revealed Resident 219 was not wearing compression stockings. Observations on July 2, 2025, at 12:13 p.m., revealed Resident 219 was wearing his compression stockings. In an interview with the resident and his family member, it was revealed that was the first time he wore the compression stockings since admission to the facility. In an interview on July 3, 2025, at 9:36 a.m., and 10:00 a.m., the Administrator confirmed that medications were administered outside of the established parameters for Resident 25 and that the compression stockings should have been on Resident 219. 28 Pa. Code 211.12(d)(1)(5) Nursing services.

Based on policy review, observations, and staff interview, it was determined that the facility failed to properly serve food and maintain sanitary conditions in the one of two dining rooms. (First floor dining room) Findings include: Review of the facility policy entitled, Personal Appearance Standards, last reviewed March 11, 2025, revealed that male staff with facial hair, moustache, and/or beard, must wear a beard guard while in the production kitchen, and defines the production kitchen as the area as where food is prepared or plated from a hot or cold workstation. Observation of meal service in the first-floor production kitchen on July 1, 2025, from 12:15 p.m. to 12:45 p.m., and July 2, 2025, at 8:20 a.m. to 8:35 a.m., revealed the Nutrition Service Manager had a beard, was working in the production kitchen during the lunch and breakfast meal services, and was not observed wearing a beard guard. Observations on July 2, 2025, from 12:10 p.m. to 12:30 p.m., revealed the Nutrition Service Manager was working in the production kitchen during the lunch meal service and was wearing a surgical mask. His facial hair was observed uncovered out of the sides of the mask. In an interview on July 3, 2025, at 9:30 a.m., the Administrator stated that the Nutrition Service Manager should have had a beard guard on in the production kitchen. 28 Pa. Code 201.18(b)(3) Management.

Based on review of facility policy, observation, and staff interview, it was determined that the facility failed to maintain sanitary conditions in the dietary department. Findings include: Review of the facility policy entitled Cleaning and Sanitation Culinary Nutrition Department, last reviewed April 11, 2023, revealed that a regular schedule of cleaning was to be developed and posted for employees to maintain cleanliness and sanitation of the culinary nutrition services department. The procedure was for the culinary services manager to initiate the cleaning schedule and supervise employee compliance to the schedule. All cleaning tasks were to be checked nightly to ensure that they met standards. Observations during the environmental tour of the kitchen on July 11, 2023, at 9:34 a.m., revealed the following: The steel back splash of the main service oven was splattered and stained with a black substance behind the burners on the stove. The fryer was soiled with grease and oil. The warmer device located over the fryer was also soiled with grease and oil. The main grill had heavily soiled rags that were stored beneath the grill in a dry metal bin. The rags were not in any type of sanitizing solution. The main grill was soiled with a black substance. The ceramic tiles behind the walls of the main cooking area were soiled with splattered grease and oil. The floors were soiled with crumbs and debris behind, around and on the sides of the ovens. There was a steel divider between the ovens that was also soiled and stained with a black substance. Further observations revealed that there was a second main service oven on the other side of the kitchen that was heavily soiled with a black substance on the outside of the doors, front of the oven and tops of the oven doors. The inside of this oven was also soiled with crumbs and a black substance. All four convection ovens were heavily soiled with grease and burnt crumbs on the bottom, inside and outside of the ovens. The baking racks inside the ovens were soiled. The glass doors on all four ovens were covered with grease and dark substances. In an interview on July 11, 2023, at 10:00 a.m., the Director of Culinary and Nutritional Services stated that the ovens were to be cleaned weekly. The Director confirmed that the ovens, floors and walls observed during this environmental tour were soiled and in need of cleaning. CFR 483.60(i)(1)(2) Food Procurement, Store/Prepare/Serve-Sanitary Previously cited 8/12/22 28 Pa. Code 201.18(b)(1)(3) Management. 28 Pa. Code 207.2(a) Administrator's responsibility.