Based on facility policy and procedure review, observations and staff interview it was determined the facility failed to store food in sanitary manner in the kitchen. Findings include: Review of facility policy (unnamed and undated) regarding food storage, revealed that all food items stored in the refrigerator or freezer should be covered, labeled, dated, and discarded once expired, or beyond their use by date. Observation of facility main kitchen walk-in refrigerator #1 on January 07, 2025, at 1:00 pm revealed one container of expired lime juice that was opened without a date of first use and three unopened expired containers of lime juice. All were expired and dated for December 17, 2024. Observation of facility main kitchen walk-in refrigerator #1 revealed a case of liquid egg cartons that were dated illegibly. These eggs were inside of a case that was dated for January 05, 2025, Nursing Home Administrator and Employee E3 confirmed that the carton of eggs was illegible and discarded at the time of the findings. Observation of facility main kitchen walk-in freezer #1 on January 07, 2025, at 1:15 p.m. revealed a box with a bag of unsealed frozen salmon. Observation on January 07, 2025, at 1:15 pm in the presence of Nursing Home Administrator, Employee E3, and Employe E4 all confirmed the noted expiration dates and Employee E3 discarded these items. Interview with Employee E3 on January 07, 2025 @ 1:30 pm revealed that the expired case of liquid eggs had recently arrived from the distributer and the case was opened and dated at the facility on January 05, 2025. Interview with the Nursing Home Administrator on January 08, 2025 @ 11:00 a.m. confirmed that all food in the freezers and refrigerators were to be sealed, labeled appropriately, and dated and discarded once expired. 28 Pa. Code 211.6(f) Dietary services

Based on clinical records review and staff interview, it was determined the facility failed to follow the physician's order regarding medication for one of the 12 residents reviewed (Resident 44) Findings include: Review of Resident 44's clinical record including diagnosis list includes Diabetes (group of metabolic disorders characterized by a high blood sugar level over a prolonged period). Review of Resident 44's clinical record including physician order dated June 20, 2023, revealed an order of Novolog (fast-acting insulin) Flex Pen U-100 Inulin administered seven units subcutaneously (Insertion of medication beneath the skin by injection) with meals. Hold if blood sugar is below 180 mg/dl. Review of Resident 44's clinical record including January 2024, Medication Administration Record (MAR) revealed from January 1, 2024, until January 31, 2024, Novolog insulin was administered to the resident on the following days out of parameter: January 9, 2024, at 8:00 a.m., (BS-134 mg/dl); January 13, 2024, at 8:00 a.m., (BS-140 mg/dl); January 15, 2024, at 8:00 a.m., (BS-97 mg/dl); January 16, 2024, at 8:00 a.m., (BS- 124 mg/dl); January 18, 2024, at 8:00 a.m., (BS- 143 mg/dl); January 22, 2024, at 8:00 a.m., (BS- 108 mg/dl); January 22, 2024, at 12 noon, (BS- 165 mg/dl); January 23, 2024, at 8:00 a.m., (BS- 90 mg/dl); January 23, 2024, at 12 noon, (BS- 90 mg/dl); January 24, 2024, at 8:00 a.m., (108 mg/dl); January 25, 2024, at 8:00 a.m., (BS- 153 mg/dl); January 27, 2024, at 8:00 a.m., (BS- 102 mg/dl); January 28, 2024, at 8:00 a.m., (BS- 129 mg/dl); January 29, 2024, at 4:00 p.m., (BS- 125 mg/dl). Review of February 2024 MAR revealed that from February 1, 2024, until February 22, 2024, Novolog insulin was administered to the resident on the following days out of parameter: February 1, 2024, at 8:00 a.m., (BS- 143 mg/dl); February 2, 2024, at 8:00 a.m., (BS- 171 mg/dl); February 3, 2024, at 8:00 a.m., (BS- 172 mg/dl); February 7, 2024, at 8:00 a.m., (BS- 124 mg/dl); February 7, 2024, at noon, (BS- 156 mg/dl); and February 19, 2024, at 4:00 p.m., (BS-139 mg/dl). Review of Resident 44's clinical record revealed Resident 44 was administered Novolog Insulin outside of parameter 14 times in January 2024, and six times in February 2024. The above information was conveyed to the Director of Nursing on February 23, 2024, at 11:00 a.m. The facility failed to ensure Resident 44's insulin parameters order was followed. 28 Pa. Code 211.5(f) Clinical Records 28 Pa. Code 211.12(d)(1)(3)(5) Nursing Services

Based on clinical records review and staff interview, it was determined that the facility failed to timely follow a wound treatment recommended by the physician for one of the four residents reviewed (Resident 38). Findings include: Review of Resident 38's clinical record revealed Resident 38 had Stage three (Thickness skin loss) to the sacrum (tail bone) with a wound treatment of Medihoney (A dressing that aids and supports debridement and a moist wound healing environment in acute and chronic wounds and burns), cover with foam dressing daily. Review of Resident 38's clinical record revealed a wound consult dated December 22, 2023, revealed a new wound treatment recommendation to cleanse the sacrum with normal saline, and apply Santyl (A topical medication used for removing damaged or burned skin to allow for wound healing and growth of healthy skin) to the base of the wound then secure with a bordered foam daily and as needed. Review of Resident 38's December 2023, Treatment Administration Record (TAR) revealed that the Medihoney treatment was discontinued on December 22, 2023. A review of the same TAR revealed that the Santyl treatment recommended by the wound NP (Nurse Practitioner) on December 22, 2023, was not implemented until December 27, 2023, five days after the wound treatment was recommended. Interview with licensed nurse Employee E3 on February 23, 2024, at 10:00 a.m., revealed the Nurse Practitioner's wound treatment recommendation to discontinue previous treatment of Medihoney was followed on December 22, 2023, but the recommendation to start new treatment of Santyl to the resident sacrum was missed until the error was discovered on December 27, 2023, five days after the wound treatment order was initiated. Employee E3 reported that the staff applied skin barrier cream to the resident Stage 3 sacrum. The facility failed to ensure wound care treatment for resident 38's stage three sacral wound was followed. 28 Pa. Code 211.5(f) Clinical Records 28 Pa. Code 211.12(d)(1)(3)(5) Nursing Services