Based on policy review, staff interview, and observation, it was determined that the facility failed to properly store food and maintain sanitary conditions in the main kitchen and in the rehabilitation unit kitchen. Findings include: Review of the facility's policy entitled, Refrigerated Storage Checkpoints, dated September 18, 2024, revealed that foods were to be labeled, dated and used by the use-by date or discarded. An interview with the Director of Dining Services (DDS) on October 29, 2024, at 10:15 a.m., revealed all opened food products were to have an opening date noted on them. Observations during the tour of the main and rehabilitation unit kitchens on October 29, 2024, at 10:14 a.m., revealed the following: In the main kitchen walk-in cooler, there was a puddle of a red liquid substance on the floor under the shelves where meat was thawing. There was a pan of sliced ham steaks that was not dated. In the walk-in freezer, there was an unwrapped chicken patty and an ice cream sandwich on the floor under the shelves. There were two dished containers of macaroni and cheese and stewed tomatoes with a use-by date of July 27. In the dry storage area, there was a sugar packet and syrup container on the floor and an opened ketchup packet that had dried ketchup splattered on the wall behind the condiment box shelves. There was a single glove on a shelf next to a container of opened shredded coconut. In the cooks' preparation area, there was a drawer with clean whisks that had a layer of food debris along the bottom of it. In the rehabilitation unit kitchen upright cooler, there was an opened container of sour cream with a use-by date of October 11, 2024, and an uncovered broken egg. In the upright freezer, there were three undated, opened bags of a cinnamon raisin bagel, sliced angel food cake, and home fries. There was a roast pork with a use-by date of October 5, 2024. In the rehabilitation dining room serving area, in the reach-in cooler, there were three undated, opened containers of orange juice concentrate, liquid egg product, and butter packages. In the reach-in freezer, there was an opened plain bag with one onion bagel in it that was not dated. In an interview on October 29, 2024, at 11:00 a.m., the DDS confirmed these items should have been dated, expired items should have been removed, and the food items were for use in the skilled areas. 28 Pa. Code 201.14(a) Responsibility of licensee.

Based on clinical record review and observation, it was determined that the facility failed to provide assistance with dining in a manner that promoted and maintained dignity to one of 13 sampled residents. (Resident 10) Findings include: Clinical record review revealed that Resident 10 had diagnoses that included dementia. According to the Minimum Data Set assessment, dated October 31, 2023, the resident was cognitively impaired and required set up assistance from staff to eat. Review of Resident 10's current care plan revealed that staff was to provide necessary assistance at meals. Observations during breakfast on November 7, 2023, and lunch on November 6 and 7, 2023, revealed the resident was eating her meals with her fingers. The resident was observed ripping pieces from a whole chicken breast and eating the pieces with her hands, scooping sliced carrots and mashed potatoes with a gravy into her mouth with her fingers, eating pancakes with syrup and slices of banana by hand, and eating whole cubes of beef in a gravy with her fingers. During the observations, the resident's fingers and hands had food and gravy or syrup on them and food was observed on her clothing protector. At no time did staff redirect or assist the resident. CFR 483.10(a) Resident Rights Previously cited 12/29/2022

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review and observation, it was determined that the facility failed to provide assistance with dining in a manner that promoted and maintained dignity for one of 12 sampled residents. (Resident 20) Findings include: Clinical record review revealed that Resident 20 had diagnoses that included dementia, depression, and dysphagia. Review of the Minimum Data Set assessment dated [DATE], revealed that the resident had cognitive impairment and required extensive assistance from staff for activities of daily living. A physician's order dated December 5, 2022, directed staff to provide regular utensils, not plastic. On December 27, 2022, at 1:18 p.m., Resident 20 was observed in the dining room. The resident was eating food from a bowl with her fingers, there was a plastic spoon observed on Resident 20's lap. At 1:26 p.m., Nurse Aide (NA) 1 retrieved the plastic spoon from Resident 20's lap and proceeded to feed the resident while standing. NA 1 continued to feed the resident while standing until her meal was completed at 1:35 p.m. 28 Pa. Code 201.29(j) Resident rights. 28 Pa. Code 201.12(d)(1)(5) Nursing services.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on facility policy review, clinical record review, and staff interview it was determined that the facility failed to thoroughly investigate alleged violations of abuse for one of 12 sampled residents. (Resident 10) Findings include: Review of the facility policy entitled, Resident Abuse and Neglect Prevention Policy, last reviewed July 21, 2022, revealed that all reported instances of abuse would be promptly investigated. Clinical record review revealed that Resident 10 was admitted to the facility on [DATE], with diagnoses that included dementia, depression, and anxiety. Review of the Minimum Data Set assessment dated [DATE], revealed that the resident had no cognitive impairment and exhibited behavioral symptoms not directed at others on one to three days during the review period. On May 19, 2022, a nurse documented that Resident 10 grabbed a female resident's hand and placed it over his private area. On May 19, 2022, a nurse also documented that Resident 10 was observed caressing a resident inside her thighs. On June 20, 2022, a nurse documented that Resident 10 was observed standing over a female resident who stated the resident touched her shoulder and asked her to have sex. On September 7, November 6, 7, 9 and 23, 2022, nurses documented that Resident 10 was following female residents and making sexual comments. There is no documented evidence that these incidents were thoroughly investigated. In an interview on December 29, 2022, at 10:04 a.m., the Director of Nursing confirmed the alleged violations of resident-to-resident abuse were received but were not investigated. 28 Pa. Code 211.12(d)(5) Nursing services.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review, resident interview, and staff interview, it was determined that the facility failed to provide treatment and services to prevent further limitations in range of motion for two of 12 sampled residents. (Resident 23, 25) Findings include: Clinical record review revealed that Resident 23 had diagnoses that included unsteadiness on feet, muscle weakness, abnormalities of gait and mobility, and malnutrition. Review of the Minimum Data Set (MDS) assessment dated [DATE], revealed that Resident 23 had no cognitive impairment and required extensive assistance with transfers. Review of the care plan revealed Resident 23 received a restorative nursing program (RNP) to prevent decline in mobility. The intervention was for staff to assist her to ambulate (walk) to and from the dining room three times a day. In an interview on December 27, 2022, at 11:28 a.m., Resident 23 stated that staff does not walk her. There was no documented evidence that Resident 23 was ambulated or offered to ambulate 24 out of 26 times in December 2022. In an interview on December 29, 2022, at 1:12 p.m., the Director of Nursing (DON) confirmed there was no documentation that Resident 23 was ambulated or offered to ambulate. Clinical record review revealed that Resident 25 had diagnoses that included dementia, anxiety, abnormal posture, and muscle weakness. Review of the MDS assessment dated [DATE], revealed that the resident required extensive assistance from staff for activities of daily living and had limitations in range of motion to both lower extremities (hip, knee, ankle, foot). Review of the care plan revealed the resident was at risk for deterioration in functional abilities. The intervention was for staff to follow therapy recommendations. Review of a physical therapy Discharge summary dated [DATE], revealed that the therapist recommended a RNP for active and passive range of motion for Resident 25. There was no evidence that a RNP was implemented per the therapist's recommendations. In an interview on December 29, 2022, at 10:05 a.m., the DON stated the the RNP was not implemented per the therapists recommendation. 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services.