Based on facility policy review, observation, record review, and staff and resident interview, it was determined that the facility failed to provide services to maintain adequate grooming and hygiene for one of 26 sampled residents. (Resident 25) Findings include: Review of the facility policy entitled, Resident Showers/Bathing, last reviewed November 19, 2024, revealed that staff were to assist residents with hygiene needs following bathing. Clinical record review revealed that Resident 25 had diagnoses that included anxiety and osteoporosis. Review of the care plan revealed that the resident required assistance with activities of daily living (ADLs) and had fragile skin. Staff were to check fingernail length and trim and clean on bath days as needed, and her fingernails were to be kept short. On November 19, 2024, at 12:56 p.m., the resident was observed out of bed in her wheelchair. Her fingernails were long and dirty; there was a dark colored substance underneath the nails. The resident stated that her fingernails needed to be cut. On November 20, 2024, at 10:24 a.m., the resident was observed in bed, her finger nails remained long and dirty. In an interview on November 21, 2024, at 9:21 a.m., Nurse Educator 1 confirmed that the resident's fingernails should have been trimmed and cleaned with bathing and as needed. 28 Pa. Code 211.12(d)(1)(5) Nursing services.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review and resident interview, it was determined that the facility failed to provide services to enhance each resident's quality of life by offering showers as scheduled to two of 24 sampled residents. (Residents 7, 107) Findings include: Clinical record review revealed that Resident 7 had diagnoses that included hemiplegia and depression. The Minimum Data Set (MDS) assessment dated [DATE], indicated that the resident was oriented and needed substantial/maximal assistance from staff for bathing. The resident was to receive a shower twice per week on Mondays and Thursdays. During an interview on December 12, 2023, at 12:05 p.m., the resident reported that she preferred to take a shower twice a week and was not offered the opportunity to do so. Review of documentation in the clinical record revealed that the resident was not offered a shower seven of nine scheduled times from November 13, 2023, through December 11, 2023. Clinical record review revealed that Resident 107 had diagnoses that included congestive heart failure and chronic obstructive pulmonary disease. The MDS assessment dated [DATE], indicated that the resident needed substantial/maximal assistance from staff for bathing. The resident was to receive a shower twice per week on Mondays and Thursdays. During an interview on December 12, 2023, at 12:25 p.m., Resident 107 stated that she preferred to take a shower twice a week and was not offered the opportunity to do so. Review of documentation in the clinical record revealed that the resident was not offered a shower seven of eight scheduled times from November 16, 2023, through December 11, 2023. 28 Pa. Code 211.12(d)(5) Nursing services.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review and staff interview, it was determined that the facility failed to ensure that the Minimum Data Set (MDS) assessment was complete to accurately reflect the resident's status for one of 24 sampled residents. (Resident 32) Findings include: Clinical record review revealed that Sections C (Cognitive Patterns) and D (Mood) of Resident 32's MDS assessment dated [DATE], was incomplete. In an interview on December 15, 2023, 12:57 p.m., the Administrator confirmed that the identified MDS sections were not completed during the assessment period to reflect the resident's current status.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review, observation, and interview it was determined that the facility failed to provide necessary services to maintain good personal hygiene for three of 24 sampled residents. (Residents 44, 91, 116) Findings include: Clinical record review revealed that Resident 44 had diagnoses that included tremor, osteoarthritis left hand, and major depressive disorder. Review of the Minimum Data Set (MDS) assessment dated [DATE], indicated that the resident had no memory impairment and required assistance from staff with daily hygiene and grooming. Review of the current care plan revealed that staff was to provide the resident assistance with hygiene. Observations on December 12, 2023, at 2:16 p.m. and December 14, 2023, at 1:09 p.m., revealed that the resident had long and jagged fingernails with a dark brown substance under the nails. Clinical record review revealed that Resident 91 had diagnoses that included generalized muscle weakness and mild cognitive impairment and end stage renal disease. The care plan dated December 1, 2023, indicated that Resident 91 had difficulty caring for himself due to his physical and cognitive limitations and interventions included for staff to provide assistance with daily hygiene and grooming. Observations on December 13, 2023 at 12:14 p.m., and December 14, 2023 at 3:00 p.m., 2023, revealed that Resident 91's mustache had grown over his mouth, interfering with eating. Clinical record review revealed that Resident 116 had diagnoses that included fracture of right lower leg, tremor, and diabetes. Review of the MDS assessment dated [DATE], indicated that the resident had no memory impairment and required assistance from staff with daily hygiene and grooming. Review of the current care plan revealed that staff was to provide the resident assistance with hygiene. Observations on December 12, 2023, at 1:47 p.m., December 13, 2023, at 9:57 a.m., and December 14, 2023, at 1:14 p.m., revealed that the resident had thick facial hair growth. The resident stated that he needed assistance from staff to shave and had asked staff to shave his facial hair on December 11, 2023, but that staff did not provide the assistance. In an interview on December 15, 2023, at 1:57 p.m., the Administrator stated that nail care and men's facial hair shaves and trims were to be completed with shower and bathing activities and as requested. 28 Pa. Code 211.12(d)(1)(5) Nursing services.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, it was determined that the facility failed to provide a safe, clean, and comfortable environment on two of two nursing units. (First Floor, Second Floor) Findings include: During the environmental tour of the First Floor nursing unit on December 12, 2023, at various times, the following was observed: The linoleum floor was cracked, broken, and/or taped in resident rooms 125, 126, 127, 128, 132, and 133. The floor was sticky in resident room [ROOM NUMBER]. There was a urine odor in resident rooms [ROOM NUMBERS]. Toilets were soiled with a brown substance in resident rooms [ROOM NUMBERS]. There was a rusty toilet seat in resident room [ROOM NUMBER]. The first floor resident lounge refrigerator was soiled with a brown substance inside. During an environmental tour of the Second Floor nursing unit on December 14, 2023, at various times, the following was observed: The linoleum floor was taped in resident room [ROOM NUMBER]. Light bulbs were not working in resident rooms [ROOM NUMBER]. Toilets were soiled with a brown substance in resident rooms [ROOM NUMBER]. There was peeling wallpaper in resident room [ROOM NUMBER]. The lavatory faucet leaked in resident room [ROOM NUMBER]. In the multipurpose room, there were brown-stained ceiling tiles, taped cracks in the window, and the telephone was hanging loosely on the wall. 28 Pa. Code 201.18(b)(3)(e)(2.1) Management.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review, observation, and staff interview, it was determined that the facility failed to provide services and treatment to prevent further limitations in range of motion for one of 24 sampled residents. (Resident 79) Findings include: Clinical record review revealed that Resident 79 had diagnoses that included dementia, hemiplegia, and hemiparesis. The Minimum Data Set assessment dated [DATE], indicated that the resident had memory impairment, was dependent on staff for activities of daily living including dressing, and had impaired range of motion in the left upper extremity. Review of an occupational therapy Discharge summary dated [DATE], recommended that the resident wear a palm protector splint on the left hand at all times, and to only remove it for care. On November 28, 2022, the physician ordered for staff to apply a palm protector hand splint to the resident's left hand and the splint was to be in place at all times, except when receiving care. Observations on January 11, 2023, at 11:00 a.m., and January 12, 2023, at 9:50 a.m., 10:30 a.m., and 11:18 a.m., revealed that the resident was in bed without the palm protect splint to her left hand. In an interview on January 13, 2023, at 9:25 a.m., the Director of Nursing confirmed that the left hand palm protector splint was to be in place as ordered by the physician. 28 Pa. Code 211.12(d)(1)(5) Nursing Services.

Based on observation it was determined that the facility failed to maintain sanitary conditions in the kitchen. Findings include: Observation during a tour of the kitchen on January 10, 2023, at 10:40 a.m., revealed that the wall near the floor, underneath the three compartment sink was missing with exposed insulation. In the dry storage room there was a brown stain on a ceiling tile near the doorway and on the wall underneath. There was an opened, undated bag of noodles. There were two sanitizing buckets stored on top of an unsealed bag of cake mix and the milk refrigerator contained a tube draining water into a bucket of standing water.