**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based upon clinical record review and staff interview, it was determined the facility failed to ensure accurate Minimum Data Set Assessments were completed for one of 12 residents reviewed (Resident 14). Findings include: Review of Resident 14's clinical record revealed diagnoses including End Stage Renal Disease (failure of kidney function to remove toxins from the blood). Review of Resident 14's Quarterly Minimum Data Set (MDS - periodic assessment of resident needs) dated Mach 17, 2025 failed to reveal Resident 14's diagnosis of End Stage Renal Disease. Interview with Licensed Employee E3 on June 12, 2025, at 11:43 a.m. confirmed Resident 14's Quarterly MDS dated [DATE], was inaccurately completed. 28 Pa. Code 211.5(f) Clinical Records

Based on review of clinical records and staff interviews, it was determined the facility failed to ensure that fluid restriction physician's orders were followed for one of one residents reviewed. (Resident 10) Findings include: A review of the facility's policy titled Diets and Menus, Subject: Fluid Restrictions revised 5/2023 revealed Nursing will document fluid restrictions, intake and output as per nursing policy and procedures or as per physician orders. Review of Resident 10's clinical record revealed diagnoses including acute congestive heart failure(sudden and severe condition where the heart can't pump enough blood to meet the body's needs, causing fluid buildup in the lungs and other parts of the body), and acute kidney failure (a sudden and significant loss of kidney function). Review of Resident 10's physician's orders revealed an order started on May 26, 2025, of fluid restriction of 2000cc, Split between Nursing (1000cc) and Dining (1000cc) daily. 7-3:450cc, 3-11:450cc,11-7:100cc. Review of Resident 10's Medication Administration Record revealed Resident 10's daily fluid allotment was not recorded from June 1, 2025, to June 10 2025. Interview with Director of Nursing on June 12, 2025, at approximately 12:24pm confirmed that the physician orders were not followed for fluid restriction. 28 Pa. Code 201.18(b)(1) Management 28 Pa. Code 211.5(f) Clinical records 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services

Based upon clinical record review and interview, it was determined the facility failed to ensure non-pharmaceutical interventions were completed prior to the administration of pain medication for one resident and failed to ensure side effects were being monitored during the use of anti-psychotic medication for one resident (Resident 4 and Resident 11). Findings include: Review of Resident 4's physician orders revealed an order for Oxycodone (pain medication) 10 milligrams (mg) to be administered every eight hours as needed for moderate to severe pain. Review of Resident 4's June Medication Administration Record revealed Resident 4 received Oxycodone 10 mg on June 1, 2025, June 2, 2025, June 3, 2025, June 6, 2025, and June 10, 2025. Further review of Resident 4's clinical record failed to reveal evidence that non-pharmaceutical interventions were attempted prior to the administration of Oxycodone 10 mg. Interview with the Director of Nursing on June 12, 2025, at 1:00 p.m. confirmed that non-pharmaceutical interventions were not attempted prior to the administration of Resident 4's pain medication. Review of Resident 11's diagnosis list revealed a diagnosis of Alzheimer's Dementia (a progressive disease that destroys memory and other important mental functions), unspecified mood disorders and anxiety disorder. Review of Resident 11' s physician's orders revealed an order started on Decemebr 5, 2024 for Quetiapine (anti-psychotic medication) 25 milligrams 1 tablet at bedtime. Review of Resident 11's Medication Administration Record (MAR) for May 2025 and June 2025 revealed Resident 11 received Quetiapine 25 milligrams each day at bedtime. Review of Resident 11's MAR and progress notes revealed the facility failed to ensure that side effects were being monitored during the use of anti-psychotic medication. Interview with the Director of Nursing on June 13, 2025, at 9:18 a.m. confirmed there was no documentation monitoring the side effects of the anti-psychotic medication when administered to Resident 11. 28 Pa. Code 211.12(d)(1)(5) Nursing Services Previously cited 7/11/2024

Based on observations and resident and staff interview, it was determined the facility failed to ensure Enhanced Barrier Precautions (infection control prevention designed to reduce transmission of multidrug-resistant organisms that employs targeted gown and glove use during high contact resident care activities) were in place for residents requiring enhanced barrier precautions for two of 19 residents (Residents 69 and 120). Findings include: Interview with Resident 69 on July 9, 2024, at 11:10 a.m. revealed the resident had a suprapubic catheter (tube that drains urine through the bladder via an incision in the abdomen). Observation of Resident 120 on July 9, 2024, at 10:50 a.m. revealed the resident had a central line (catheter that goes into a vein that leads to the heart) and a left knee surgical wound. Observations of Resident 69 and 120's rooms on all four days of the survey failed to reveal personal protective equipment located outside the rooms or signage indicating that the residents were on Enhanced Barrier Precautions. Interview with the Director of Nursing on July 11, 2024, at 10:50 a.m. confirmed that Residents 69 and 120 were not on Enhanced Barrier Precautions. 28 Pa. Code 201.18(b)(1) Management 28 Pa. Code 211.5(f) Clinical records 28 Pa. Code 211.12(d)(1)(3)(5) Nursing service

Based on review of facility policy, observations and staff interviews it was determined that the facility failed to treat resident with dignity and respect during the lunch meal for three out of 6 residents ( R8, R9, and R13). Finding include: Review of facility policy labeled Feeding Policy, dated January 2023, outlined the procedure for feeding a resident stating, 20. If the resident must be fed, make yourself comfortable. Sit infront of the resident . Maintain eye contact. Observations on August 28, 2023, at 12:10 p.m. revealed registered employee E3, standing at a back table with residents R8, R9, and R10 seated around the end of the table. Registered Nurse, Employee E3 stood in between residents R9 and R13, feeding a small bite to R9 and then to R13, moved the chair out of the way and fed R8, conducted while in a standing position. This continued throughout the meal moving from one resident to the next without sitting down. Observations on August 29, 2023, at 12:10 p.m. revealed Registered Nurse, Employee E3, standing at a back table while feeding the residents in the same manner as observed on August 28, 2023. Interviews with the Nursing Home Administrator and the Director of Nursing on August 30, 2023 at 11:15 a.m. confirmed that the staff should sit to feed the residents. The facility failed to treat the residents with dignity and respect during the lunch meal for residents R8, R9, and R13. 28 Pa Code: 201.29(j) Resident's rights

Based on clinical record review and interviews with staff it was determined that the facility failed to ensure assessments accurately reflect the resident's status for one of 17 residents reviewed (Resident R3). Findings include: Review of Resident R3's clinical record revealed a nursing note dated May 16, 2023, indicating the resident was discharged to another facility. Further review of the clinical record revealed a discharge Minimum Data Set (MDS-periodic assessment of the residents care needs) was not completed. Interview conducted with licensed Employee E4 on August 30, 2023 at 10:55 a.m. revealed the discharge MDS assessment was not completed. The facility failed to ensure assesments accurately reflect the resident status for Resident R3. 28 Pa. Code 211.5(f) Clinical records 28 Pa. Code 211.12(c) Nursing services 28 Pa. Code 211.12(d)(1)(5) Nursing services