**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on facility policy review, medical record review, observation, and interview, the facility failed to provide dental services for 1 resident (Resident #29) of 21 sampled residents. The finding include: Review of the facility policy Patient Rights, Dental Services, dated 1/2018, showed .the center will assist patients in obtaining routine and emergency dental services from an outside source .assist if necessary or requested in making appointments . Review of the medical record showed Resident #29 was admitted to the facility on [DATE] with diagnoses including Hypertensive Heart Disease with Heart Failure, Chronic Respiratory Failure with Hypoxia, Atherosclerotic Heart Disease, and Adjustment Disorder with Depressed Mood. Review of the quarterly Minimum Data Set (MDS), dated [DATE], revealed a Brief Interview of Mental Status (BIMS) of 13, indicating intact cognition. Review of the Care Plan for Altered Nutritional Status, updated 3/13/2022, revealed .dental consult as warranted . Review of the medical record revealed no documentation a dental referral was scheduled for Resident #29. Observation and interview with Resident #29 on 5/9/2022 at 10:45 AM, revealed brown stained lower teeth. The resident stated she had upper dentures and did not want lower dentures. She was not having pain, but was having problems with her lower teeth, and wanted to see a dentist. Continued interview confirmed she had not been asked by the facility to help her with a dental consult. During an interview on 5/10/2022 at 2:55 PM, the Social Service Director (SSD) stated she was responsible for scheduling resident dental visits. She stated the nurses either contacted her with concerns, made resident rounds, or she called family for the quarterly dental visits. A dental visit had been scheduled for 3/22/2022, but the dental group rescheduled for 5/25/2022. The SSD confirmed Resident #29 was not on the dental appointment list for 3/22/2022 or 5/25/2022; the facility did not have a consent or decline for dental services for Resident #29.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview the facility failed to ensure an accurate Minimum Date Set (MDS) for one resident (#89) of 43 sampled residents. The findings include: Medical record review revealed Resident #89 was admitted to the facility on [DATE] with diagnoses including Aphasia, Hemiplegia, and Dementia. Medical record review of a 14 day MDS dated [DATE] revealed .Section P .physical restraints .used in chair or out of bed .1 (indicating used less than daily) . Observation of the residents on 7/26/18 at 1:02 PM, in the resident's room, revealed resident alert and verbal sitting in wheelchair in room. Continued observation of the resident room revealed no restraint in place to resident or in resident room. Interview with the MDS coordinator on 7/25/18 at 8:50 AM, in the MDS office, confirmed the MDS dated [DATE] was not accurate and the resident had not used a physical restraint.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on facility policy review, review of the Lippincott Nursing Center, medical record review, facility documentation review, observation, and interview the facility failed to correctly administer medications for 1 resident (#335) of 6 residents reviewed for unnecessary medications. The findings include: Review of the undated facility policy Administering Medications revealed .3. Medications must be administered in accordance with the orders .4. The individual administering medications must verify the resident's identity before giving the resident his/her medications. Method of identifying the resident checking photograph attached to the electronic medical record .5. The individual administering the medication must check the label THREE (3) times to verify the right medication, right dosage, right time and right method (route) of administration before giving the medication .6. The following information must be check/verified for each resident prior to administering medications: a. Allergies to medications b. Vital signs, if necessary . Review of the Lippincott Nursing Center 8 Rights of Medication Administration dated 5/27/11 revealed the 8 rights of medication administration included the right patient, right medication, right dose, right route, right time, right documentation, right reason, and right response. Medical record review revealed Resident #335 was admitted to the facility on [DATE] with diagnoses including Encounter for Orthopedic Aftercare, Rheumatoid Arthritis, Long term use of Antithrombotics/Antiplatelets, and Hypertension. Medical record review of a Minimum Data Set (MDS) dated [DATE] revealed the resident's cognitive skills for daily decision making was modified independence indicating the resident had some difficulty in new situations only. Review of facility documentation dated 7/17/18 revealed Resident #335 received the medications of another resident during the 9:00 AM medication pass. Continued review revealed the medications were administered incorrectly to Resident #335 based on mistaken identity. Medical record review of Resident #335's Electronic Medication Administration Record (eMAR) revealed the resident's 9:00 AM dose of Amlodipine-Benazepril (medication for blood pressure) was held on 7/17/18. Medical record review of a nurses' note dated 7/17/18 and timed 10:30 AM revealed the resident's blood pressure was 196/87; Heart rate was 60 beats per minute; respiratory rate was 18 breaths per minute and the Oxygen saturation (amount of oxygen in the blood) was 98% (percent). Continued review revealed the resident was alert and oriented. Medical record review of a Nurse Practitioner's note dated 7/17/18 revealed .Pt [patient] was given morning meds [medications] that were prescribed to another pt. He had not received his own meds at the time. Medications were reviewed. His own morning blood pressure medication was held due to medicines he received. Pt was seen approx [approximately] 2 hours after receiving medications. He was alert and oriented. No adverse affects have occurred at this time. Discussed with patinet [patient] and daughter that he may have some drowsiness. Vital signs checked per staff and were stable . Medical record review of a nurses' note dated 7/17/18 and timed 1:45 PM revealed the resident's blood pressure was 151/76 and the resident was alert and oriented. Medical record review of nurses' notes dated 7/17/18 from 1:54 PM through 2:30 PM revealed the resident complained of nausea with some .thin watery emesis . Continued review revealed the resident remained alert, oriented and had some complaints of dizziness and sleepiness. Medical record review of a nurses' note dated 7/17/18 and timed 3:00 PM, revealed the resident had no further emesis. Continued review revealed the resident reported he was feeling .a little better . and wanted to go to his doctor's appointment. Medical record review of a nurses' note dated 7/17/18 and timed 3:30 PM, revealed the resident was out of the facility for a doctor's appointment. Medical record review of a Provider Note dated 7/18/18 revealed .patient received wrong medications including Namenda [medication for Alzheimer's Disease], Requip [medication for restless leg syndrome], Cymbalta [medication for depression], Vitamin D [calcium], Risaquad [medication to balance good bacteria in the digestive system], Cozaar [blood pressure medication], and Coreg [blood pressure medication] . Observations of Resident #335 from 7/23/18 through 7/25/18 revealed the resident was participating in physical therapy and talking with other residents in the hallway. Interview with Resident #335 and the residents' daughter on 7/23/18 at 11:30 AM, in the resident's room revealed the resident had received another resident's medication on 7/17/18. The residents' daughter reported Resident #335 received 2 blood pressure medications, an antidepressant, medication for Alzheimer's Disease, and a vitamin in error. Interview with Nurse Practitioner (NP) #1 on 7/24/18 at 3:05 PM, in the Station 4 Chart Room confirmed Resident #335 received another resident's medications on 7/17/18. Further interview revealed the resident complained of nausea for a couple of hours and vomited 1 time. Continued interview revealed the resident's vital signs remained stable, all of the labs were normal and there were no adverse side effects. Interview with Resident #335 on 7/24/18 at 3:41 PM, in the resident's room revealed the resident had received the medications in the hallway as the resident was going to therapy. The resident reported he had gotten sleepy while in therapy, had nausea and vomiting, and was light headed. Interview with Licensed Practical Nurse (LPN) #1 on 7/24/18 at 3:41 PM, in the Infection Control Office revealed she thought Resident #335 came out of room [ROOM NUMBER]. LPN #1 confirmed she gave Resident #335 the medication for the resident occupying room [ROOM NUMBER]. Interview with the Director of Nursing on 7/24/18 at 4:27 PM, in the Station 4 Resident Care Coordinator's Office confirmed Resident #335 received the incorrect medication on 7/17/18 and confirmed the facility failed to follow the facility policy for medication administration.