Every finding on record at Gardens at Easton, The

Based on observation and staff interview, it was determined that the facility failed to properly store food and maintain sanitary conditions in the dietary department. Findings include:Observations during the tour of the dietary department on May 26, 2026, at 9:26 a.m., revealed the following:In the dry stockroom, there were seven dried brown splatters on the floor. In the pot storage area, there was baseboard that was peeling from the wall and being held up by a kitchen cart's wheels. On the floor under the shelving, there was a butter packet and a condiment package. In the pot washing area, there was dried splatter on the wall. In the food preparation area, under the table, there were three floor tiles that were loose and stacked on top of other tiles, exposing the subfloor. There were two holes in the wall near the floor. There was a large piece of brown food debris on the floor. There was dried red food splatter on the wall adjacent to the floor. On a condiment shelf, there was a baking soda container that had dried food debris on the lid. Under the oven, there was paper debris.In the walk-in cooler, there were four large containers of cottage cheese that had a use-by date of May 22, 2026. Two of them were opened, with one that was noted as opened on May 20, 2026. In an interview on May 26, 2026, at 10:00 a.m., the Food Service Director confirmed the expired items should have been removed and were not. CFR 483.60(i) Food Safety RequirementPreviously cited 5/15/2528 Pa. Code 201.14(a) Responsibility of licensee.28 Pa. Code 201.18(b)(1) Management.

Based on observation, it was determined that the facility failed to provide a safe, clean, and homelike environment on three of three nursing units. (Annex, First, and Second Floors) Findings include: Observations on May 26, 2026, from 9:30 a.m. through 2:00 p.m., and May 27, 2026, from 8:45 a.m. through 2:00 p.m., revealed the following environmental issues: In room [ROOM NUMBER], the closet doors were marred and the lower surface was chipped. In room [ROOM NUMBER], behind the resident's bed there were three areas of scraped paint. In room [ROOM NUMBER] (bed 2) there was paint peeling behind the resident's headboard, the wall adjacent to the bed was splattered with a brown substance, and the air conditioning vents had an accumulation of dirt and debris. The wall adjacent to the bathroom had surface damage and was missing paint. In room [ROOM NUMBER], the air conditioning vents had an accumulation of dirt and debris and the wall below the air conditioning unit had multiple cracks and chipped paint. In room [ROOM NUMBER] (bed 2), the adjacent wall was splattered with a brown substance next to the air conditioning unit, the wall was cracked with peeling paint, and the air conditioning vents had an accumulation of dirt and debris. In room [ROOM NUMBER], the walls were marred and had peeling paint. In room [ROOM NUMBER], the air conditioning vents had an accumulation of dirt and debris, the wall under the air conditioning unit had multiple cracks. The bathroom ceiling had brown stains, and there was a black substance above the vent. In the First-Floor community shower room, there was a black substance in the far left shower stall. Throughout 100 and 200 nursing units, residents' door frames were marred and with chipped paint. The second-floor nurses' station was missing laminate on the face of the countertop and was chipped in three places with rough, unfinished wood exposed on the face and in the corners. The side walls of the nurses' station counter had chipped paint. In the shared bathroom between rooms [ROOM NUMBERS], the toilet seat was chipped and there were unpainted, spackled areas on the wall opposite the toilet. In room [ROOM NUMBER], the main wall on the left was marred with black scrapes and the corner in the room by the bathroom door had chipped paint. The ceiling in room [ROOM NUMBER] (bed 4) was cracked with small pieces of the ceiling exposed and hanging from the crack. In room [ROOM NUMBER], the window curtain rod was observed to have loose screws and to be hanging from the wall. In the second floor hallway across from room [ROOM NUMBER], a recliner was observed with white liquid stains on the seat and a black and gray metal storage cabinet was observed with dried liquid streaks along the bottom quarter of the front and right sides of the cabinet. The baseboards throughout the hallway between rooms [ROOM NUMBERS] were covered in a brown substance. Across from room [ROOM NUMBER], there was a brown substance on the wall beneath the electrical outlet. The ceiling overhang adjacent to the Second-Floor nursing station had three loose tiles. In the hallway above the Annex shower room door, there was a ceiling tile with a brown circular stain. The handrail and the baseboard along both sides of the hallway from room [ROOM NUMBER] to 315 were marred. In the hallway adjacent to the Annex janitor's closet, there were three stained ceiling tiles. In the hallway in front of room [ROOM NUMBER], the ceiling tile had a piece missing and the vent had a black substance on it. The vent in the ceiling above the Annex nurses' station across from the dining room had a layer of a black substance. Across from room [ROOM NUMBER], the door to the Annex TV lounge had a large area of wood chipped away from it on the hinge. In the hallway, the ceiling tile adjacent to the Annex soiled utility room had cobwebs and dead insects attached to it that were dangling from the tile. The soiled utility room door had a piece of exposed wood. In the hallway next to room [ROOM NUMBER], there was a dried brown substance on the wall behind the handrail. In an interview on May 27, 2026, at 2:00 p.m., the Administrator and Director of Nursing confirmed the identified environmental issues were present. CFR 483.10(i)(2) Safe EnvironmentPreviously cited 5/15/25, 5/19/26 28 Pa. Code 201.14(a) Responsibility of licensee. 28 Pa. Code 201.18(b)(1)(e )(2.1) Management. The second-floor nurses' station was missing laminate on the face of the countertop and was chipped in three places with rough, unfinished wood exposed on the face and in the corners. The side walls of the nurses' station counter had chipped paint. In the shared bathroom between rooms [ROOM NUMBERS], chipped paint was observed on the toilet seat and unpainted, spackled walls on the wall opposite the toilet. In room [ROOM NUMBER], the main wall on the left was marred with black scrapes and the corner in the room by the bathroom door had chipped paint. The ceiling in room [ROOM NUMBER] over bed 4 was cracked with small pieces of the ceiling exposed and hanging from the crack. In room [ROOM NUMBER] window curtain rod was observed to have loose screws and to be hanging out of the wall. In the second floor hallway, across from room [ROOM NUMBER], a recliner was observed with white liquid stains on the seat and a black and gray metal storage cabinet observed to have dried liquid streaks all along the bottom quarter of the front and right side of the cabinet. The baseboards throughout the hallway between rooms 223 to 230 were covered in brown substance. Across from room [ROOM NUMBER] there was a brown substance on the wall beneath the electrical outlet. The ceiling overhang adjacent to the Second-Floor nursing station had three loose tiles. In the hallway above the Annex Shower Room door, there is a ceiling tile has a brown circular stain on it. The handrail and the baseboard along both sides of the hallway from room [ROOM NUMBER]-315 were marred. In the hallway above the Annex Janitor Closet door, there were three stained ceiling tiles. In the hallway in front of room [ROOM NUMBER], the ceiling tile had a piece missing and the vent had a black substance on it. The vent in the ceiling above the Annex nurses station across from the dining room had a layer of a substance across it that was shaped as black circles. Across from room [ROOM NUMBER], the door to the Annex TV lounge had a large area of wood chipped away from it on the hinge side that exposed some wood shards. In the hallway, the ceiling tile above the Annex Soiled Utility Room had several cobwebs and dead insects attached to it that were dangling from the tile. The Soiled Utility Room door had a piece of wood sticking out into the hallway. In the hallway next to room [ROOM NUMBER], there was a dried brown substance on the wall behind the handrail. In an interview on May 27, 2026, at 2:00 p.m., the Administrator and Director of Nursing confirmed the environmental issues were present. CFR 483.10(i)(2) Safe EnvironmentPreviously cited 5/15/25, 5/19/26 28 Pa. Code 201.14(a) Responsibility of licensee. 28 Pa. Code 201.18(b)(1)(e )(2.1) Management

Based on clinical record review, observation, and staff interview, it was determined that the facility failed to provide interventions to prevent new or worsened pressure ulcers for two of three sampled residents with wounds. (Residents 3, 15)Findings include: Clinical record review revealed that Resident 3 had diagnoses that included left heel deep tissue injury (damage to the underlying soft tissue from pressure and/or shear forces), malignant neoplasm of the brain, and chronic obstructive pulmonary disease. Review of the Minimum Data Set (MDS) assessment dated [DATE], revealed Resident 3 required substantial assistance from staff for activities of daily living. Review of the comprehensive care plan revealed the resident was at risk for skin impairment. A physician's order dated April 16, 2026, directed staff to offload heels every shift. Observations on May 26, 2026, at 9:50 a.m., 12:15 p.m., and 2:37 p.m., revealed Resident 3 in bed, with heels directly on the bed. In an interview on May 28, 2026, at 9:00 a.m., the Director of Nursing confirmed that staff did not follow the physician's orders for Resident 3. Clinical record review revealed that Resident 15 had diagnoses that included a stroke with residual left-sided upper and lower extremity weakness. The MDS assessment dated [DATE], indicated that Resident 15 was cognitively impaired, required substantial assistance from staff for activities of daily living, and had an advanced pressure wound on her sacrum. Review of the care plan revealed the resident had limited mobility, had actual skin breakdown, and was at risk for further skin impairment related to decreased mobility and included an intervention for staff to maintain pressure reducing devices as ordered. On March 10, 2025, the physician ordered for staff to apply bilateral heel boots to offload pressure so that both heels were not in contact with the mattress or pillows. Observations on May 26, 2026, from 10:07 a.m. to 1:52 p.m., and on May 28, 2026, at 10:30 a.m., revealed that Resident 15 was lying in bed, and her heels were observed to be directly on the bed, with no heel boots in place. In an interview on May 28, 2026, at 10:06 a.m., the Director of Nursing confirmed that staff did not apply the heel boots as ordered by the physician for Resident 15. 28 Pa. Code 211.12(d)(1)(5) Nursing services.

Based on clinical record review, resident interview, and observation, it was determined that the facility failed to provide timely assistance with care in a manner that maintained dignity for one of 33 sampled residents. (Resident 3) Findings include: Clinical record review revealed that Resident 3 was frequently incontinent of urine and stool, was able to communicate her needs, and was dependent on staff for toileting. According to the care plan, staff were to assist the resident to toilet as needed. On May 26, 2026, at 11:30 a.m., the resident turned on her call light. At that time, she stated, I need to be changed. At 11:35 a.m., a nurse aide entered the room and turned off her call light without assisting the resident. Staff did not assist the resident until 12:45 p.m. 28 Pa. Code 211.12(d)(1)(5) Nursing services.

Based on observation, it was determined that the facility failed to provide a safe, clean, and comfortable environment on one of three nursing units. (Second Floor)Findings include:Observations on May 19, 2026, from 10:30 a.m. through 12:30 p.m., revealed the following environmental issues:There was a mouse trap in the resident's closet in room [ROOM NUMBER]. There were multiple mouse droppings on the floor of the closet and along the base of a wall in the resident's room. There was a hole in the tape around the air conditioning unit under the window. 28 Pa. Code 201.14(a) Responsibility of licensee. 28 Pa. Code 201.18(b)(1)(e )(2.1) Management.

Based on policy review, observation, and staff interview, it was determined that the facility failed to properly store food and maintain sanitary conditions in the dietary department. Findings include: Review of the facility's policy entitled, Employee Sanitary Practices, dated January 8, 2025, revealed that all staff were to cover all of their hair with a hair restraint. Observations during the tour of the dietary department on May 13, 2025, at 10:22 a.m., revealed the following: There was a blender lid on the floor next to the pot rack. There were four large containers of dry cereal that had a layer of sticky food debris on the outside of the lid and bottom of each container. In the walk-in freezer, there was ice build up and condensation on the three fan vents on the wall. On the floor below the fans, there were multiple spots of ice and condensation. On the two shelves below the fans, there was a box of sherbet and peas that were covered with ice. Next to this, on another shelf, there were two opened boxes of pretzels that were covered with ice. There was a large ice formation on each of two shelves below the fans. Observation during of the lunch meal service tray line on May 14, 2025, from 12:15 p.m. to 12:30 p.m., revealed Dietary Employee (DE) 1 was observed with a mustache that was not covered. In an interview on May 14, 2025, at 12:55 p.m., the Food Service Director confirmed that DE 1 should have been wearing a hair restraint to cover the mustache during the meal tray line. CFR 483.60(i) Food Safety Requirement Previously cited 4/18/24 28 Pa. Code 201.14(a) Responsibility of licensee.

Based on a review of facility policy, staff interview, and observation, it was determined that the facility failed to properly store medications on one of three nursing units. (Second Floor nursing unit) Findings include: Review of the facility policy entitled, Medication Storage and Labeling, last reviewed January 8, 2025, revealed that medications requiring refrigeration were to be stored in a refrigerator located in the medication room at the nurses' station or other secured location. Medications were to be stored separately from food and were to be labeled accordingly. In an interview on May 14, 2025, at 10:19 a.m., the Administrator stated that the acceptable temperature for a medication refrigerator was to be between 36 degrees Fahrenheit and 46 degrees Fahrenheit. Observation of the Second Floor medication refrigerator on May 14, 2025, at 9:00 a.m., revealed a temperature of 60 degrees Fahrenheit. At 10:02 a.m., the temperature was 58 degrees Fahrenheit. At 12:22 p.m., the temperature was 59 degrees Fahrenheit. At 1:26 p.m., the Maintenance Director confirmed the refrigerator temperature was 54 degrees Fahrenheit. At each observation, there were two opened medications that required refrigeration, Cefepime and Konvomep. Per manufacturer guidelines, these medications were to be stored at a temperature between 36 degrees Fahrenheit and 46 degrees Fahrenheit. In an interview on May 14, 2025, at 3:01 p.m., the Administrator confirmed the temperatures of the Second Floor medication refrigerator were above acceptable temperatures. 28 Pa. Code 201.14(a) Responsibility of licensee. 28 Pa. Code 201.18(b)(3)(e)(2.1) Management. 28 Pa. Code 211.12 (d)(1)(2)(5) Nursing services.

Based on facility policy review, clinical record review, observation, and resident and staff interview it was determined that the facility failed to obtain a physician's order for oxygen and provide appropriate care for respiratory equipment for one of 32 sampled residents. (Resident 93) Findings include: Review of the facility policy entitled, Equipment Changing, last reviewed January 8, 2025, revealed that all respiratory therapy equipment should be changed on a weekly basis and as needed when the equipment came in contact with the ground. Clinical record review revealed that Resident 93 had diagnoses that included end stage renal disease and chronic congestive heart failure. Observations on May 13, 2025, at 11:16 a.m. and again on May 14, 2025, at 12:09 p.m., revealed Resident 93 was sitting up in bed with oxygen being administered using a nasal cannula. In an interview at that time, Resident 93 stated that he always wears oxygen except for when going outside to smoke. Review of the nurse practitioner's progress notes dated February 27, 2025, and March 4, 2025, revealed that Resident 93 was on oxygen at all times. Review of the oxygen saturation summary dated November 18, 2024, through May 7, 2025, revealed that Resident 93 was using oxygen via nasal cannula. Review of the May 2025 physician's orders revealed no order for oxygen therapy via nasal cannula. There was also no documented evidence that staff changed the oxygen tubing weekly according to facility policy. In an interview on May 15, 2025, at 1:45 p.m., the Director of Nursing confirmed that the resident should have had a physician's order for the oxygen and that tubing should be changed weekly. 28 Pa. Code 211.12(d)(1)(2)(5) Nursing services.

Based on clinical record review, observation, and staff interview, it was determined that the facility failed to ensure that the Minimum Data Set (MDS) assessments were completed to accurately reflect the residents' current status for two of 32 sampled residents. (Residents 27, 93) Findings include: Clinical record review revealed that Resident 27 had diagnoses that included diabetes mellitus and pulmonary embolism. A physician's order dated April 9, 2025, directed staff to administer an anti-coagulant medication (dabigatran). Review of the MDS assessment dated [DATE], revealed that the resident was on an anti-platelet medication in the last seven days, not an anti-coagulant medication. The MDS inaccurately reflected the use of an anti-platelet medication, as the dabigatran was an anti-coagulant medication. Clinical record review revealed that Resident 93 had diagnoses that included end stage renal disease and chronic congestive heart failure. Review of the nurse practitioner's progress notes dated February 27, 2025, and March 4, 2025, revealed that Resident 93 was on chronic oxygen via nasal cannula. Review of the oxygen saturation summary dated November 18, 2024, through May 7, 2025, revealed that Resident 93 was on oxygen via nasal cannula. Observations on May 13, 2025, at 11:16 a.m. and again on May 14, 2025, at 12:09 p.m., revealed Resident 93 sitting up in bed with oxygen via nasal cannula. Review of the MDS assessment dated [DATE], did not identify the resident was receiving oxygen therapy. In an interview on May 15, 2025, at 2:05 p.m., the Director of Nursing confirmed that Resident 27's and 93's MDS assessments were inaccurate and did not reflect the residents' current status.

Based on observation, it was determined that the facility failed to maintain residents' environment and equipment in a safe, clean, comfortable, and homelike manner on two of three nursing units. (First and Second Floor nursing units) Findings include: Observations on May 13, 2025, from 9:30 a.m. through 2:00 p.m., and May 14, 2025, from 8:45 a.m. through 3:00 p.m., revealed the following environmental issues: In room [ROOM NUMBER] (bed 1) there was paint peeling behind the resident's headboard. In room [ROOM NUMBER] (bed 1) the privacy curtain was torn. In the First Floor community shower room there was a black substance in the far left shower stall, in the middle shower stall, there were chipped tiles in the floor and a missing shower head and faucet, the bottom of the handle on the bathtub had a dark substance on it, and the toilet area had chipped paint on the right side of the wall and a brown substance behind the toilet. Resident 62's wheelchair had a broken and torn left arm rest, the back of the wheelchair was torn, and had loose axles. In the Second Floor dining room, there was dust was in the corners of the room, peeling tape around the two air conditioning units and on the window sills, the curtain on the middle window had a brown stain, and the dining room hand sanitizer dispenser was empty. The heater in the hallway outside of room [ROOM NUMBER] was covered with a black substance and the wall behind it was cracked. The handrails between the dining room and room [ROOM NUMBER], and between rooms 202 to 205, rooms 207 to 209, rooms 216 to 219, rooms 220 to 222, and between rooms [ROOM NUMBERS] had cracked paint and were loose. The bottom of the window curtains in resident rooms 223 (bed 3) and 226 (bed 1), were stained, and the windows were cloudy with a black residue in corners. 28 Pa. Code 201.14(a) Responsibility of licensee. 28 Pa. Code 201.18(b)(1) Management.

Based on observation, it was determined that the facility failed to store and serve food under sanitary conditions in the kitchen. Findings include: Observation of the kitchen and tray line service on April 16, 2024, at 7:43 a.m., revealed the following: There was a spatula with multiple chips on all sides of the rubber scraper. There were various items, which included boxes of gloves, bandages, Styrofoam bowls, and a bathroom key, on a counter surface. There was a black substance on the wall tiles adjacent to the dish machine. There were multiple areas of chipped tile. A subsequent observation of the kitchen and tray line service on April 17, 2024, at 12:10 p.m., revealed the following: There was a drainpipe that was dripping onto the shelf under the food preparation surface. There was a box of potatoes and a container of oatmeal stored on the shelf. There were various substances splattered on the wall behind that same food preparation surface. Dietary Employee (DE) 1 was wearing gloves and operating the tray line. DE 1 stepped away from the tray line, answered the phone, then returned to the tray line and continued handling resident meal plates and trays without changing gloves or performing hand hygiene. DE 2 was wearing gloves and operating the tray line. DE 2 touched ready to eat food for resident trays, walked away from the tray line, obtained and donned oven mitts for another task. DE 2 took off the oven mitts and returned to tray line wearing the same gloves and continued to plate resident meals, which included touching ready to eat foods, without changing gloves or performing hand hygiene. 28 Pa. Code 201.18 (b)(3)(e)(2.1) Management.

Based on review of the facility disaster plan, observation, and staff interview, it was determined that the facility failed to establish written procedures to ensure that potable (drinking) water was available to essential areas during periods when there was a loss of normal water supply. Findings include: Review of the facility disaster preparedness assessment last reviewed February 1, 2023, revealed that the facility was to conduct an assessment on an annual basis to determine the readiness of the physical plant and associated supplies/provisions within the facility that would be utilized to manage a crisis or disaster situation. An adequate supply of emergency items and equipment would be maintained in appropriate quantities and in accordance with all applicable regulations to accommodate the needs of residents and staff members. Supplies and equipment would be stored in clearly designated locations and easily accessible during a crisis or disaster situation. Further review of the facility's disaster preparedness assessment revealed that the facility determined a need of 741 gallons of water per day were needed for residents and employees. Observation of the dry storage room on April 26, 2023, at 9:18 a.m., revealed that there were 69 gallons of emergency drinking water stored onsite. In an interview, the Director of Dining Services stated that the facility's emergency water supply was accesible and stored in dry storage. There was no evidence that the facility's disaster plan included provisions to obtain the minimum amount of water required for staff and residents in the event of an emergency. In an interview on April 27, 2023, at 11:04 a.m., the Administrator stated that the facility required a minimum of 247 gallons of water to sustain staff and residents for 24 hours in the event of a loss of normal water supply and that there was only 70 gallons of emergency water onsite. 28 Pa. Code 201.18(b)(1)(3) Management. 28 Pa. Code 209.7(a) Disaster preparedness.

Based on observation during environmental tours, it was determined that the facility failed to maintain residents' environment and equipment in a clean, functional, sanitary, and homelike manner on three of three nursing units. (First and Second floor nursing units and the Annex) Findings include: Observations on April 25, 2023, from 9:52 a.m., through April 26, 2023, at 10:05 a.m., on the first floor nursing unit revealed that the walls were marred and scratched in resident rooms 111, 112, 117, 119, 122, 123, 124, 127, and 128. In resident room [ROOM NUMBER], the bottom corner of the wall between the bathroom and the room was gouged, the baseboard was missing, the toilet paper holder was broken, and the faucet for the bathroom sink was loose. In resident room [ROOM NUMBER] there was an orange substance on the wall behind the resident's bed, and the privacy curtain between bed. The air conditioner in resident room [ROOM NUMBER] was covered in dirt and a dried pink substance. Observations on April 25, 2023, at 1:48 p.m., on the second floor nursing unit revealed that the walls in resident room [ROOM NUMBER] were marred and scratched. In resident room [ROOM NUMBER] the entire lower back wall underneath the windows was marred, scratched and missing paint. Observations on April 25, 2023, between 9:57 a.m., and 10:14 a.m., on the Annex nursing unit revealed that in room [ROOM NUMBER] there was a piece of molding that was peeling away from the wall by bed four. In addition, the wall was marred. In resident room [ROOM NUMBER], the dresser between beds one and two was missing the second, top drawer. The foot board on bed two and three was cracked. The towel bar was off of the wall and observed on the sink. CFR 483.10(i)(1-7) Safe/Clean/Comfortable/Homelike Environment Previously cited 5/5/22 28 Pa. Code 207.2 (a) Administrator's responsibility.

Based on review of facility policy, review of personnel files and staff interview, it was determined that the facility failed to implement the abuse prohibition policy related to employee screening for one of five newly hired employees. (Employee 4) Findings include: Review of the facility policy entitled Abuse Policy, last updated February 1, 2023, revealed that to ensure abuse protection, the facility was to have processes in place to include screening, training, prevention, identification, protection, investigation, reporting and response to allegations of potential abuse and neglect. The policy guidelines included a procedure in preventing abuse and neglect of residents. The abuse prevention program provided policies included screening and protocols for conducting employment background checks including state criminal background check and any other reviews required under the state or federal regulation. Any employee with a positive initial or annual background check was not to be permitted to work until the issue was thoroughly investigated and a suitable determination was made by the facility. The facility policy referenced an appendix that it was unconstitutional for the offenses listed in the Older Protective Services Act to result in a lifetime employment ban without further evaluation. The appendix included the recommendation that the facility perform an individualized risk assessment on a case by case basis and consult with legal counsel regarding employment. Review of the personnel file for Employee 4 revealed a state criminal background check was requested on March 9, 2023. The state criminal background check was noted as compiled on March 21, 2023, with a positive result for a criminal record. The actual start date for Employee 4 was March 29, 2023. The initial background check had a result of pending for control. The final compiled report indicated that Employee 4 had a criminal background. This final report was not obtained until April 26, 2023. As a result, the individualized risk assessment to determine if the employee was suitable for employment was not completed by the facility until April 27, 2023. In an interview on April 27, 2023, the Administrator confirmed that Employee 4 had been working in the facility from March 29, 2023, through April 27, 2023. 28 Pa. Code 201.10 (1)(e) Management 28 Pa. Code 201.14(a) Responsibility of licensee. 28 Pa. Code 201.19 Personnel policies and procedures. 28 Pa. Code 201.29(a) Resident rights.

Based on observations and resident interview, it was determined that the facility failed to provide a safe, clean, and comfortable environment on two of three nursing units. (Annex and Second Floor nursing units) Findings include: Observations of the Annex unit on May 3, 2022, revealed a large ant in room 310. Observations in room 309 revealed bed one's dresser was missing a top drawer, and there was a hole in the wall behind bed three. Observations in room 311 revealed a dresser inside the doorway with a missing drawer handle, the bedside dresser for bed four was missing a top drawer, and the wood covering was peeled off bed two's night stand, exposing the rough cork board. Observations of the Annex unit on May 4, 2022, revealed a black buildup on the floor tiles in the doorways of rooms 307, 310, 311, and 312, broken tiles in first and second stalls of shower room, and two large ants in the hallway outside the nursing station. Observations of the solarium activity area revealed the lower wall cover was missing, exposing the rough dried glue residue. In an interview on May 4, 2022, at 12:24 p.m., Resident 43 stated that ants crawl around in her bathroom. Observations at this time, revealed two large ants in Resident 43's bathroom. Observations of the Second Floor unit on May 4, 2022, revealed broken floor tiles in room 219. The floor was also dirty and sticky. 28 Pa. Code 207.2(a) Administrator's responsibility.

Based on clinical record review, policy review, observation, and staff interview, it was determined that the facility failed to ensure that licensed nurses, (a registered nurse), maintained professional standards of quality care in the administration of medications set forth in the Pennsylvania Code Title 49, Professional and Vocational Standards for one of 30 sampled residents. (Resident 8) Findings include: Review of the facility's policy entitled Administering Medication, dated February 2, 2022, revealed that medications were to be prepared, administered, and recorded only by licensed nurses. After ensuring that a medication was administered, the nurse who gave the medication must accurate document on the Medication Administration Record [MEDICAL RECORD OR PHYSICIAN ORDER] . Clinical record review revealed that Resident 8 had diagnoses [MEDICAL RECORD OR PHYSICIAN ORDER] . On February 6, 2022, the physician ordered that staff administer a muscle relaxer ([MEDICATION(S)] 750 milligrams, or mg) every eight hours for back pain. The physician also ordered that staff administer a blood pressure medication ([MEDICATION(S)] 30 mg) every six hours. During observation of the medication pass on May 4, 2022, at 9:21 a.m., LPN 1 was observed giving Resident 8 his medications. At that time, a small plastic cup was observed on the resident's beside table that contained two pills. LPN 1 stated that the two pills were [MEDICATION(S)] 30 mg and [MEDICATION(S)] 750 mg, and that these medications were to be administered the previous evening. According to the MAR, RN 2 incorrectly documented that Resident 8 received the two medications the previous evening. There was no documented evidence that the physician or interdisciplinary team determined that it was safe to leave medications at the bedside. 28 Pa. Code 211.5(f) Clinical records. 28 Pa. Code 211.9(c) Pharmacy services. 28 Pa. Code 211.10(c) Resident care policies. 28 Pa. Code 211.12(d)(1)(5) Nursing services.

Based on clinical record review, facility documentation review and staff interview, it was determined that the facility failed to provide a skilled nursing facility advanced beneficiary notice (SNF-ABN) and/or a Notice to Medicare Provider Non-coverage (NOMNC) forms to the resident or the resident's representative following the end of their Medicare coverage for two of three sampled residents who were discontinued from Medicare Part A with benefit days remaining. (Residents 55, 122) Findings include: Clinical record review revealed that Resident 55 had diagnoses [MEDICAL RECORD OR PHYSICIAN ORDER] . Resident 55 received Medicare Part A services from December 24, 2021 to February 18, 2022. According to the SNF (Skilled Nursing Facility) Beneficiary Protection Notification Review form completed by the facility, she was discontinued from Medicare Part A with benefit days remaining and the termination of skilled services was initiated by the facility. Review of the clinical record revealed that there was no documented evidence that the resident's representative was notified in writing and provided the required SNF-ABN form (a notice given to Medicare beneficiaries to convey that Medicare is not likely to provide coverage in a specific case) or NOMNC form (form that conveys the right to a review of the service termination). Clinical record review revealed that Resident 122 had diagnoses [MEDICAL RECORD OR PHYSICIAN ORDER] . Her family member was designated as the responsible party for financial and care decisions. Resident 122 received Medicare Part A services from March 15, 2022 through April 4, 2022. According to the SNF Beneficiary Protection Notification Review form completed by the facility, she was discontinued from Medicare Part A with benefit days remaining and the termination of skilled services was initiated by the facility. Review of the clinical record revealed that there was no documented evidence that the resident's representative was notified in writing and provided the required SNF-ABN form or NOMNC form. In an interview conducted on May 4, 2022, at 10:40 a.m., the Registered Nursing Assessment Coordinator (RNAC)confirmed that documentation to support that written SNF-ABN and NOMNC notices were provided to the residents' representatives was not available. 28 Pa. Code 201.18(e)(1) Management.

Based on record review and staff interview, it was determined that the facility failed to ensure pharmacy recommendations were acknowledge by the attending physician for one of 28 residents. (Resident 93) Findings include: Clinical record review revealed that Resident 93 had diagnoses that included dementia with behavioral disturbances. Review of the Minimum Data Set assessment dated [DATE], revealed Resident 93 was cognitively impaired. On September 7, 2020, the consultant pharmacist recommended Resident 93's attending physician consider an attempted dose reduction or discontinuation of [MEDICATION(S)] (an anti-depressant medication). If a dose reduction or discontinuation could not be accomplished, it was recommended the physician document risk versus benefit of continued therapy with the medication regimen. There was no documented evidence that Resident 93's attending physician addressed the pharmacy recommendation that was submitted on September 7, 2020. In an interview on March 12, 2021, at 9:30 a.m., the Assistant Director of Nursing confirmed that Resident 93's attending physician did not acknowledge the pharmacy recommendation. 28 Pa Code 211.12(d)(5) Nursing Services

Based on clinical record review, policy review and staff interview, it was determined that the facility failed to implement nutritional interventions to ensure that residents maintained stable weight for one of 28 sampled residents. (Resident 75) Findings include: Review of the facility policy entitled Weight Assessment and Intervention dated January 4, 2021, revealed that any weight change of 5 pounds or more would warrant a reweigh for confirmation. If the weight change was verified, nursing was to notify the physician and dietician. Clinical record review revealed that Resident 75 had diagnoses [MEDICAL RECORD OR PHYSICIAN ORDER] . A Minimum Data Set assessment dated [DATE], identified that the resident was provided a therapeutic diet for management of health conditions. The care plan identified the resident's diagnosis [MEDICAL RECORD OR PHYSICIAN ORDER] . Review of the weight record revealed that on January 21, 2021, the resident weighed 274 pounds and on January 28, 2021, the resident weighed 243 pounds, a loss of 31 pounds. On February 5, 2021, the resident weighed 268 pounds, a weight gain of 26 pounds. On February 25, 2021, the resident weighed 300 pounds, a weight gain of 33 pounds. There was no documentation that staff notified the dietician or the physician of the weight change, and there was no evidence to support that a reweigh was completed on the aforementioned dates to ensure that the weights were accurate. In an interview on March 12, 2021, at 10:00 a.m., the Dietician confirmed that reweighs had not been completed as per the facility policy and there was no documented evidence to support that staff notified the dietician or the physician. 28 Pa. Code 211.12(d)(3) Nursing Services

Based on observation, review of facility documentation, and staff interview, it was determined that the facility failed to ensure mechanical equipment was in safe operating condition in the kitchen. Findings include: Observation of the kitchen on March 10, 2021, at 9:28 a.m., revealed the dishwashing machine temperature gauge did not read a temperature of 150 degrees Fahrenheit or higher during the wash cycle. During that same observation period, an interview with the Director of Dinning Services confirmed the wash cycle temperature gauge was not displaying the correct water temperature. Review of a local health bureau inspection report revealed a malfunction of the wash cycle thermometer was identified on March 9, 2021. On March 11, 2021, a maintenance report confirmed the wash tank was not reading the correct temperature and the gauge required replacement. 28 Pa. Code 201.18 (b)(3) Management.

Based on facility policy review, observation, clinical record review, and staff interview, it was determined that the facility failed to provide care and treatment to a resident that was identified with a skin tear for one of 34 sampled residents resulting in the skin tear increasing in size and depth and causing the resident pain and physical harm. (Resident 11) Findings include: Review of the facility policy titled, Pain - Clinical Protocol, dated (MONTH) 25, 2019, revealed that the physician and staff were to identify individuals who have pain or who are at risk for having pain and that the physician was to be notified to help identify causes of pain and order appropriate tests as needed. Clinical record review revealed that Resident 11 was admitted to the facility's secured Annex unit on (MONTH) 9, (YEAR), and had [DIAGNOSES REDACTED]. The resident was ordered by the physician to receive [MEDICATION NAME] (a blood thinner) daily. The quarterly Minimum Data Set (MDS) assessment (a periodic evaluation of resident care needs), dated (MONTH) 27, 2019, indicated that the resident was cognitively impaired with orientation and memory problems. Observation of Resident 11 on (MONTH) 18, 2019, at 11:48 a.m., revealed that the resident was wearing two long-sleeved shirts. When NA 1 moved the sleeves on the resident's left arm, Resident 11 winced (made a high-pitched sound) and stated, Ouch. At that time, observation of the resident's left arm revealed a bruised area covering the elbow with an open area consisting of a skin flap with dried blood. The injury had eight steri-strips (adhesive wound closure tape) applied. Observation of the resident's right arm revealed bruising from the elbow to the mid forearm with an approximate one inch long scabbed wound. During a treatment on (MONTH) 18, 2019 at 1:52, Resident 11 winced and stated It hurts. LPN 1 failed to discontinue the treatment and provide measures to ensure that the resident was kept as comfortable as possible and to notify the physician of the resident's pain. Review of nursing documentation revealed no evidence to support the resident had any injuries to either arm. There was no treatment ordered by the physician. In an interview on (MONTH) 19, 2019, at 4:30 p.m., the Director of Nursing (DON) stated that Resident 11's injuries were the result of an incident that occurred on (MONTH) 15, 2019. The DON stated that LPN 2 performed a treatment to Resident 11's elbow and failed to report the injury to nursing management, failed to complete an incident report, failed to document the injury (including the description) in the clinical record and failed to notify the physician. Review of a statement dated (MONTH) 18, 2019 at 5:30 p.m., revealed that LPN 2 had applied two steri-strips to the residents left elbow after noticing blood coming through his shirt. LPN 2 described the injury as an approximate one by two centimeter (cm) clean cut at that time Review of the facility incident report (completed after the observation of the wound with the eight steri-strips) dated (MONTH) 19, 2019, at 2:09 p.m., revealed that the resident's left elbow wound had increased in size and severity as evidenced by the increased measurement of 4.5 centimeters by 2.0 centimeters by 0.1 centimeters deep. It was noted to have been 80 percent folded over skin which resembled eschar and 20 percent granulation with scant drainage. The facility failed to enure that LPN 2 properly communicated and documented the presence and identification of an injury requiring treatment and as a result the wound increased in size and the resident experienced pain. 28 Pa. Code 201.18(e)(1) Management. Previously cited 2/2/18 and 1/11/19 28 Pa. Code 211.10(d) Resident care policies. 28 Pa. Code 211.12 (d)(1) Nursing services. Previously cited 1/11/19 28 Pa. Code 211.12(d)(3) Nursing services. 28 Pa. Code 211.12(d)(5) Nursing services. Previously cited 2/2/18