Every finding on record at Highland View Rehabilitation & Healthcare Center

Based on observations, review of facility policies and documents, and staff interview, it was determined that the facility failed to provide housekeeping services necessary to maintain a clean environment for five of 27 resident rooms (Resident rooms 2, 3, 5, 8, and 12). Findings include: A facility policy entitled Daily Resident/Patient Room Cleaning dated 1/02/26, indicated that staff is expected to dust mop the floor and sweep all trash and debris to the door and pick it up with the dustpan, empty and clean the trashcans, and wet mop the room. A facility policy entitled Restroom Cleaning dated 1/02/26, indicated that staff disinfect and clean all parts of the toilet, and damp mop the room. A facility policy entitled Cleaning Adaptive Equipment dated 1/2/26, indicated All reusable equipment will be cleaned and disinfected as frequently as necessary or when visibly soiled. Observations on 2/10/26, between 12:40 p.m. and 1:04 p.m. and 2/11/26, between 9:45 a.m. and 10:15 a.m. revealed the following: room [ROOM NUMBER], a tube of Chapstick on floor between bed one and recliner, alcohol pad and salt wrapper on floor between bed two and the window, clear ointment in a clear plastic medicine cup on top of bed two's dresser, a white hairbrush on the floor under the bathroom sink and a built-up of a black substance around toilet base.room [ROOM NUMBER], two clear plastic lids on the floor under bed one, food crumbs under bed one, a bedpan laying on the floor under the bathroom sink, and a built-up of a black substance around toilet base.room [ROOM NUMBER], clear plastic cup on the floor under bed one, a used tissue on the floor behind the bathroom trashcan, and a built-up of a black substance around toilet base.room [ROOM NUMBER], food crumbs on the floor under bed one, and a built-up of a black substance around toilet base.room [ROOM NUMBER], fall mats lying on the floor beside the bed with scattered areas of a dry white substance and scattered areas of a dark brown substance that appeared to be feces. During an interview on 2/11/26, at 10:20 a.m. the Nursing Home Administrator confirmed the following observations: room [ROOM NUMBER], alcohol pad and salt wrapper remained on the floor between bed two and the window, clear ointment remained in the clear plastic medicine cup on top of bed two's dresser, a white hairbrush remained on the floor under the bathroom sink, and a built-up of a black substance around toilet base.room [ROOM NUMBER], a yellow wet floor sign situated at the doorway, food crumbs remained under bed one, a bedpan remained laying on the floor under the bathroom sink, and a built-up of a black substance around toilet base.room [ROOM NUMBER], clear plastic cup remained on the floor under bed one, a used tissue remained on the floor behind the bathroom trashcan, and a built-up of a black substance around toilet base.room [ROOM NUMBER], a yellow wet floor sign situated at the doorway, food crumbs remained under bed one, and a built-up of a black substance around toilet baseroom [ROOM NUMBER], fall mats lying on the floor beside the bed with scattered areas of a dry white substance and scattered areas of a dark brown substance that appeared to be feces. 28 Pa. Code 201.14(a) Responsibility of Licensee 28 Pa. Code 201.18(b)(1)(3) Management 28 Pa. Code 201.18(e)(2.1) Management

Based on review of clinical records and Minimum Data Set (MDS - federally mandated standardized assessment conducted at specific intervals to plan resident care), and staff interview, it was determined that the facility failed to ensure that MDS assessments accurately reflected the status of two of 14 residents reviewed (Residents R27 and R40). Findings include: MDS instructions for section N Medications, subsection N0350A Insulin Injections Record the number of days that insulin injections were received during the last 7 days or since admission/entry or reentry if less than 7 days. MDS instructions for section N Medications, subsection N0350B Orders for Insulin Record the number of days the physician (or authorized assistant or practitioner) changed the resident's insulin orders during the last 7 days or since admission/entry or reentry if less than 7 days. Resident R27's clinical record revealed an admission date of 8/21/25, with diagnoses that included Diabetes (a health condition caused by the body's inability to produce enough insulin), Multiple Sclerosis (MS - is an autoimmune disease that affects the central nervous system resulting in a range of physical and cognitive symptoms), and High Blood Pressure. Resident R27's quarterly MDS with an Assessment Reference Date (ARD- a look back period of time for the MDS assessment) of 11/3/25, revealed section N0300 Injections Record the number of days that injections of any type were received during the 7 days or since admission/entry or reentry if less than 7 days was coded as 7. Resident R27's quarterly MDS with an ARD of 11/3/25, revealed section N0350 Insulin Injections Record the number of days that insulin injections were received during the last 7 days or since admission/entry or reentry if less than 7 days was coded as 7. Resident R27's quarterly MDS with an ARD of 2/2/26, revealed section N0350 Insulin Injections Record the number of days that insulin injections were received during the last 7 days or since admission/entry or reentry if less than 7 days was coded as 1. Review of R27's physician orders from 8/21/25, through 2/28/26, revealed Resident R27 received Mounjaro (weekly injection that is used to help control blood sugar levels. It is not an insulin but is a Glucagon-like-peptide-1). During an interview on 2/12/26, at 8:35 a.m. Registered Nurse Assessment Coordinator (RNAC) confirmed that Resident R27's 11/3/25, quarterly MDS sections N0300 should have been coded as 1 and section N0350 should have been coded as 0, and 2/2/26, quarterly MDS section N0350 should have been coded as 0. Resident R40's clinical record revealed an admission date of 11/01/19, with diagnoses that included Duchenne Muscular Dystrophy (condition that causes skeletal and heart muscle weakness that quickly gets worse with time), Schizoaffective Disorder, bipolar type (mental health condition with a mix of hallucinations, delusions, and mood disorders causing extreme mood swings, from manic highs to depressive lows, that significantly disrupt daily life and functioning), and seizures. Further review of Resident R40's clinical record revealed a Level I Preadmission Screening and Resident Review (PASRR- federal requirement to help ensure that individuals are not inappropriately placed in Nursing Facilities for long term care) dated 10/29/19, indicated that Resident R40 had a positive screen and required a further PASRR Level II evaluation completed. A Level II letter from the Pennsylvania Department of Human Services dated 11/01/19, indicated that Resident R40 was appropriate for nursing facility placement. Resident R40's Annual MDS dated [DATE], Section A1500 was coded No (does not have a serious mental illness and/or ID/DD (intellectual disabilities/developmental disabilities) or a related condition. During an interview on 2/12/26, at 10:12 a.m. the RNAC confirmed that the annual MDS dated [DATE], Sections A1500 and was coded incorrectly for Resident R40. 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 211.5(f)(ix) Medical Records

Based on review of facility policy, clinical records, and staff interview, it was determined that the facility failed to provide a clinical rationale for the continued use of a PRN (as needed) psychotropic (affecting the mind) medication beyond 14-days and failed to provide evidence that non-pharmacological interventions (interventions attempted to calm a resident other than medication) were attempted prior to the administration of a PRN psychotropic (mind altering) medication, and failed to provide evidence of attempted gradual dose reductions (GDR) and/or evidence that a GDR was clinically contraindicated for two of six residents reviewed (Residents R35 and R13). Findings include: A facility policy entitled Psychotropic Medication Use dated 1/2/26, indicated. Non-pharmacological approaches are used (unless contraindicated) to minimize the need for medications. PRN orders for psychotropic medications are limited to 14 days. , and residents on psychotropic medications receive GDRs, unless clinically contraindicated, in an effort to discontinue these medications. Review of Resident R35's clinical record revealed an admission date of 11/21/25, with diagnoses that included anxiety (a condition that causes a person to be nervous, uneasy, or worried about something or someone), and altered mental status (a condition that changes a person's mental functions that can cause confusion, and difficulty in thinking or communicating). Review of Resident R35's physician's orders revealed an order dated 1/5/26, to administer Ativan (anti-anxiety) 0.5 milligrams (mg) by mouth every 12 hours PRN for anxiety and lacked the required clinical rationale for continued use beyond 14 days. Review of Resident R35's January 2026, and February 2026, Medication Administration Records (MARs) revealed that the PRN Ativan was used on 1/5/26, 1/7/26, 1/8/26, 1/15/26, 1/18/26, 1/28/26, 1/29/26, 1/31/26, 2/1/26, 2/6/26, and 2/11/26. The clinical record lacked evidence of non-pharmacological interventions being attempted prior to the administration of the PRN Ativan for the eight administrations in January 2026 and for the three administrations in February 2026. Resident R13's clinical record revealed an admission date of 5/23/22, with diagnoses that included stroke with right-sided paralysis (complete or partial loss of function), mood disorder, dementia, and muscle weakness. Resident R13's clinical record revealed a physician's order dated 4/16/25, for Lorazepam (Ativan) 0.5 milliliters under the tongue every four hours as needed for seizures and lacked the required clinical rationale for continued use beyond 14 days. Resident R13's clinical record also contained a physician's order dated 5/10/25, for Ativan one milligram by mouth daily and lacked evidence of a GDR and/or clinically contraindication for dose reduction. During an interview on 2/12/26, at 10:42 a.m. the Director of Nursing (DON) confirmed that Resident R35's PRN Ativan lacked the required stop date within 14 days or a clinical rationale for continued use beyond 14 days and lacked evidence that non-pharmacological interventions were being attempted prior to administering the PRN Ativan. During an interview on 2/13/26, at 12:43 p.m. the DON confirmed that Resident R13's PRN Ativan lacked the required stop date within 14 days or a clinical rationale for continued use beyond 14 days and lacked evidence of clinical contraindication for an attempted GDR for Resident R13's routine Ativan. 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services

Based on review of facility policies, clinical records, and staff interviews it was determined that the facility failed to provide the resident and/or resident representative with a written notice of the facility bed-hold policy (explanation of how long a bed can be held during a leave of absence and the cost per day), and failed to make certain that the necessary resident information was communicated to the receiving health care provider upon transfer to the hospital for two of four residents reviewed (Residents R1 and R44).Findings include: Review of facility policy entitled Transfer or Discharge, Facility-Initiated dated 1/2/26, indicated Notice of facility bed-hold and return policies are provided to the resident and representative within 24 hours of emergency transfer. And Should a resident be transferred or discharged for any reason, the following information is communicated to the receiving facility or provider: Contact information of the practitioner responsible for the care of the residentResident representative information including contact informationAdvance directive informationAll other information necessary to meet the resident's needs.All special instructions and/or precautions for ongoing care.Comprehensive care plan goalsAll other information necessary to meet the resident's needs including but not limited to:Resident status.Diagnosis and allergiesMedicationsMost relevant labs. Review of Resident R1's clinical record revealed an admission date of 8/8/25, with diagnoses that included Chronic Obstructive Pulmonary disease (a disease that obstructs air flow from the lungs), diabetes (a health condition that is caused by the body's inability to produce enough insulin), and chronic respiratory failure (a condition where your lungs don't exchange air properly). Review of Resident R1's progress notes revealed a note dated 11/29/25, indicating transfer to the hospital. The clinical record lacked evidence that his/her necessary clinical information was communicated to the receiving health care provider. His/her clinical record also lacked evidence indicating that he/she and/or his/her representative were provided with a copy of the bed-hold policy upon transfer on 11/29/25. Review of Resident R44's clinical record revealed an admission date of 12/9/24, with diagnoses that included diabetes (a health condition that is caused by the body's inability to produce enough insulin), hypertension (high blood pressure), and obstructive sleep apnea (a condition when a person repeatedly stops and starts breathing when they are sleeping). Review of Resident R44's progress notes revealed a note dated 12/10/25, indicating transfer to the hospital. The clinical record lacked evidence that his/her necessary clinical information was communicated to the receiving health care provider. His/her clinical record also lacked evidence indicating that he/she and/or his/her representative were provided with a copy of the bed-hold policy upon transfer on 12/10/25. During an interview on 2/12/26, at 1:38 p.m. the Director of Nursing (DON) confirmed that Resident R1's clinical record lacked evidence that the necessary clinical information was provided to the receiving healthcare provider and lacked evidence indicating that he/she and/or his/her representative were provided with a copy of the bed-hold policy upon transfer. He/she also confirmed when the transfers occurred clinical information should have been provided to the receiving healthcare provider and bed hold policy should have been provided to the resident/representative upon transfer. During an interview on 2/13/26, at 11:15 a.m. the DON confirmed that Resident R44's clinical record lacked evidence that the necessary clinical information was provided to the receiving healthcare provider and lacked evidence indicating that he/she and/or his/her representative were provided with a copy of the bed-hold policy upon transfer. He/she also confirmed when the transfers occurred clinical information should have been provided to the receiving healthcare provider and bed hold policy should have been provided to the resident/representative upon transfer. 28 Pa. Code 201.18(e)(1) Management 28 Pa. Code 201.29(c.3) (2) Resident rights

Based on review of facility policy, clinical records, and staff interview, it was determined that the facility failed to review and revise comprehensive care plans to reflect the current care and services for one of 14 residents reviewed (Resident R2). Findings include: Facility policy dated 1/2/26, entitled Care Plans, Comprehensive Person-Centered revealed a comprehensive, person-centered care plan that includes measurable objectives, and timetables to meet the resident's physical, psychosocial, and functional needs is developed and implement for each resident. The policy further stated that assessments of residents are ongoing and care plans are revised as information about the residents and the residents' conditions change. Resident R2's clinical record revealed an admission date of 11/5/24, with diagnoses that include Down Syndrome (congenital condition caused by defect involving chromosome 21 characterized by a distinctive pattern of physical characteristics including a flattened skull, pronounced folds of skin in the inner corner of the eyes, large tongue, and short stature and by some degree of limitation of intellectual ability and social and practical skills), Seizures, and Percutaneous Endoscopic Gastrostomy (PEG) tube (a feeding tube placed into your stomach used to give nutrition, medications, and fluids when you cannot safely chew or swallow). Resident R2's physician orders dated 11/20/25, revealed Enteral Tube site care with soap and water and apply split gauze at site daily and as needed for drainage / dislodgement, Flush PEG Tube with 100 cubic centimeters (cc) of water every shift for patency, Flush PEG but with 30 cc water before and after medications and 5 cc between medications every shift, and Ok to give all medications by mouth (crushed) when accepted by resident. If he/she refused to take medications by mouth, may still administer via PEG tube. Resident R2's care plan revealed a goal Will have no complications related to tube feeding or presence of tube was resolved on 7/15/25, and care plan lacked any current goals or interventions related to presence of PEG tube or related orders. During an interview on 2/12/26, at 10:36 a.m. Director of Nursing confirmed that Resident R2 should have a care plan for his/her PEG tube and related orders and his/her clinical record lacked evidence of having one in place. 28 Pa. Code 211.5(f)(ix) Medical records 28 Pa. Code 211.10(c)(d) Resident care policies

Based on observation, review of drug manufacturer instructions, and staff interviews, it was determined that the facility failed to appropriately date and store medications in one of one medication storage rooms. Findings include: Observation on 2/18/25, at 1:15 p.m. in the medication storage room, revealed an opened vial of Purified Protein Derivative (PPD-a skin testing agent for tuberculosis) without an opened date marked on the vial. A review of the drug manufacturer leaflet indicated a vial of Tubersol which has been entered and in use for 30 days should be discarded. At the time of the observation, Licensed Practical Nurse Employee E1 confirmed the PPD vial was opened, undated and not dated to indicate when the medication should be discarded. The Director of Nursing confirmed on 2/18/25, at 2:37 p.m. the PPD vial should have been noted with an opened date to indicate after 30 days of use, the vial would be discarded. 28 Pa. Code 211.9(a)(1) Pharmacy services 28 Pa. Code 211.12(d)(1)(5) Nursing services

Based on observations, review of facility policy and clinical records and staff interview, it was determined that the facility failed to assess a resident for self-administration of medications for one of 12 residents reviewed (Resident R19). Findings include: Review of facility policy entitled Self-Administration of Medications dated 1/10/25, revealed that Residents have the right to self-administer medications if the interdisciplinary team has determined that it is clinically appropriate and safe for the resident to do so. Staff and practitioner will assess each resident's mental and physical abilities to determine whether self-administering medications is clinically appropriate for the resident. Staff and practitioner will perform a more specific skill assessment, including (but not limited to) the resident's: Ability to read and understand medication labels; Comprehension of the purpose and proper dosage and administration time for his/her medications; Ability to remove medications from a container and to ingest and swallow (or otherwise administer) the medication; Ability to recognize risks and major adverse consequences of his/her medications. The staff and practitioner will document their findings and the choices of residents who are able to self-administer medications. Self-administered medications must be stored in a safe and secure place, which is not accessible by other residents. The staff and practitioner will periodically (for example, during quarterly MDS reviews) reevaluate a resident's ability to continue to self-administer medications. Resident R19's clinical record revealed an admitted [DATE], with diagnoses that included Anxiety (a condition that causes a person to be nervous, uneasy, or worried about something or someone), Asthma (a condition that causes a person's airway to become inflamed, narrow, swell and make it difficult for a person to breath), and muscular dystrophy (a genetic disease that causes progressive weakness and loss of muscle mass). Observations on 2/18/25, at 2:40 p.m., on 2/19/25, at 9:48 a.m. and again on 2/20/25, at 12:15 p.m. revealed Resident R19 with a Ventolin HFA Inhalation Aerosol Solution (inhaler medication to treat asthma) on the bedside tray table. During an interview with Resident R19 on 2/18/25 at 9:48 a.m. he/she stated I always have my inhaler on my bedside table, I just tell the nurse if I have used it. During an interview with Resident R19 on 2/19/25, at 9:48 a.m. he/she stated I haven't used my inhaler in a long time, maybe a few months. Resident R19's clinical record revealed a physician's order dated 11/10/23, for Ventolin HFA Inhalation Aerosol Solution 108 MCG [micrograms]/ACT 2 puffs inhale orally every 4 hours as needed for SOB [shortness of breath]/wheezing. Resident R19's clinical record lacked a self-administration of medication assessment or a physician's order to keep the Ventolin Inhaler at the bedside. During an interview on 2/20/25 at 12:15 p.m. the Nursing Home Administrator confirmed that Resident R19's Ventolin Inhaler was on his/her bedside table and that his/her clinical record lacked a self-administration assessment of medication and self-administration order. 28 Pa. Code 211.5(f)(i)(ii)(iii) Medical records 28 Pa. Code 211.12(d)(1)(5) Nursing services

Based on review of clinical records, facility documentation, and staff interview, it was determined that the facility failed to maintain complete and accurate records for one of 14 residents reviewed (Resident R6). Findings include: Review of Resident R6's clinical record revealed an admitted [DATE], with diagnoses that included bipolar disorder (mental health condition that causes extreme mood swings that include emotional highs (mania or hypomania) and lows (depression), anxiety disorder, and depression. Further review of Resident R6's clinical record revealed that he/she was admitted to the hospital psychiatric unit on 2/19/22, and returned to the facility on [DATE], with diagnoses including major depressive disorder, recurrent, severe, with possible psychotic feature, and generalized anxiety disorder, and a physician's order for Perphenazine (anti-psychotic medication used to treat the symptoms of schizophrenia [a mental illness that causes disturbed or unusual thinking, loss of interest in life, and strong or inappropriate emotions]), manic phase of bipolar disorder, and schizoaffective disorder (mental health problem where you experience psychosis as well as mood symptoms). A Note to Attending Physician/Prescriber from the pharmacy medication record review dated 5/02/22, included a recommendation from the pharmacist to clarify an approved Food and Drug Administration (FDA) diagnosis for the Resident R6's use of Perphenazine. The clinical record revealed a physician's order dated 5/06/22, for a diagnosis of schizophrenia. Resident R6's clinical record lacked evidence of an existing diagnosis of schizophrenia. During an interview on 4/05/23, at 11:45 a.m. the Medical Director confirmed that the diagnosis of schizophrenia was documented in error and that Resident R6's use of Perphenazine was to treat his/her bipolar depression (an FDA approved diagnosis for the use of Perphenazine). 28 Pa. Code 211.5(f) Clinical records

Based on review of facility policy and clinical records, observations and staff interview, it was determined that the facility failed to provide appropriate care regarding a urinary catheter (a tube placed and held in the bladder to drain urine) for one of fourteen residents reviewed (Resident R144). Findings include: Review of facility policy dated 1/4/23, entitled Catheter Care, Urinary indicated purpose of this procedure is to prevent catheter (a tube placed and held in the bladder to drain urine) associated urinary tract infections and Be sure the catheter tubing and drainage bag are kept off the floor. Review of Resident R144's clinical record revealed an admitted [DATE] with diagnoses that included obstructive and reflux uropathy (condition which causes the flow of urine to be blocked), high blood pressure, and gastro-esophageal reflux (stomach acid flow back into the esophagus, which is a tube that connects the mouth and stomach). Observation on 4/3/23, at 3:20 p.m. revealed that Resident R144's urinary catheter drainage bag and tubing were lying on the floor without a cover over the drainage bag. Observation on 4/4/23, at 8:33 a.m. revealed that Resident R144's urinary catheter drainage bag and tubing were lying on the floor without a cover over the drainage bag. During an interview on 4/4/23, at 8:36 a.m. the Assistant Director of Nursing confirmed that Resident R144's urinary catheter drainage bag and tubing should not have been on the floor and should have a cover over the drainage bag. 28 Pa. Code 211.12(d)(1)(5) Nursing services

Based on observations and staff interviews, it was determined that the facility failed to label multi-dose containers of insulin (medication to treat elevated blood sugar levels) and [MEDICATION(S)] solution (used to test for the disease [CONDITION(S)]) with the date they were opened in two of two medication carts (East and West) and one of one medication storage rooms. Findings include: Observation on 5/12/22, at 3:15 p.m. of the East unit medication cart revealed an opened and undated multi-dose vial of [MEDICATION(S)] (insulin), and the West unit medication cart revealed an opened and undated multi-dose vial of [MEDICATION(S)] (insulin), and the medication storage refrigerator contained an opened and undated multi-dose vial of [MEDICATION(S)] solution. During an interview at that time the Director of Nursing, confirmed that the multi-dose vials of insulin and [MEDICATION(S)] solution should have been labeled with the dates each were opened. During an interview on 5/12/22, at 9:35 a.m. the Nursing Home Administrator confirmed that the multi-dose vials are labeled to discard after 30 days opened, and that staff would not be able to determine when to discard the vials due to the lack of an opened date. 28. Pa. Code 201.18(b)(1) Management 28. Pa. Code 211.9(a)(1) Pharmacy services 28 Pa. Code 211.12(d)(1)(5) Nursing services

Based on review of facility policy and clinical record review, and staff interview, it was determined that the facility failed to ensure that a PRN (as needed) anti-anxiety [CONDITION(S)] (any drug that affects brain activities associated with mental processes and behavior) medication had clinical rationale identified for the use beyond the limitation of fourteen days for one of 12 residents reviewed (Resident R32). Findings include: Review of a facility policy entitled, Medication Orders dated 1/12/22, indicated that PRN [CONDITION(S)] medication orders (antipsychotic, anxiolytic, antidepressant and sedative/hypnotic) are to be stopped automatically after fourteen days, unless the prescriber specifies a different number of doses or duration of therapy to be given. Review of Resident R32's clinical record revealed an admitted [DATE], with diagnoses that included dementia (a disease of the brain that affects decision making, memory, mood and behavior), [CONDITION(S)] (high cholesterol), depression (depressed mood involving a loss of interest in activities), and anxiety. The clinical record revealed a physician's order dated 4/10/22, for [MEDICATION(S)] (anti-anxiety medication) 0.5 milligram (mg), ½ tablet by mouth every eight hours PRN for anxiety/restlessness. Review of the April 2022 Medication Administration Record (MAR) revealed that Resident R32 was administered PRN [MEDICATION(S)] at 7:30 p.m. on 4/27/22, at 5:39 p.m. on 4/28/22, and at 1:15 p.m. on 4/29/22. Review of the May 2022 MAR revealed that Resident R32 was administered PRN [MEDICATION(S)] at 5:43 p.m. on 5/02/22, at 2:33 a.m. on 5/03/22, at 5:34 p.m. on 5/03/22, at 6:17 p.m. on 5/04/22, at 6:20 on 5/07/22, at 5:24 p.m. on 5/08/22, at 6:30 p.m. on 5/09/22, and at 6:42 p.m. on 5/10/22. Resident R32 was administered [MEDICATION(S)] PRN eleven times beyond the limitation of fourteen days without clinical rationale identified for the use. During an interview on 5/12/22, at 12:57 p.m. the Director of Nursing confirmed that there was no clinical rationale documented by the physician for the extended time-period of Resident 32's PRN [MEDICATION(S)] usage beyond 14 days. 28 Pa. Code 211.12 (d)(d)(3) Nursing services

Based on observations, review of clinical records and staff interview, it was determined that the facility failed to promote cleanliness regarding respiratory care equipment according to physician orders [MEDICAL RECORD OR PHYSICIAN ORDER] . Findings include: Review of Resident R4's clinical record revealed an admitted [DATE], with diagnoses [MEDICAL RECORD OR PHYSICIAN ORDER] . Resident R4's clinical record revealed a physician's orders [MEDICAL RECORD OR PHYSICIAN ORDER] . Observations on 5/10/22, at 1:30 p.m. 5/11/22, at 1:45 p.m., 5/12/22, at 2:20 p.m. revealed the oxygen concentrator filter was covered with a gray/white flaky substance that dissipated into the air when the filter was shaken, and that the tubing was dated 5/08/22. During an interview on 5/12/22, at 2:20 p.m. Licensed Practical Nurse Employee E1 confirmed that the oxygen concentrator filter was covered with a gray/white flaky substance, and not clean. 28 Pa. Code 211.5(f)(h) Clinical records 28 Pa. Code 211.12(d)(1)(5) Nursing services

Based on review of facility policy, observations, and staff interview, it was determined that the facility failed to maintain a clean and sanitary resident room for two of 12 residents (Residents R19 and R36). Findings include: Review of a facility policy entitled, Daily Housekeeping Responsibilities dated 1/12/22, indicated that daily cleaning of resident rooms included: sweeping and mopping floors (including under beds, and under and behind furniture); overbed tables (tops and base); top of cabinets are clear; dirty dishes, dead flowers, and vases removed; extra linens and laundry removed; clean inside windows, windowsills, mirrors, and TV screen when needed. Review of Resident R19's clinical record revealed an admitted [DATE], with diagnoses including Type 2 Diabetes (condition that affects how the body uses glucose [sugar]), high blood pressure, abnormal posture, [CONDITION(S)], and difficulty walking. Review of Resident R36's clinical record revealed an admitted [DATE], with diagnoses including [CONDITION(S)]-Disorder (mood disorder that can cause intense mood swings), [CONDITION(S)], Type 2 Diabetes, Asthma (condition in which your airways narrow and swell and may produce extra [MEDICATION(S)]), and [CONDITION(S)] ([CONDITION(S)]- group of diseases that cause airflow blockage and breathing-related problems). Review of a Quarterly Minimum Data Set (MDS-a periodic assessment of resident care needs) dated 4/17/22, Section C0500 indicated that Resident R36's Brief Interview for Mental Status (BIMs-15-point cognitive screening measure that evaluates memory and orientation and includes free and cued recall items) was 15 (cognitively intact). Observations between 5/10/22, at 1:40 p.m. and 5/12/22, at 2:25 p.m. revealed Resident R19's wheelchair with a large amount and variety of food crumbs and dried spills on the right chair frame, and Resident R36's bedroom contained clear plastic wrapper on the floor to the right side of the bed, a black tube of Chapstick under the bottom left edge of the bed, two crumpled white tissues between the left side of the bed and the heating unit, accumulation of dust/dirt on top of the wardrobe, over bed lights, and lid of electric roller case. Also observed at the above days and times was black, sticky substance on the bathroom floor, and dark brown substance on the rim and inside of the toilet bowl. During an interview on 5/10/22, at 1:40 p.m. Resident R36 confirmed that his/her room is seldom cleaned and that staff do not clean the floors, dust, clean the bathroom, or remove his/her garbage daily. During an interview on 5/12/22, at 2:25 p.m. the Director of Housekeeping Services confirmed the above observations for both Residents R19 and R36. During an interview on 5/13/22, at 9:40 a.m. the Nursing Home Administrator confirmed that housekeepers should be going into resident rooms and performing daily tasks as per policy, and the room is to be swept and mopped daily, garbage removed daily, and toilets checked and cleaned as needed. 28 Pa. Code 201.18 (b)(1)(3) Management

Based on review of facility policy, observation, and staff interview, it was determined that the facility failed to safely secure medications on one of two nursing units (West Wing). Findings include: The facility policy entitled Security of Medication Cart, dated 3/21/19, indicated that the nurse must secure the medication cart during the medication pass to prevent unauthorized entry and the medication cart must be securely locked at all times when out of the nurse's view. Observation on 12/16/19, at 4:35 p.m. revealed that Licensed Practical Nurse (LPN) Employee E1 walked away from the medication cart to administer medications, leaving the medication cart in the hallway, unattended, unlocked, and out of view. During an interview on 12/16/19, at 4:40 p.m. LPN Employee E1 confirmed that the medication cart was unattended, unlocked and out of view. 28. Pa. Code 201.18(b)(1) Management Previously cited 11/9/18 28. Pa. Code 211.9(a)(1) Pharmacy services 28 Pa. Code 211.12(d)(1) Nursing services Previously cited 11/9/18

Based on review of clinical records and staff interview, it was determined that the facility failed to complete Minimum Data Set (MDS-a mandated assessment of resident care needs) assessments related to cognition for two of 14 residents reviewed (Residents R30 and R148). Findings include: A comprehensive admission MDS assessment dated [DATE], for Resident R30 revealed that Cognitive Pattern Sections C0100 through C were all not assessed. A comprehensive admission MDS assessment dated [DATE], for Resident R148 revealed that Cognitive Pattern Sections C0100 through C were all not assessed. During an interview on 12/18/19, at 10:30 a.m. the Nursing Home Administrator confirmed that Residents R30 and R148's comprehensive MDS assessments were not completed to include the cognitive portion of the assessments. 28 Pa. Code 211.5(f) Clinical records Previously cited 11/9/18

Based on review of clinical records, educational/training curriculum, and Pennsylvania Code Title 49 Professional and Vocational Standards and staff interview, it was determined that the facility failed to provide Intravenous (IV) therapy services to residents by a trained qualified professional for two of four residents reviewed (Residents R2 and R3). Findings include: The Pennsylvania Code Title 49 Professional and Vocational Standards through the Department of State indicates under the Functions of the Licensed Practical Nurse (LPN) that An LPN who had met the education and training requirements of 21.145 b (relating to IV therapy curriculum requirements) may perform the following IV therapy functions .(3) Administration of IV fluids and medications . Resident R3's (MONTH) 2019 Medication Administration Record [REDACTED] 4/2 at 6:00 a.m.; 4/3/19 at 6:00 a.m. and 12:00 p.m.; 4/4 at 6:00 a.m. and 12:00 p.m.; 4/7 at 6:00 a.m. and 12:00 p.m. 4/8 at 12:00 p.m.; 4/10 at 12:00 p.m.; 4/11 at 6:00 a.m. and 12:00 p.m.; 4/12 at 6:00 and 12:00 p.m.; 4/16 at 12:00 p.m.; 4/17 at 12:00 p.m.; 4/18 at 12:00 p.m.; 4/22 at 12:00 p.m.; 4/24 at 12:00 p.m.; 4/25 at 12:00 p.m.; 4/26 at 12:00 p.m.; 4/29 at 12:00 p.m.; and 4/30 at 12:00 p.m. Resident R2's (MONTH) and (MONTH) 2019 MAR's revealed the following administration of IV antibiotics through a PICC line by LPN Employee E1: 5/13 at 6:00 a.m.; 5/14 at 12:00 p.m.; 5/8 at 6:00 a.m.; 5/19 at 6:00 a.m. and 12:00 p.m.; 5/23 at 12:00 p.m.; 5/24 at 12:00 p.m.; 5/30 at 12:00 p.m. 6/2 at 12:00 p.m. Upon request, the facility was unable to produce evidence that LPN Employee E1 had completed an IV therapy course through an approved curriculum and was qualified to administer IV medications through a PICC line. During an interview on 6/13/19, at 11:48 a.m. the Nursing Home Administrator confirmed that there was no evidence that LPN Employee E1 was qualified to administer IV medications through a PICC line. 28 Pa. Code 201.3 Definitions 28 Pa. Code 211.12(d)(1)(5) Nursing services Previously cited 11/09/18

Based on observations, review of select facility policies, and staff interview, it was determined that the facility failed to maintain food safety requirements for a sanitary kitchen. Findings include: The Dietary Infection Control policy, dated 10/2/18, indicated that hair restraints are required in the kitchen area, clean dishes should be placed on the drain board to dry and then put away, and that the ice machine is be to cleaned monthly. During initial tour of the kitchen on 11/6/18, between 2:15 p.m. and 2:50 p.m. there were pans, cookie sheets, and serving scoops that were nested wet, the meat cutter had crumbs on it, the ice machine had brownish areas on both sides of the walls, and the ice scoop container had brownish areas on the bottom of the container. Observation on 11/7/18, the surveyor noticed that Housekeeping Employee E2 entered the kitchen area without donning a hair net. During an interview on 11/6/18, at 2:20 p.m. and on 11/7/18 at 10:30 a.m. Dietary Manager Employee E1 confirmed the above information. 28 Pa. Code 201.18(b)(1) Management Previously cited 12/14/17 28 Pa. code 211.6(f) Dietary services

Based on review of facility policies and documentation and staff interviews and employee personnel records, it was determined that the facility failed to assure training was completed regarding abuse prevention training for three of 36 employees (Employees E7, E8 and E9) and failed to obtain reference checks for three of five newly hired employees (Nurse Aide (NA) Employees E11 and E12, and Dietary Employee E13). Findings include: Review of the employment records for NA Employee E11 and NA Employee E12, and Dietary Employee E13, lacked verification that the reference checks were completed for employment. During an interview on 11/9/18, at 9:20 a.m. Business Manager Employee E10 confirmed that reference checks were not completed for the above new employees. The Abuse Policy, dated 10/02/18, revealed training is done during its orientation program and through ongoing training programs, . Review of the inservicing schedule for employees revealed that in (MONTH) (YEAR), employees were to complete the Abuse and Neglect and Protecting Resident Rights inservices. During review of the completed inservices on 11/07/18, it was noted that three employees (Dietary Employees E7 and E8 and Nurse Aide Employee E9) had not completed the required abuse training. During an interview on 11/07/18, at 12:23 p.m. the Business Office Manager, Employee E10 confirmed that there was not a designated person to track employee completion of the required inservices and monitor ongoing trainings. During an interview on 11/08/18, at 9:20 a.m. the Assistant Nursing Home Administrator confirmed that it had been longer than a year since Dietary Employees E7 and E8 and Nurse Aide Employee E9 had completed abuse training. 28 Pa. Code 201.19 Personnel policies and procedures 28 Pa. Code 201.20(a)(b)(c)(d) Staff development

Based on review of clinical records, facility policy, and staff interview, it was determined that the facility failed to update a care plan for one of 15 residents (Resident R24). Findings include: The Care Plans, Comprehensive Person-Centered policy, dated 10/2/18, indicated that residents' care plan should be updated at least quarterly. Resident R24's clinical record revealed an admission date of [DATE], with [DIAGNOSES REDACTED]. Resident R24's clinical record revealed a current care plan related to respiratory impairment, dated 7/27/18, indicating that a replacement [MEDICAL CONDITION] (tube inserted in windpipe that provides an alternative airway for breathing) and Ambu bag (hand-held device to aid in breathing) should be at his/her bedside and [MEDICAL CONDITION] (opening through the neck into the windpipe) care should be done per protocol. Observation of Resident R24 on 11/6/18 at 3:30 p.m. and 11/8/18 at 1:10 p.m. revealed that he/she did not have a [MEDICAL CONDITION] and did not have a replacement [MEDICAL CONDITION] or Ambu bag at bedside. During an interview on 11/8/18, at 1:19 p.m. the Director of Nursing confirmed that Resident R24 does not have a [MEDICAL CONDITION] and the care plan should have been updated to reflect Resident R24's current status. 28 Pa. Code 211.5(f) Clinical records Previously cited 12/14/17 28 Pa. code 211.12(d)(1)(5) Nursing services Previously cited 12/14/17

Based on observations, review of clinical records, facility policy, and staff interview, it was determined that the facility failed to obtain a physician order [REDACTED]. Findings include: The Oxygen Administration policy, dated 10/2/18, indicated that before applying oxygen, verify there is a physician's orders [REDACTED].>Observation of Resident R24 on 11/6/18, at 3:30 p.m. and 11/8/18, at 1:10 p.m., revealed that he/she was wearing oxygen. Current physician orders [REDACTED].>During an interview on 11/8/18, at 1:19 p.m. the Director of Nursing confirmed that there was no order for oxygen use during the day for Resident R24. 28 Pa. Code 211.5(f) Clinical records Previously cited 12/14/17 28 Pa. code 211.12(d)(1)(5) Nursing services Previously cited 12/14/17