Every finding on record at Meadville Medical CTR Tcu

Based on review of clinical records and staff interview, it was determined that the facility failed to provide a written summary of the baseline care plan and order summary to the resident and/or representative for eight of eight residents reviewed (Residents R9, R24, R25, R26, R28, R31, R35 and R37). Findings include: No facility policy was provided that included a written summary of the baseline care plan shall be provided to the resident and representative in a language that the resident/resident representative can understand, including a summary of the resident's medications and dietary instructions, any services and treatments to be administered. Resident R9's clinical record revealed an admission date of 10/23/25, with diagnoses including, aftercare from spinal surgery, high blood pressure, cervical myelopathy (compression of the spinal cord in the neck that can cause balance problems, weakness, and loss of fine motor skills), and osteoarthritis (a type of joint disease that results of breakdown of cartilage and bone). Resident R24's clinical record revealed an admission date of 11/13/25, with diagnoses including ortho aftercare from fractured right femur nailing (surgical procedure to stabilize a fractured or weakened femur, thigh bone in upper leg connecting to hip), morbid obesity (a person who is severely overweight), diabetes mellitus (a chronic condition where the body doesn't produce enough insulin or can't use the insulin effectively leading to high blood sugar levels), and high blood pressure. Resident R25's clinical record revealed an admission date of 11/17/25, with diagnoses including infection of sacral stage four decubitus (infection of a severe pressure injury to sacrum, the large triangular bone at base of spine, that extends into muscle, tendon, or bone), diabetes mellitus, hypothyroidism (a condition when the thyroid gland doesn't make enough thyroid hormone to meet the body's needs), chronic obstructive pulmonary disease (COPD - a group of respiratory conditions that involve shortness of breath, a persistent cough, and excess mucus). Resident R26's clinical record revealed an admission date of 11/04/25, with diagnoses including ortho aftercare status post repair of fractured distal fibula, anxiety, hyperlipidemia (high levels of fat, including cholesterol and triglycerides, in the blood) and high blood pressure. Resident R28's clinical record revealed an admission date of 11/10/25, with diagnoses including ortho aftercare from a right total hip repair, atrial fibrillation (abnormal heart rythm), hyperlipidemia (high levels of fat, including cholesterol and triglycerides, in the blood) and high blood pressure. Resident R31's clinical record revealed an admission date of 11/11/25, with diagnoses including ortho aftercare from fractured left acetabular fracture (hip fracture), left hip pain, repeated falls, and restless leg syndrome. Resident R35's clinical record revealed an admission date of 11/06/25, with diagnoses including ortho aftercare from trans metatarsal amputation, left foot osteomyelitis (bone infection) hyperlipidemia and high blood pressure. Resident R37's clinical record revealed an admission date of 11/06/25, with diagnoses including ortho aftercare from fractured right femur nailing, chronic deep vein thrombus of right leg (blood clot of circulatory system of leg), hyperlipidemia (high levels of fat, including cholesterol and triglycerides, in the blood) and high blood pressure. Interview on 11/20/25, at 1:00 p.m. the Director of Nursing (DON) confirmed there was no evidence that a copy of the baseline care plan including physician orders with medications, dietary orders, therapy services was provided to Resident R9, R24, R25, R26, R28, R31, R35 and R37 and/or their representative. 28 Pa. Code 211.10(c) Resident care plan 28 Pa. Code 211.12 (d)(1)(3)(5) Nursing services

Based on observation, review of drug manufacturer instructions, and staff interview, it was determined that the facility failed to appropriately date and store medications in one of two nursing medication rooms (Med Room One). Findings include: Observation on 11/18/2025, at 1:20 p.m. in Med Room One, revealed three opened vials of Purified Protein Derivative (PPD-a skin testing agent for tuberculosis) without an open date marked on the vials. 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, the Director of Nursing (DON) confirmed the PPD vials were opened, undated and not dated to indicate when the medication should be discarded. The DON confirmed the PPD vials should have been labeled with an open date to indicate after 30 days of use, the vials would be discarded. 28 Pa. Code 211.9(a)(1) Pharmacy services 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services

Based on review of facility policy, facility documentation, clinical records and staff interview, it was determined that the facility failed to ensure that each resident's medical record included documentation that indicated, at a minimum that the resident or resident's representative was provided education regarding the benefits and potential side effects of COVID-19 immunization; and that the resident either received the COVID-19 immunization or did not receive the COVID-19 immunization due to medical contraindications or refusal for eight of eight residents reviewed (Residents R9, R24, R25, R26, R28, R31, R35, and R37). Findings include: Facility policy Respiratory Viral Outbreak dated 10/15/25, revealed vaccination is one of the most important ways people can prevent infection, hospitalization, and death from respiratory illness. Encourage everyone to remain up to date with all recommended vaccine doses to protect HCP (health care professional), residents, and visitors. Provide education and resources to HCP, residents, and visitors about the importance of receiving the vaccines for illnesses such as influenza, COVID-19, RSV (respiratory syncytial virus), and pneumonia. Residents R9, R24, R25, R26, R28, R31, R35, and R37's clinical records lacked evidence of a consent process or education provided to the resident and/or resident representative regarding immunization related to the COVID-19 vaccine. During an interview on 11/20/25, at 1:05 p.m. the Director of Nursing and Nursing Home Administrator confirmed that the facility lacked evidence that each resident's medical record, as noted above. included documentation that indicated, at a minimum that the resident or resident's representative was provided education regarding the benefits and potential side effects of COVID-19 immunization; and that the resident either received the COVID-19 immunization or did not receive the COVID-19 immunization due to medical contraindications or refusal. 28 Pa. Code 201.14(a) Responsibility of Licensee 28 Pa. Code 201.18(b)(1)(e)(1) Management 28 Pa. Code 211.10(c) Resident care policies

Based on review of facility policy, facility documentation, clinical records and staff interview, it was determined that the facility failed to ensure that each resident's medical record included documentation that indicated, at a minimum that the resident or resident's representative was provided education regarding the benefits and potential side effects of Influenza/Pneumococcal immunizations; and that the resident either received the Influenza/Pneumococcal immunizations or did not receive the Influenza/Pneumococcal immunizations due to medical contraindications or refusal for eight of eight residents reviewed (Resident R9, R24, R25, R26, R28, R31, R35, and R37). Findings include: Facility policy Influenza Immunization Policy for Inpatients dated 10/15/25, revealed the nurse will assess the patient's immunization status upon arrival to the nursing unit. Vaccine history and updates are entered into the Meditech electronic assessment form and remain in the demo recall system. If the patient meets the criteria, is unsure of vaccination history, the vaccine is not contraindicated, the nurse will document that the vaccine is indicated and initiate vaccine teaching. The nurse will document in the EMR (electronic medical record) that the patient received the current Vaccine Information Statement (VIS). When the patient meets criteria for the vaccine as assessed in the nursing assessment, the vaccine will be added to the e-MAR (electronic medication administration record) by pharmacy. Unless the patient refuses or has a temperature greater than 100.5 degrees Fahrenheit or is one of the exceptions listed above, the nurse will administer the vaccine(s). Facility policy Respiratory Viral Outbreak dated 10/15/25, revealed vaccination is one of the most important ways people can prevent infection, hospitalization, and death from respiratory illness. Encourage everyone to remain up to date with all recommended vaccine doses to protect HCP (health care professional), residents, and visitors. Provide education and resources to HCP, residents, and visitors about the importance of receiving the vaccines for illnesses such as influenza, COVID-19, RSV (respiratory syncytial virus), and pneumonia. Residents R9, R24, R25, R26, R28, R31, R35, and R37's clinical records lacked evidence of a consent process or education provided to the resident and/or resident representative regarding immunization related to the Influenza/Pneumococcal vaccines. During an interview on 11/20/25, at 1:05 p.m. the Director of Nursing and Nursing Home Administrator confirmed that the facility lacked evidence that each resident's medical record, as noted above, included documentation that indicated, at a minimum that the resident or resident's representative was provided education regarding the benefits and potential side effects of Influenza/Pneumococcal immunization; and that the resident either received the Influenza/Pneumococcal immunization or did not receive the Influenza/Pneumococcal immunization due to medical contraindications or refusal. 28 Pa. Code 201.14(a) Responsibility of Licensee 28 Pa. Code 201.18(b)(1)(e)(1) Management 28 Pa. Code 211.10(c) Resident care policies

Based on review of facility policies and clinical records, and staff interview, it was determined that the facility failed to fully investigate an incident with injury in a timely manner for one of 10 residents reviewed (Residents R78). Findings include: Review of a facility policy entitled Abuse Policy of the Transitional Care Unit dated 11/08/2024, revealed that, all investigations shall be comprehensive and responsive and shall occur promptly after notification of an alleged abuse . Review of facility policy entitled Accidents and Incident Reports dated 11/08/24, revealed a written report shall be made of any accident or incident in which a resident is involved in the facility . Review of Resident R78's clinical record revealed an admitted [DATE], with diagnoses that included arthritis, pain in right hip, and infection and inflammatory reaction due to internal right hip prosthesis (artificial hip joint). Review of Resident R78's clinical record revealed a progress note dated 7/07/2024, that indicated Resident R78 was sitting on his/her buttocks in front of wheelchair. It was reported by a Nurse Aide that Resident R78 had stood up and was attempting to transfer into bed independently with the call bell alarming. The Nurse Aide in response to the call bell, assisted Resident R78 and their knees buckled causing the resident to fall to the floor. Resident R78 was assessed with complaint of pain to the left lower leg. An order was received from the physician to transfer Resident R78 to the hospital. Resident R78 returned from the hospital with a diagnosis of fractured left femur. Review of Resident R78's clinical record and incident documentation revealed a lack of evidence that an investigation was completed. Further review of the clinical record and facility documentation lacked evidence of interviews from staff present at the time of the incident or handwritten statements from staff of the incident investigation to ensure the resident was free from abuse and/or neglect. During an interview on 11/14/2024, at 10:40 a.m. the Nursing Home Administrator (NHA) confirmed that there was a lack of a thorough investigation completed on Resident R78's incident with injury. The NHA also confirmed that all incidents should be investigated which included obtaining written statements. 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 201.18(b)(1) Management 28 Pa. Code 201.18(e)(1) Management 28 Pa. Code 211.12(d)(1)(5) Nursing services

Based on review of manufacturer's guidelines, facility records, observations, and staff interviews, it was determined the facility failed to maintain safe storage of ice for residents for one of one ice machines located in the kitchen. Findings include: Review of the manufacturer's guidelines for the Kold-Draft GT & GB Models (ice machine) revealed that Individual drains must never be directly connected to a common manifold, drain, or standpipe. If individual drains are to be discharged into a common manifold, drain, or standpipe, a minimum one and half-inch air gap must be provided at each connection. This is to prevent any backflow or back-siphoning of drain water into the ice maker or ice bin. Review of ice machine maintenance records provided by the facility on 12/12/23, indicated that the ice machine was last serviced and cleaned on 9/25/23. Observation on 12/11/23, at 11:14 a.m. revealed a black, slimy substance on the outside of the white plastic drainpipe from the bottom of the ice bin. The bottom edge of the pipe was resting against the top edge of the drainpipe to the floor, and there was black, slimy substance on the inside edge of the drainpipe to the floor, and there was no one and half-inch air gap. During an interview on 12/11/23, at 11:14 a.m. the Dietary Manager confirmed the presence of the black, slimy substance on both pipes and that the pipes were resting together. During an interview on 12/12/23, at 1:30 p.m. the Nursing Home Administrator confirmed the presence of the black, slimy substance; the edges of the pipes were touching; the ice machine was last cleaned on 9/25/23; and that the ice machine piping was dirty and should have been cleaned and measures taken to prevent the development of the black, slimy substance. 28 Pa. Code 201.14(a) Responsibility of licensee

Based on review of position description and job duties and facility documentation, and staff interviews, it was determined that the facility failed to ensure that a registered nurse was employed as the Director of Nursing on a full-time basis since October 26, 2023. Findings include: Review of the position description section for the Director of Nursing - (DON) revealed that the role of the DON includes to coordinate total nursing care for residents using nursing standards and the nursing process in accordance with current Federal, State, and Local standards, guidelines, and regulations that govern the Long Tern Care Facility to assure that the highest degree of quality care can be provided to our residents at all times. The Job Duties for the DON included to promote an environment in which the resident care team can work cooperatively toward objectives, directs, supervises, delegates and evaluates all nursing care provided to the residents by using professional skills and judgements. Functions as clinical and managerial resource to guide and validate the independent decision making of staff. Review of information submitted by the facility regarding a change in the DON position revealed that Employee EI began as the DON on November 6, 2023. During an interview on December 13, 2023, at 10:30 a.m. DON Employee E1 reported he/she was serving as the temporary DON while they work to fulfill the job with a permanent employee. Employee E1 reported that they also work as the Nursing Supervisor in the acute care hospital two to three days a week. During an interview on December 13, 2023, at 10:30 a.m. the Nursing Home Administrator confirmed that Employee E1 assumed the DON role on November 6, 2023, and the former DON's last day worked was on October 26, 2023. The NHA also confirmed that the current DON does not work on a full-time basis as they also work as the Nursing Supervisor in the acute care hospital two to three days a week. 28 Pa Code 201.14 (a) Responsibility of license 28 Pa Code 211.12 (b) Nursing Services

Based on review of clinical records, facility documentation and staff interview, it was determined that the facility failed to provide the notice of bed hold policy prior to or at the time of transfer to the hospital for one of three residents (Resident R20). Findings include: Resident R20 was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. Resident R20 was transferred from the facility to the hospital on [DATE]. There was no evidence in the clinical record that either Resident R20 or their responsible party received notice of bed hold policy at the time the resident was admitted to the facility or was transferred to the hospital. During an interview on 8/2/18, at 1:35 p.m. the Nursing Home Administrator confirmed that Resident R20 did not receive the bed hold information at the time of admission or transfer to the hospital. 28 Pa. Code 201.14 Responsibility of licensee Previously cited 9/1/17 and 8/31/16

Based on review of facility policies, observations and staff interviews, it was determined the facility failed to consistently monitor refrigerator, freezer, dishwasher and three compartment sink temperatures and the three compartment sink sanitizer level; failed to maintain sanitary conditions of fans and appropriately wash hands and discard outdated food. Findings include: The facility policy Temperature Checks of Coolers and Freezers in Food Service Department dated 6/20/17, indicated that temperatures of refrigerators and freezers would be checked daily by assigned staff and recorded on the appropriate log and that assigned supervisory staff would review logs for completion on a daily basis and follow up as needed. Observations of the kitchen environment, coolers, freezers on 8/30/17, between 11:00 a.m. and 11:30 a.m. and associated August 2017 temperature logs, revealed the following: A fan near the main kitchen entrance with dust and dark material on the blades and fan guard. Cooks Upright Freezer log - No temperatures recorded on 8/24/17 and 8/29/17. Upright Freezer (meats/ice cream) log - No temperatures recorded on 8/23/17 and 8/24/17. Cooks Cooler log - No temperatures recorded on 8/21/17, 8/22/17, 8/24/17, and 8/29/17. Produce Cooler log - No temperatures recorded on 8/15/17, 8/21/17, 8/22/17, 8/24/17, and 8/29/17. Walk -in Freezer - No temperatures recorded on 8/24/17 and 8/29/17. A covered bowl of fruit on a tray in the produce cooler, labeled pitch by 8/26/17. On 8/30/17, at 11:30 a.m., Dietary Supervisor Employee E3 confirmed the temperature logs were incomplete, that the fruit was outdated for use and should be discarded, and that the fan was unclean. The facility policy Infection Control for the Food Service Department, dated 6/20/17, indicated that manufacturer's recommended temperatures for the dishwasher are to be recorded and any not meeting standards are to be reported to the supervisor. The August 2017 log of temperatures for the facility dish washer revealed the following: No temperatures of wash, or final rinse recorded at breakfast on 8/19/17, 8/20/17, and 8/25/17. No temperatures of wash or final rinse recorded at lunch on 8/19/17, 8/20/17, 8/23/17, 8/24/17, and 8/25/17. No temperatures of wash or final rinse at dinner on 8/07/17, 8/17/17, 8/23/17, 8/29/17, or 8/30/17. On 8/30/17, at 4:40 p.m., Dietary Employee E5 washed his/her hands at the sink and turned the faucet off with their clean, wet hand before drying with a paper towel. During an interview on 9/01/17, at 9:15 a.m., Registered Infection Control Nurse Employee E7 confirmed that faucets are considered contaminated and should be turned off with a paper towel upon completion of washing hands. The facility policy Food Service Warewashing dated 6/20/17, indicated that pots and pans are to be soaked and excess soil removed, then washed rinsed and placed in a sanitizing rinse for at least one minute. On 8/30/17, at 5:00 p.m., Dietary Employee E4, proceeded to fill the three compartment sinks and instill sanitizing solution in the third compartment. Instructions posted above the sink indicated the sanitizing rinse should register between 150 and 400 parts per million (PPM) and tested by appropriate testing paper. A fan above the sinks was circulating air with a build up of dust and dark material on the blades and fan guard. Dietary Employee E4 stated during the observation that the water temperatures of the wash, rinse and sanitizing sinks were 107, 109, and 109 degrees Fahrenheit (F) respectively and that was okay and that the sanitizer should register less than 400 PPM, but that lately when it dispenses I've had to add more water to get it down below 500. The August 2017 Three Compartment Sink log, indicated that the acceptable pot wash and rinse should be 110 to 120 degrees Fahrenheit (F); the final sanitizing rinse should be between 75 and 120 degrees (F); and that the sanitizing rinse should register between 200 to 300 PPM. The August 2017 Three Compartment Sink log revealed the following: No temperatures and sanitizing levels recorded at 9:00 a.m. on 8/19/17, 8/20/17, and 8/25/17. No temperatures and/or sanitizing levels recorded at 2:00 p.m. on 8/01/17, 8/02/17, 8/03/17, 8/14/17; 8/18/17; 8/20/17 8/21/17; 8/24/17; and 8/30/17. No temperatures and sanitizing levels recorded at 5:30 p.m., on 8/23/17 and 8/29/17. The log also indicated that the three compartment sink wash and rinse temperature reached the acceptable wash and rinse temperature (110-120 degrees F) on only one of 77 documented occasions. On 8/30/17, at 5:00 p.m., the Dietary Supervisor confirmed the incomplete logs for the dishwasher and three compartment sink and the elevated sanitizing levels dispensed by the equipment. 28 Pa. Code 201.14(a) Responsibility of licensee Previously cited 8/31/16

Based on review of clinical records and facility policy, observations and staff interview, it was determined that the facility failed to prevent potential cross contamination and appropriately wash hands during a dressing change for one of one residents (Resident R2). Findings include: The facility policy Hand Hygiene, dated 6/20/17, indicated that hands are to be washed with soap and water after contact with body fluids, mucus membranes and wound dressings, and after removing gloves. The policy further indicated that hands can be sanitized with an alcohol based cleanser if not visibly soiled. Resident R2's clinical record revealed an admission date of [DATE], [DIAGNOSES REDACTED]. Resident R2's physician orders, dated 8/18/17, included direction to apply Venelex (promotes wound healing through increased circulation and anti-bacterial properties) to the sacral pressure ulcer twice a day; orders for Preparation H (for rectal pain) to the inner rectum every twelve hours and Critic-Aid (an anti-fungal skin barrier product) to the outer rectal area. During observation of a dressing change on 8/31/17, at 9:30 a.m., Licensed Practical Nurse (LPN) Employee E1 placed three creams/ointments in labeled cups on Resident R2's bedside stand. With gloved hands prior to the dressing care, LPN Employee E1 proceeded to clean Resident R2's rectal area of stool with wet cloths. Without removing gloves or washing hands, LPN Employee E1 then proceeded to look for a wound cleansing product, opening the bedside stand drawers, the chest of drawers and touching the bed linen while wearing the potentially contaminated gloves. Following wound cleansing, LPN Employee E2 then proceeded to apply the Preparation H to the rectal area, Venelex to the wound and the Citric-Aid to the surrounding skin, changing gloves between each application, but failing to wash his/her hands after removing the soiled gloves and before applying the clean ones. During an interview on 8/31/17, at 9:50 a.m., LPN Employee E1 confirmed the cross contamination of the linen and furniture in Resident R2's room and the failure to wash his/her hands in conjunction with changing gloves. 483.65 Previously cited state deficiency 8/31/16 28 Pa. Code 201.18(b)(1) Management Previously cited 8/31/16 28 Pa. Code 211.10(c)(d) Resident care policies Previously cited 8/31/16 28 Pa. Code 211.12(d)(1)(2)(5) Nursing services Previously cited 8/31/16

Based on review of facility policy and clinical records and staff interview, it was determined that the facility failed to assure that an antipsychotic medication (medication to treat major mental disorders) was given for appropriate reasons for one of 11 residents (Resident R1). Findings include: The facility policy, [MEDICAL CONDITION] (impacting mental state) Drug Monitoring, dated 6/20/17, indicated that anti-psychotic medications are not given unless necessary to treat a specific condition as diagnosed and documented in the clinical record by the physician. Resident R1's clinical record revealed an admission date of [DATE], and [DIAGNOSES REDACTED]. Physician orders, dated 8/16/17, included an order for [REDACTED]. The clinical record including [DIAGNOSES REDACTED]. During an interview on 8/31/17, at 1:30 p.m. Registered Nurse Employee E6 confirmed the clinical record lacked documentation to support the use of an antipsychotic medication for Resident R1. 28 Pa. Code 211.12 (d)(1)(5) Nursing services Previously cited 8/31/16

Based on observations, review of clinical records and facility policy and staff interview, it was determined that the facility failed to prevent the potential for cross contamination on one of one unit (Transitional Care Unit). Findings include: The facility Isolation Policy and Procedure policy dated 5/2016, stated that patients infected with MRSA (Methicillin-resistant Staphylococcus aureus-a difficult to treat infection) would be placed in contact precautions (a form of isolation). The face sheet revealed that Resident R6 was admitted to the facility on [DATE]. Review of physician's orders [REDACTED]. Laboratory results from a left knee culture dated 8/23/16, revealed infection with a large amount of MRSA. Observation of Resident R6's room on 8/30/16, at 9:35 a.m., revealed isolation signage and that personal protective equipment was required to be worn prior to entering the room. Observation of a dressing change on 8/30/16, from 9:35 a.m. to 9:45 a.m. revealed that Licensed Practical Nurse (LPN) Employee E3 donned a gown and gloves as required prior to entering the room, then proceeded to change Resident R6's left knee dressing. During the dressing change, LPN Employee E3 reached under their protective gown with gloved hands and retrieved lotion from a uniform pocket and again pulled the protective gown aside and searched their uniform pockets with gloved hands, removing pens and scissors, then replaced them in the uniform pockets. Observation of blood glucose (blood sugar) monitoring on 8/29/16, at 4:25 p.m. revealed that Medical Technologist Employee E4 entered Resident R4's room, placed the glucometer (a medical device that utilizes a small drop of blood to calculate the blood glucose level) on the bed next to the resident and proceeded to check Resident R4's blood glucose levels. Medical Technologist Employee E4 placed the glucometer on top of the cart without the benefit of cleaning and pushed the cart to to Resident R3's room. Medical Technologist Employee E4 then used the glucometer to check Resident R3's blood glucose levels, returned the glucometer to the top of the cart without the benefit of cleaning and left the unit. During an interview on 8/31/16 at 12:30 p.m., Infection Preventionist Employee E5 confirmed that LPN Employee E3 contaminated their uniform and items in the pockets and did not follow proper isolation procedure during the dressing change and that Medical Technologist Employee E4 should have cleaned the glucometer after each use. 483.65 Previously cited state deficiency 9/02/15 28 Pa. Code 201.18(b)(1)(3) Management Previously cited 9/02/15 28 Pa. Code 211.10(c)(d) Resident care policies Previously cited 9/02/15 28 Pa. Code 211.12(d)(1)(2)(3)(5) Nursing services Previously cited 9/02/15, 8/29/14

Based on review of attendance records for the Quality Assessment and Assurance (QA&A) committee and staff interview, it was determined that the facility failed to conduct a quarterly QA&A meeting with all required members present for one of four meetings within the last year. Findings include: The facility's attendance records for QA&A committee meetings conducted between October 2015 through August 2016 revealed that the April 27, 2016, scheduled QA&A meeting was cancelled. There was no evidence to indicate that another time was scheduled to conduct the quarterly QA&A meeting. During an interview on 8/30/16, at 9:45 a.m., the Nursing Home Administrator confirmed that the quarterly meeting scheduled on 4/27/16, was cancelled and was not rescheduled. 28 Pa. Code 201.18 (e)(3) Management Previously cited 9/02/15

Based on clinical record review and staff interview, it was determined that the facility failed to document required information regarding the additional assessment performed on the care areas triggered by the completion of the Minimum Data Set (MDS-periodic assessment of care needs) for two of 10 residents reviewed. (Residents R1 and R2). Findings include: The Resident Assessment Instrument (RAI) User's Manual provides the instruction that the documentation related to the Care Area Assessments (CAAs) should indicate the basis for the care plan decision, why the finding requires an intervention, and the rationale for selecting specific interventions. For each triggered care area, the facility must indicate the date and location of where the information related to the CAAs can be found in the resident's clinical record. Review of Resident R1's admission MDS assessment dated [DATE], revealed that the CAA summary did not indicate the location and date of where the information related to the CAA could be found for the triggered areas, and stated only see chart. Review of Resident R2's admission MDS assessment dated [DATE], revealed that the CAA summary did not indicate the location and date of where the information related to the CAA could be found for the triggered areas, and stated only see chart. During an interview on 8/30/16, at 1:35 p.m., Registered Nurse Assessment Coordinator Employee E2 confirmed that the source of information related to the triggered areas of the CAAs for Residents R1 and R2 was listed only as see chart and did not include where the CAA information and decision making documentation could be found on the residents' records. 28 Pa Code 211.5(f) Clinical records 28 Pa Code 211.12(d)(1)(2)(5) Nursing Services Previously cited 9/02/15, 8/29/14

Based on observations, review of clinical records and facility policy and staff interview, it was determined that the facility failed to provide privacy and dignity for two of 10 residents (Residents R6 and R2). Findings include: The face sheet revealed that Resident R6 was admitted to the facility on [DATE]. Review of physician's orders [REDACTED]. Observation of a dressing change to Resident R6's left knee on 8/30/16, at 9:35 a.m. revealed that Licensed Practical Nurse (LPN) entered Resident R6's room and changed the left knee dressing without first pulling the curtain or closing the door to provide privacy. The facility Nasogastric/Orogastric/Feeding Tube Management policy dated 5/2016, does not address provision of privacy during medication administration via a feeding tube. The 8/24/16, admission Minimum Data Set (MDS-a periodic assessment of care needs) revealed that Resident R2 was admitted to the facility on [DATE], and received nutrition via a feeding tube (a tube inserted into the stomach to provide nutrition). Observation of medication administration on 8/30/16, at 12:15 p.m. via Resident R2's feeding tube revealed that LPN Employee E1 administered medications and nutrition without first pulling the curtain or closing the door to provide privacy. During an interview on 8/31/16, at 11:45 a.m. the Director of nursing confirmed that privacy should be provided when changing a dressing and/or administering medications via a feeding tube. 28 Pa. Code 201.29(a)(j) Resident rights 28 Pa. Code 211.12(d)(1)(5) Nursing services Previously cited 9/02/15, 8/29/14

Based on observations, review of facility policy and staff interview, it was determined that the facility failed to utilize sanitary practices during handwashing and provide a sanitary environment in 8 of 21 bathrooms (Rooms 364, 365, 372-375, 379 and 380) and the bathing area. The findings include: The facility Hand Hygiene policy, dated August 2015, instructed staff, after handwashing, to turn off contaminated faucet with paper towel. Observation on 9/01/15, at 1:40 p.m., revealed that Licensed Practical Nurse Employee E1 assisted Resident R9 to use the toilet, applied a treatment to the rectal area, then washed their hands at the bathroom sink and turned off the contaminated faucet using his/her bare hands rather than a dry paper towel. Observation on 9/01/15, at 5:35 p.m., revealed that Nurse Aide Employee E2 washed their hands in the nourishment center sink, then turned off the contaminated faucet using his/her bare hands rather than a dry paper towel. Observations during a tour of the facility on 9/01/15, from 11:00 a.m. through 11:45 p.m., revealed the following: In the bathroom of room [ROOM NUMBER], the lower portion of the call bell cord was in direct contact with the floor near the toilet and a bedpan was located on top of the garbage can. In the bathroom of room [ROOM NUMBER], the lower portion of the call bell cord was in direct contact with the floor, a urine hat (measuring device for urine) was located on top of the garbage can and the bucket from a bedside commode was directly on the bathroom floor. In the bathroom of room [ROOM NUMBER], the lower portion of the call bell cord was in direct contact with the floor and a bedside commode bucket was directly on the floor. In Rooms 372, 374, 375, 379 and 380, the lower portion of the bathroom call bell cords were directly on the floor. In the bathing area, a bedside commode bucket was directly on the top surface of a supply storage cart. During an interview on 9/01/15, at the time of the observations from 11:00 a.m. through 11:45 a.m., Activity Director Employee E3 confirmed the call bell cords on the floor in Rooms 364, 365, 372-375, 379 and 380, the bedpan on top of the garbage can in the bathroom of room [ROOM NUMBER], the urine hat on top of the garbage can and the bedside commode bucket on the bathroom floor in room [ROOM NUMBER], the bedside commode bucket on the bathroom floor of room [ROOM NUMBER] and the bedside commode bucket directly on top of the supply storage cart in the bathing area. 28 Pa. Code 201.18(b)(3) Management. 28 Pa. Code 211.10(d) Resident care policies. 28 Pa. Code 211.12 (d)(1)(3)(5) Nursing services. Previously cited 8/29/14.

Based on observations and staff interview, it was determined that the facility failed to permit only authorized personnel to have access to an area that medications are stored for one of one medication storage room. The findings include: During observation of medication administration on 8/26/14, at 2:20 p.m., Nurse Aide Employee E1 was observed entering the medication storage area after putting in a code on the door to enter and exited out of the room with heel protectors for a resident. Observation of the medication storage area at 8/26/14, at 2:25 p.m., with Licensed Practical Nurse (LPN) Employee E2, revealed a container sitting out in the medication storage room with 12 labeled medication boxes and one unmarked medication box with one to seven medications in each container, accessible to anyone entering the room. It was also noted that there were keys hanging from the storage cabinet with the cabinet door unlocked. During an interview at the time of the observation with LPN Employee E2, it was confirmed that the medications should have been locked in the cabinet and the keys should not have been hanging from the cabinet door. 28 Pa. Code 211.12(d)(1)(5) Nursing services.

Based on observations, review of facility policy and staff interview, it was determined that the facility failed to properly store food and follow sanitation practices in the kitchen area. The findings include: The "Storage of Foods and Supplies" policy dated 6/27/12, indicated that all stock is rotated by the first in first out method. Observations of food storage in the refrigerator of the Nourishment Center on 10/7/13, at 10:55 a.m., revealed a total of eight thick & easy juices past their expiration dates. Three of the juices expired on 8/13/13, a period of 55 days past the expiration. Five of the juices expired on 9/13/13, a period of 24 days past the expiration. During an interview on 10/7/13, at the time of the above observations, the Director of Nursing confirmed that the juices were not to be used past the expiration date. 28 Pa. Code 201.14(a) Responsibility of licensee. 28 Pa. Code 201.18(b)(1)(3) Management.

Based on observation, review of facility procedure and staff interviews, it was determined that the facility failed to prevent the potential for cross-contamination during medication administration by one of five employees (Licensed Practical Nurses (LPN) Employee E1). The findings include: The "Subcutaneous (under the skin) Injection" procedure, dated 7/09/11, indicated that staff perform hand hygiene and "put on gloves" prior to giving an insulin injection. Observation of medication pass on 9/28/11, at 8:00 a.m., revealed that LPN Employee E1 administered a subcutaneous injection without wearing protective gloves. During an interview on 9/28/11, at 8:15 p.m., the Director of Nursing, indicated that protective gloves were required to be worn when administering injections. 28 Pa Code 201.18(b)(1)(d) Management. 28 Pa Code 201.29(d) Resident rights. 28 Pa Code 211.10(a)(d) Resident care policies. 28 Pa Code 211.12(d)(1)(2)(3)(5) Nursing services. Previously cited 8/04/10.