Every finding on record at Mosser Nursing Home

Based on observation, staff interview, and facility policy review, it was determined that the facility failed to store and serve food in a sanitary manner in the dietary department.Findings included: Review of the facility policy entitled, Food and Supply Storage Procedures, dated March 2, 2026, revealed that staff was to label foods with a use by date and foods past the use by date should be discarded. Foods in the dry storage area that must be opened were to be stored in containers that have tight-fitting lids, with the bin and lid labeled and dated. Observations during the kitchen tour on March 31, 2026, at 9:24 a.m., revealed the following: In the freezer in the cooking area, nine prepared manicotti pasta shells were stored in a freezer bag, undated. In the refrigerator in the cooking area, four hard-boiled eggs with a yellow watery substance were stored in a plastic bag labeled with a use by date of March 27, 2026. On the shelves in the dry storage room, there were five bags of sauerkraut that were labeled with expiration dates of March 15, 2026, an opened bag of rice and a 25-pound bag of Panko breadcrumbs, exposed to the air, without proper containers. In the walk-in refrigerator, there was an opened, undated bag of Texas Toast. On March 31, 2026, at 9:50 a.m., the Certified Dietary Manager confirmed that the items observed were improperly stored and/or labeled. 28 Pa. Code 201.14(a) Responsibility of licensee.

Based on clinical record review and staff interview, it was determined that the facility failed to complete an accurate Minimum Data Set (MDS) assessment for two of 12 sampled residents. (Residents 19 and 29) Findings include: Clinical record revealed that Resident 19 had diagnoses that included cognitive communication deficit and major depressive disorder. Review of the MDS assessment dated [DATE], revealed that Sections C (the Brief Interview for Mental Status) and D (the Mood assessment/interview) were incomplete. Clinical record review revealed that Resident 29 had diagnoses that included dementia and nontraumatic intracranial hemorrhage (bleeding within the brain in the absence of trauma or surgery). On December 21, 2024, the physician ordered that the facility provide hospice services. Review of the MDS assessment dated [DATE], revealed no documentation that resident had hospice services in place during the review period. The MDS assessment inaccurately reflected that the resident was not receiving hospice services. In an interview on May 21, 2025, at 12:50 p.m., the Registered Nurse Assessment Coordinator (RNAC) confirmed that Resident 19's and 29's MDS assessments were inaccurate.

Based on facility policy review, clinical record review, and staff interview, it was determined that the facility failed to ensure physician's orders were implemented for one of 12 sampled residents. (Resident 7) Findings include: Review of the policy entitled, Medication Administration, last reviewed January 31, 2025, revealed staff was to obtain vital signs if necessary, and document in the medical record the physician ordered medication administration information. Clinical record review revealed that Resident 7 had diagnoses that included atrial fibrillation (an irregular heartbeat), chronic kidney disease, and hypertensive retinopathy (damage to the retina caused by chronic high blood pressure). On July 15, 2024, the physician ordered staff to administer a blood pressure medicine (metoprolol tartrate) twice a day. Staff was not to administer the medication if the heart rate was less than 60 beats per minute or if the resident's systolic blood pressure (the first measurement of blood pressure when the heart beats and the pressure is at its highest) was less than 110 millimeters of mercury (mm/Hg). Review of Resident 7's April and May 2025 Medication Administration Records revealed that staff administered or held the medication 86 times with no documentation that the heart rate and blood pressure were assessed prior to medication administrating or holding of the medication per physician's order. In an interview on May 21, 2025, at 10:30 a.m., the Director of Nursing confirmed there was no documented evidence that the heart rate or the blood pressure were taken prior to medication administrating or holding of the medication per physician's order and they should have been there for Resident 7. 28 Pa. Code 211.10(d) Resident care policies. 28 Pa. Code 211.12(d)(1)(5) Nursing services.

Based on clinical record review, observation, and staff interview, it was determined that the facility failed to implement interventions to prevent further decline and/or improve range of motion for one of two sampled residents with limited range of motion. (Resident 26) Findings include: Clinical record review revealed that Resident 26 had diagnoses that included dementia, muscle weakness, and other abnormalities of gait and mobility. The Minimum Data Set (MDS) assessment dated [DATE], indicated that the resident had cognitive impairment and was dependent on staff for personal hygiene and dressing. Review of the physical therapy progress note dated February 11, 2025, indicated that resident had limited range of motion to his right foot. On March 3, 2025, the physician ordered that staff apply a MAFO (molded ankle foot orthosis-a custom made brace that provided support and control) in Velcro closure sneakers to be worn at all times on the right foot when Resident 26 was out of bed. Observations on May 20, 2025, at 10:30 a.m. and 12:11 pm, and on May 21, 2025, at 9:00 a.m., revealed that Resident 26 was in his wheelchair without the MAFO brace on. In an interview on May 21, 2025, at 10:58 a.m., the Therapy Director confirmed that the resident was identified with a contracture (a condition of shortening and hardening of muscles, tendons, or other tissue, often leading to deformity and rigidity of joints) of his right foot, and that the MAFO brace should have been on when the resident was observed.

Based on policy review, observation, and staff interview, it was determined that the facility failed to administer medications in a manner that prevents the spread of infections on one of two nursing units. (West Wing) Findings include: Review of the facility policy entitled, Infection Control Plan: Standard Precautions, last reviewed January 31, 2025, revealed that gloves should be worn whenever exposure to the mucus membranes (soft tissue that lines the body's canals and organs, such as the eye) is planned or anticipated. On May 20, 2025, at 9:11 a.m., Licensed Practical Nurse (LPN) 1 was observed administering medications to Resident 33. The nurse applied Ocusoft lid scrubs to the eyes of the resident with her ungloved hands. In an interview on May 21, 2025, at 9:30 a.m., the Director of Nursing confirmed that the nurse should have been wearing gloves to administer medications around the eyes. 28 Pa. Code 211.10(d) Resident care policies. 28 Pa. Code 211.12(d)(1)(5) Nursing services.

Based on facility policy review, observation, and staff interview, it was determined the facility failed to store food under sanitary conditions in the dietary department. Findings include: Review of the facility policy entitled, Storage of Food and Supplies, dated November 23, 2022, revealed that all food, non food items, and supplies used in food preparation were to be stored in such a manner as to prevent contamination to maintain the safety and wholesomeness of the food for human consumption. Observation during the initial kitchen tour on May 2, 2023, at 9:48 a.m., revealed in the cook's cooler that all ten of the wire shelves had rust and peeled and chipped paint on the bottom and top and along the length of the wire shelves. There was an unwrapped eggplant stored directly on the shelves. In an interview conducted on May 4, 2023, at 10:00 a.m., the Administrator confirmed the presence of rust and paint in the cook's cooler. 28 Pa. Code 201.18(b)(3) Management. 28 Pa. Code 211.6(c) Dietary services.

Based on observation, interview, and review of facility policy, it was determined that the facility failed to store foods under sanitary conditions in the kitchen. Findings include:Review of facility policy entitled, Food Safety Policies, Food Safety Product Labeling, and Dating Guide dated November 9, 2020, revealed that purchased, ready to eat foods removed from the original container and not served during the next meal must be labeled and dated. Items received from vendors must be labeled with received date. Open commercially prepared food items must be labeled with item name, prep date, use by date, and employee name. Review of facility policy entitled, Food Product Shelf Life Guideline dated November 9, 2020, revealed hard cheeses in opened packages stored at or below 41 degrees Fahrenheit (F) may be stored for three to four weeks. Prepared foods that were stored at temperatures at or below 41 degrees F may be stored for five days. During observation of the kitchen on June 2, 2021, at 10:15 a.m., the following items were observed in the reach in refrigerator: a plastic container of monteray jack cheese dated March 24, a plastic container of mozarella cheese dated April 27, a plastic container of buffalo chicken dip dated May 24, a bag of shredded carrots with a use by date of May 4, 2021, and a bag of sliced turkey deli meat that did not have a date on the bag. During a subsequent observation of the kitchen on June 2, 2021, at 1:00 p.m., there were seven bags of frozen french fries and three bags of frozen hash brown potatoes that were removed from the box/packaging they arrived in from the vendor and stored in the reach in freezer. The bags were not labeled with an arrival or use by date. In an interview with the General Manager during the observation, it was confirmed the bags of frozen french fries and hash brown potatoes should have been dated when placed in the freezer.

Based on record review and interview, it was determined that the facility failed to review and revise the care plan for one of 14 sampled residents. (Resident 13) Findings include: Clinical record review revealed that Resident 13 had diagnoses [MEDICAL RECORD OR PHYSICIAN ORDER] . The Minimum Data Set (MDS) assessment dated [DATE], revealed Resident 13 received antipsychotic and antidepressant medications seven days during the review period. On May 24, 2019, the physician wrote an order for [MEDICAL RECORD OR PHYSICIAN ORDER] . On February 25, 2020, the physician wrote and order for 5mg [MEDICATION(S)] (an antipsychotic medication), half tablet by mouth at bedtime for major depressive disorder. On September 16, 2020, an order for [MEDICAL RECORD OR PHYSICIAN ORDER] . Review of Resident 13's care plan revealed a focus area for use of [MEDICATION(S)] for depression. There was an additional focus area for use of an antianxiety medication, [MEDICATION(S)]. Resident 13's care plan was not updated to include use of an antipsychotic medication, [MEDICATION(S)], and remove the focus area for the use of an antianxiety medication, [MEDICATION(S)]. In an interview on June 4, 2021, at 11:59 a.m., the Director of Nursing confirmed the care plan was not updated to reflect Resident 13's current medication regimen. 28 Pa. Code. 211.11(d) Resident Care Plan.

Based on clinical record review, observation and interview, it was determined that the facility failed to provide services to prevent a decrease in functional range of motion (ROM) and provide a support device for limited mobility for two of 14 sampled residents. (Resident 29, 30) Findings include: Clinical record review revealed that Resident 29 had diagnoses [MEDICAL RECORD OR PHYSICIAN ORDER] . The Minimum Data Set (MDS) assessment dated [DATE], revealed Resident 29 had a limitation in ROM on one side to both upper (shoulder, elbow, wrist, hand) and lower (hip, knee, ankle, foot) extremities. Review of the care plan revealed Resident 29 had an activities of daily living self care performance deficit related to limited mobility. There was an intervention for a left foot support to be on the wheelchair footrest at all times while Resident 29 was out of bed. On October 27, 2020, the physician wrote an order for [MEDICAL RECORD OR PHYSICIAN ORDER] . On June 2, 2021, at 11:13 a.m., Resident 29 was observed sitting up in her wheelchair in her room, the left foot support was not on the wheelchair footrest. On June 2, 2021, at 12:10 p.m., Resident 29 was observed sitting in her wheelchair in the dinning room. There was no footrest or left foot support in place. Clinical record review revealed that Resident 30 had diagnoses [MEDICAL RECORD OR PHYSICIAN ORDER] . The MDS assessment dated [DATE], revealed Resident 30 had limited ROM to her lower extremities on one side. Review of a physical therapy discharge summary dated August 3, 2020, revealed a recommendation for a restorative nursing program (RNP) for active and passive ROM to both lower extremities. There was no documented evidence that a RNP was initiated. During an interview on June 4, 2021, at 11:10 a.m., the Director of Nursing confirmed a RNP was not initiated per the physical therapy discharge recommendations. 28 Pa.Code 211.12(d)(1)(5) Nursing services.

Based on clinical record review, policy review, observation, and staff interview, it was determined that the facility failed to ensure that one of one sampled residents with an indwelling urinary catheter received appropriate treatment and services to prevent urinary tract infection. (Resident 7) Findings include: Review of the facility policy entitled, Infection Control under Care and Maintenance of Foley Catheters revealed that in an effort to prevent urinary tract infections, staff were to ensure that the urinary collection bag was kept off the floor. Clinical record review revealed that Resident 7 had diagnoses [MEDICAL RECORD OR PHYSICIAN ORDER] . Observation on June 2, 2021, at 12:19 p.m., and 3:00 p.m., revealed the indwelling catheter collection bag was on the floor in direct contact with the floor and was not attached to the bed frame. In an interview on June 4, 2021, at 9:53 a.m., the Director of Nursing stated that the catheter bag should not have been on the floor. 28 Pa. Code 211.12(d)(1)(5) Nursing Services.

Based on review of facility policy, clinical record review and staff interview, it was determined that the facility failed to attempt non-pharmacological interventions to alleviate pain prior to administration of pain medication prescribed on an as needed basis and failed to ensure pain management was consistent with professional standards of practice for three of 12 residents. (Resident 18, 48, 49) Findings include: Review of the facility policy entitled, Appropriately Manage Pain dated (MONTH) 2019, revealed that the standard of care at the facility was that each resident will have his or her pain managed and provide non-drug and/or drug interventions based on the resident's pain characteristics with supportive documentation as to the intervention's effectiveness. The policy did not define specific pain parameters to determine a resident's level of pain or indicate which physician ordered as needed pain medication was to be administered. Clinical record review revealed that Resident 18 had [DIAGNOSES REDACTED]. The Minimum Data Set (MDS) assessment dated (MONTH) 15, 2019, indicated that the resident required extensive assistance from staff to complete activities of daily living, experienced constant pain and used a pain medication (opioid) in the last seven days. On (MONTH) 9, 2019 and (MONTH) 21, 2019, a physician ordered for staff to administer an as needed pain medication ([MEDICATION NAME]) every six hours for severe pain, then ordered that same medication on (MONTH) 13, 2019 and (MONTH) 7, 2019, for unspecified pain. On (MONTH) 14, (YEAR), a physician also ordered an as needed pain medication (Tylenol) every six hours for unspecified pain. Review of the Medication Administration Record [REDACTED]. There was no documentation to support that prior to administering the pain medications staff attempted non-pharmacological interventions. There was no documentation to support that staff identified the resident's level of pain as mild, moderate, or severe to ensure that the correct pain medication was administered. Clinical record review revealed that Resident 48 had [DIAGNOSES REDACTED]. The MDS assessment dated (MONTH) 25, 2019, indicated that the resident required extensive assistance from staff to complete activities of daily living and received pain management. On (MONTH) 20, 2019, a physician had ordered an as needed pain medication (Tylenol) every six hours for mild pain. On (MONTH) 23, 2019, (MONTH) 27, 2019, and (MONTH) 24, 2019, a physician ordered for staff to administer an as needed pain medication ([MEDICATION NAME]) every six hours for pain, but ordered that same medication on (MONTH) 10, 2019, every four hours for moderate and severe pain. On (MONTH) 17, 2019, a physician also ordered an as needed pain medication ([MEDICATION NAME]) every six hours for pain. Review of the MAR for (MONTH) 2019, revealed the resident received pain medication on 14 of 31 day, for (MONTH) 2019, on 21 of 30 days, for (MONTH) 2019, on 17 of 31 days, for (MONTH) 2019, on 14 of 30 days and for (MONTH) 2019, four of 12 days. There was no documentation to support that prior to administering the pain medications staff attempted non-pharmacological interventions. There was no documentation to support that staff identified the resident's level of pain as mild, moderate, or severe to ensure that the correct pain medication was administered. Clinical record review revealed that Resident 49 had [DIAGNOSES REDACTED]. The MDS assessment dated (MONTH) 26, 2019, indicated that the resident required extensive assistance from staff to complete activities of daily living and experienced constant pain and used a pain medication (opioid) in the last seven days. On (MONTH) 19, 2019, and (MONTH) 14, 2019, a physician ordered for staff to administer an as needed pain medication ([MEDICATION NAME]) every six hours for severe pain. On (MONTH) 19, 2019, a physician also ordered an as needed pain medication (Tylenol) every six hours for mild pain. Review of the MAR for (MONTH) 2019, revealed the resident received pain medication on 16 of 31 days, for (MONTH) 2019, three of 17 days, for (MONTH) 2019, 14 of 17 days, for (MONTH) 2019, nine of 30 days and for (MONTH) 2019, four of 12 days. There was no ocumentation to support that prior to administering the pain medications staff attempted non-pharmacological interventions. There was no documentation to support that staff identified the resident's level of pain as mild, moderate, or severe to ensure that the correct pain medication was administered. In an interview on (MONTH) 12, 2019, at 9:00 a.m., the Director of Nursing confirmed that there was no documented evidence that pain parameters for as needed pain medications was consistent and that staff had offered non-pharmacological interventions prior to the administration of the as needed pain medication. 28 Pa. Code 211.12(d)(1)(5) Nursing services.

Based on facility policy, clinical record review and staff interview, it was determined that the facility failed to ensure that the facility policy and a physician's order was implemented for two of 12 sampled residents. (Resident 16, 20) Findings include: Review of the facility policy entitled, Bowel Management Protocol dated (MONTH) 10, 2019, revealed that the standard of care at the facility was that each resident at risk for constipation was to be placed on a bowel regimen. A physician's order was to be obtained to implement the bowel regimen. Licensed nurses on all shifts were to review the BM records list for all residents to ensure proper elimination patterns. The bowel protocol steps were as follows: after 48 hours without a bowel movement, staff was to offer prune juice or fibersauce. If no bowel movement in 72 hours (9 shifts per physician order) staff was to administer milk of magnesia if ordered. If the milk of magnesia was ineffective, the next shift was to administer a [MEDICATION NAME] suppository if ordered. If the [MEDICATION NAME] suppository was ineffective, the next shift was to administer a Fleet enema if ordered. If the Fleet enema was ineffective, a physical assessment was to be completed, including vital signs and abdominal assessment of bowel sounds, abdominal pain, bloating or tenderness. Upon completion of the assessment the physician was to be notified for further instructions. Verbal report from shift to shift was to include residents on the bowel protocol and what step they were at in the bowel protocol process. Nursing was to document the effectiveness of medications/treatment provided. The Nursing Assistant was to document bowel movements every shift. Clinical record review revealed that Resident 16 was admitted on (MONTH) 25, (YEAR), with [DIAGNOSES REDACTED]. The Minimum Data Set (MDS) dated , (MONTH) 17, 2019, revealed that the resident's memory was impaired and that she required extensive assistance of staff for most activities of daily living including toileting. The MDS revealed that the resident was always incontinent of bowel. The resident's current care plan identified that the resident was at risk for constipation. On (MONTH) 16, (YEAR), the physician ordered a bowel protocol as follows: after 9 shifts without a bowel movement, staff was to administer milk of magnesia. If milk of magnesia was ineffective in one shift, a [MEDICATION NAME] suppository was to be administered. If the suppository was ineffective in one shift, a Fleet enema was to be administered. Nurse aide documentation and review of the Medication Administration Records (MAR) from (MONTH) 1, 2019, through (MONTH) 12, 2019, revealed Resident 16 had seven occurrences of no bowel movements for nine shifts or more where the physician orders and bowel management protocol should have been utilized. There was no documentation to support the milk of magnesia, [MEDICATION NAME] suppository, Fleet enema or physical assessment with notification to the physician occurred according to facility policy and physician order. Clinical record review revealed that Resident 20 was admitted on (MONTH) 17, 2019, with [DIAGNOSES REDACTED]. The Minimum Data Set (MDS) dated , (MONTH) 22, 2019, revealed that the resident's memory was impaired, and she required extensive assistance of staff for most activities of daily living including toileting. The MDS revealed that the resident was always incontinent of bowels. On (MONTH) 17, 2019, the physician ordered a bowel protocol as follows: after 9 shifts without a bowel movement, staff was to administer milk of magnesia. If milk of magnesia was ineffective in one shift, a [MEDICATION NAME] suppository was to be administered. If the suppository was ineffective in one shift, a Fleet enema was to be administered. Nurse aide documentation and review of the Medication Administration Record [REDACTED]. There was no documentation to support the milk of magnesia, [MEDICATION NAME] suppository, Fleet enema or physical assessment with notification to the physician occurred according to facility policy and physician order. In an interview on (MONTH) 12, 2019, at 9:21 a.m., the Director of Nursing confirmed that there was no documentation to support that the facility policy and physician ordered bowel protocol was being followed for either of these residents. 28 Pa. Code 211.12 (d)(1)(5) Nursing services

Based on clinical record review, observation, and staff interview, it was determined that the facility failed to review the risks and benefits related to the use of bed rails with residents or their representatives and obtain informed consent for utilization of bed rails for seven of 14 sampled residents (Resident 6,19, 30, 35, 37, 48, 150) Findings include: Clinical record review revealed that Resident 6 had [DIAGNOSES REDACTED]. On (MONTH) 11, (YEAR), at 10:30 a.m., Resident 6 was observed in bed with two bed rails in the upright position at the top of the bed. Clinical record review revealed that Resident 19 was readmitted to the facility on (MONTH) 4, (YEAR), with [DIAGNOSES REDACTED]. A MDS assessment completed (MONTH) 11, (YEAR), revealed that the resident had no memory impairment and required extensive assistance of two staff member for transfers. On (MONTH) 11, (YEAR), at 10:54 a.m., Resident 19 was observed in bed with two bed rails in the upright position at the top of the bed. Clinical record review revealed that Resident 30 had [DIAGNOSES REDACTED]. On (MONTH) 11, (YEAR), at 10:40 a.m. and 11:00 a.m., Resident 30 was observed in bed with two bed rails in the upright position at the top of the bed. Clinical record review revealed that Resident 35 had [DIAGNOSES REDACTED]. A MDS assessment completed (MONTH) 8, (YEAR), revealed that the resident had no memory impairment and required extensive assistance of two staff members for transfers. On (MONTH) 11, (YEAR), at 10:36 a.m., Resident 35 was observed in bed with two bed rails in the upright position at the top of the bed. Clinical record review revealed that Resident 37 was admitted to the facility on (MONTH) 3, (YEAR), with [DIAGNOSES REDACTED]. A MDS assessment completed (MONTH) 10, (YEAR), revealed that the resident had no memory impairment and required assistance of two staff members for transfers. On (MONTH) 11, (YEAR), at 10:00 a.m., Resident 37 was observed in bed with two bed rails in the upright position at the top of the bed. Clinical record review revealed that Resident 48 was readmitted to the facility on (MONTH) 31, (YEAR), with [DIAGNOSES REDACTED]. A MDS assessment completed (MONTH) 12, (YEAR), revealed that the resident had some memory impairment and required extensive assistance of two staff members for transfers. On (MONTH) 11, (YEAR), at 10:38 a.m., Resident 48 was observed in bed with two bed rails in the upright position at the top of the bed. Clinical record review revealed that Resident 150 was admitted to the facility on (MONTH) 29, (YEAR), with [DIAGNOSES REDACTED]. Clinical documentation revealed that the resident was able to make her needs known and required extensive assistance of one staff member for transfers. On (MONTH) 11, (YEAR), at 10:45 a.m., Resident 150 was observed in bed with two bed rails in the upright position at the top of the bed. In an interview on (MONTH) 11, (YEAR), at 12:30 p.m., the Director of Nursing stated that the facility had no evidence to support that residents or their responsible parties were provided information on the risks and benefits of utilizing side rails and consented for the side rails to be utilized.

Based on review of facility policy, observation and staff interview, it was determined that the facility failed to review and update the facility-wide assessment and evaluate the associated policy and procedure, regarding equipment (bed rails) that was necessary to care for residents who needed assistance with bed mobility. Findings include: Review of the facility assessment dated (MONTH) 14, (YEAR), revealed that the facility was to ensure adequate supplies and that equipment was to be maintained to protect and promote the health and safety of residents. Observations on (MONTH) 11, (YEAR), from 10:00 a.m. through 11:00 a.m., revealed multiple residents in bed with bed rails in the upright position. Further review of the facility assessment revealed that the facility had not identified bed rails as equipment to be used and maintained for resident care. In an interview on (MONTH) 14, (YEAR), at 12:30 p.m., the Nursing Home Administrator confirmed that the facility assessment did not address the use and maintenance of bed rails by the facility for resident care. 28 Pa. Code 201.14(a) Responsibility of licensee. 28 Pa. Code 201.18(b)(1) Management.

Based on clinical record review and staff interview, it was deterimined that the facility failed to implement physician's orders for one of 13 sampled residents. (Resident R15) Findings include: Clinical record review revealed that Resident R15 had [DIAGNOSES REDACTED]. Review of the physician's orders revealed that since October 15, 2017, staff was to administer a medication for Vitamin D deficiency (Vitamin D 50,000 unit capsule) once every month of the fifteenth day of the month. Review of the January 2018, Medication Administration Record [REDACTED]. Review of the nursing progress note for that date at 6:00 a.m., revealed that the Vitamin D capsule had not been administered because it was not available from the pharmacy. Further review of the MAR indicated [REDACTED]. In an interview on January 19, 2018, at 10:01 a.m., the Director of Nursing confirmed that although the medication had arrived from the pharmacy in a timely manner, staff failed to administer the Vitamin D capsule until January 18, 2018. The Director of Nursing further confirmed that the facility failed to administer the medication in a timely manner as ordered by the physician. 483.25 Quality of Care Previously cited 12/9/16 28 Pa. Code 211.12(d)(1)(5) Nursing services. Previously cited 12/9/16

Based on clinical record review and staff interview, it was determined that the facility failed to document attempts to offer non-pharmacological interventions prior to the administration of an as needed anti-anxiety medication for one of five sampled residents who were on [MEDICAL CONDITION] medications. (Resident R16) Findings include: Clinical record review revealed that Resident R16 had [DIAGNOSES REDACTED]. Review of the Minimum Data Set assessment dated [DATE], indicated that the resident had cognitive impairment, exhibited behaviors occassionally and had anti-anxiety medications administered five times in the assessment period. Review of the current care plan revealed that there was a problem area identified for the resident's behavior related to physical aggression towards staff and other residents . Interventions included to administer an as needed anti-anxiety medication ([MEDICATION NAME]) and to provide non-medication interventions prior to administering the [MEDICATION NAME]. There was a current physician's orders [REDACTED]. Review of the Medication Administration Record [REDACTED]. There was no documented evidence that the staff attempted non-pharmacological interventions prior to the administration of the as needed [MEDICATION NAME]. In an interview on January 19, 2018, at 9:35 a.m., the Director of Nursing confirmed that there was no documented evidence that staff attempted non-medication interventions as per the care plan for the aformentioned dates. 28 Pa. Code 211.12 (d)(1)(5) Nursing services. Previously cited 12/9/16

Based on observation, clinical record review, policy review and staff interview, it was determined that the facility failed to maintain an effective system to report, investigate and analyze infection control data to prevent the spread of infection, failed to ensure that staff implemented prevention to prevent the spread of infection related to handwashing and failed to store respiratory equipment properly and according to physician's orders [REDACTED]. (Resident R60) Findings include: Review of the facility's infection control policy, dated December 6, 2016, revealed that the facility was to report, investigate, control and prevent infections in the facility. Review of facility documentation for September through November 2016 revealed no documented evidence that surveillance was completed during this time period for all infections. In an interview on December 8, 2016, at 4:15 p.m. the infection control nurse confirmed that there had been no documented surveillance or analysis completed during this time frame. Review of the facility's Hand hygiene in long term care policy, revealed that staff was to wash their hands before and after administering eye drops, nasal sprays, aerosol treatments. Additionally, staff was to utilize waterless handwashing products for routinely decontaminating hands when the handwashing policy with water did not apply. Observation on December 7, 2016, from 9:10 a.m. to 9:50 a.m. revealed RN1 did not wash her hands or utilize a waterless handwashing product at any time during the passing of medications to two residents which included administration of eye drops, nebulizers, nasal sprays and inhalers. Review of the facility's Use of Oxygen policy revealed staff was to change oxygen cannula weekly. Clinical record review revealed that Resident R60 had a physician's orders [REDACTED]. Staff was to label and date the equipment when changed. On December 7, 2016, at 9:40 a.m., Resident R60 was observed with oxygen on at a rate of two liters per minute. The oxygen tubing in use was dated November 20, 2016, indicating that staff had failed to change the oxygen tubing and nasal cannula weekly in accordance with the physician's orders [REDACTED]. 28 Pa. Code 211.12(d)(5) Nursing services.

Based on clinical record review, it was determined that the facility failed to ensure that staff administered a cardiac medication and monitored weights in accordance with physician's orders [REDACTED]. (Resident R38) Findings include: Clinical record review revealed that Resident R38 was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. On November 11, 2016, a physician's orders [REDACTED]. Staff was ordered to administer the [MEDICATION NAME] to the resident twice daily at 8:30 a.m. and 8:30 p.m. Staff documented on the Medication Administration record (MAR) on November 28, 2016, at 8:30 a.m. a systolic blood pressure of 103 mm/Hg and on December 4, 2016, at 8:30 a.m. and 8:30 p.m. readings of 96 mm/Hg and 104 mm/Hg. Staff failed to follow the physician's orders [REDACTED]. On November 18, 2016, a physician's orders [REDACTED]. Staff failed to weigh the resident daily on eight days from November 27, 2016, through December 4, 2016, in accordance with the physician's orders [REDACTED].>28 Pa. Code 211.12(d)(1)(5) Nursing services.

Based on observation, clinical record review and resident interview, it was determined that staff failed to ensure that a resident had access to a call bell to alert staff remotely of the need for help on one of two nursing units. (West Nursing Unit) Findings include: Clinical record review revealed that Resident R34 had [DIAGNOSES REDACTED]. A Minimum Data Set assessment (MDS) dated [DATE], identified that the resident was dependent on staff for activities of daily living and that the resident did not walk. The current care plan directed staff to keep a call bell within reach of the resident when she was in her room. On December 6, 2016, from 9:12 a.m. through 10:42 a.m. Resident R34 was in bed in her room on the West Nursing Unit without the call bell within reach. The call bell was attached to the back of the bed frame underneath the mattress behind the resident. During the observation, Resident R34 stated that her call bell was not within her reach and that she utilizes the call bell to alert staff of her needs. 28 Pa. Code 211.12(d)(1)(5) Nursing services.

Based on resident group interview, observations, and staff interview, it was determined that the facility failed to ensure that residents had knowledge of their right to examine survey results, including the location of the most recent survey results and that the survey reports were readily accessible for residents. Findings include: During a group interview with residents on December 7, 2016, at 10:30 a.m. three of four residents who attended the meeting stated that they were not aware of their right to examine survey results and were not aware of where the survey results were located. Observations on December 6, 2016, at 9:00 a.m. and December 7, 2016, at 9:00 a.m. revealed no posting of the availability of the survey reports in areas that were prominent and accessible to the public. In an interview on December 8, 2016, at 9:00 a.m. the Nursing Home Administrator confirmed that the sign located on the bulletin board that indicated the location of the survey results was not prominent. The survey results were located in the multipurpose rooms in a binder that was not labeled. In addition, the binder was at a height elevation not readily accessible to residents. 28 Pa. Code 201.29 (i) Resident Rights.