Every finding on record at Yardley Rehabilitation and Healthcare Center

Based on clinical record review and staff interview, it was determined that the facility failed to implement physicians' orders for two of 35 sampled residents. (Residents 23, 158)Findings include:Clinical record review revealed that Resident 23 had diagnoses that included hypertension (high blood pressure) and type 2 diabetes. A physician's order dated May 26, 2023, directed staff to administer a blood pressure medication (amlodipine) daily. The physician ordered that staff were not to administer the medication if the resident's systolic blood pressure (SBP, the first measurement of blood pressure when the heart beats and the pressure is at its highest) was lower than 120 millimeters of mercury (mm/Hg). Review of Resident 23's Medication Administration Records (MAR) for October, November and December 2025, and January and February 2026, revealed that the staff administered amlodipine once in October, once in December, six times in January, and once in February when Resident 23's SBP was lower than 120 mm/Hg.Clinical record review revealed that Resident 158 had diagnoses that included hypertension (high blood pressure) and multiple sclerosis. A physician's order dated May 15, 2025, directed staff to administer a blood pressure medication (diltiazem) three times a day. The physician ordered that staff were not to administer the medication if the resident's SBP was lower than 110 mm/Hg or if their heart rate was less than 60 beats per minute. Review of Resident 158's clinical record revealed that Resident 158's heart rate was measured only two times in September 2025, and once each in January and February 2026. Review of Resident 158's MAR for October, November and December 2025, revealed that staff administered diltiazem to Resident 158 three times daily without measuring the resident's heart rate.In an interview on February 27, 2026, at 10:53 a.m., the Director of Nursing confirmed that physicians' orders for residents 23 and 158 were not followed and medications were administered outside the ordered parameters as identified.28 Pa. Code 211.12(d)(1)(5) Nursing services.

Based on facility policy review, clinical record review, and staff interview, it was determined that the facility failed to attempt non-pharmacological interventions to alleviate pain prior to the administration of pain medication prescribed on an as needed basis for one of 35 sampled residents. (Resident 13)Findings include: Review of the facility policy entitled, Pain Management, last reviewed January 25, 2026, revealed that the physician would order non-pharmacological and medication interventions to address a resident's pain. Staff were to provide a comfortable environment and complementary interventions that included local heat or ice, repositioning, massage, and the opportunity to talk about chronic pain. Clinical record review revealed that Resident 13 had diagnoses that included dementia, diabetes, and abnormalities of gait and mobility (unusual patterns of walking that affect balance). On November 26, 2025, the physician ordered for the resident to receive tramadol every 12 hours as needed for pain. Review of Resident 13's care plan revealed that the resident had pain and the interventions included that staff provide pain relief measures with positioning, relaxation therapy, heat, cold application, bathing, and/or muscle stimulation. Review of Medication Administration Records revealed that the resident received the as needed tramadol with no documented evidence that non-pharmacological interventions were attempted prior to administration 15 times in December 2025, 13 times in January 2026, and 18 times in February 2026. In an interview on February 27, 2025, at 10:36 a.m., the Assistant Director of Nursing confirmed that there was no evidence to support that non-pharmacological interventions for pain had been provided prior to the administration of as needed pain medication as identified. 28 Pa. Code 211.12(d)(1)(5) Nursing services.

Based on facility policy review, clinical record review, observation, and staff interview, it was determined that the facility failed to implement enhanced barrier precautions (EBP) and the use of personal protective equipment (PPE) to prevent the spread of infection for one of 35 sampled residents. (Resident 1)Findings include: Review of the facility policy entitled, Enhanced Barrier Precautions, last reviewed January 25, 2026, revealed that EBP were to be used with any high-risk resident with a wound or indwelling device during high contact care activities including during wound care, the care of feeding and tracheostomy tubes, providing hygiene, and changing briefs and linens. EBP included the use of PPE such as protective gowns and gloves during high-risk activities. Clinical record review revealed that Resident 1 had diagnoses that included Steele-Richardson-Olszewski syndrome (a neurodegenerative disorder that affects movement, balance, eye control, speech, swallowing, and cognition), dementia, the presence of an enteral feeding tube, and pressure ulcers. The Minimum Data Set assessment dated [DATE], revealed that Resident 1 had stage four pressure ulcers on the sacrum (lower back), the right hip, and buttocks, and was dependent on staff for toileting and personal hygiene. On February 25, 2026, at 12:00 p.m., a nurse aide (NA 1) was observed entering Resident 1's room to change her briefs without wearing a protective gown. In an interview at that time, NA 1 stated that she provided incontinence care without a gown. On February 27, 2026, at 1:00 p.m., the Director of Nursing confirmed that staff did not use appropriate PPE during Resident 1's care. 28 Pa. Code 211.10(d) Resident care policies. 28 Pa. Code 211.12(d)(1)(5) Nursing services.

Based on resident and staff interviews, review of facility policy, and clinical record review, it was determined that the facility failed to provide adequate treatment and care for a peripherally inserted catheter (a thin plastic tube inserted into a vein using a needle) in accordance with professional standards of practice for one of two residents. (Resident 4) Findings include: According to the Association of Vascular Access, at a minimum, the clinician overseeing the care of the resident conducts a daily peripheral intravenous catheter (PIVC) assessment. Clinicians must routinely inspect the insertion site and assess the functionality of the PIVCs for signs of complications and document assessment results. Clinicians must perform a daily evaluation for the ongoing need of the PIVC. Healthcare teams must review a resident's vascular access needs as part of a comprehensive, interdisciplinary evaluation to ensure effective communication and appropriate care planning. Further, clinicians should notify the provider if the PIVC is not used for 24 hours or more and remove PIVCs when they are no longer required for the plan of care. Review of the facility policy entitled, Peripheral Intravenous (IV) Catheter Removal last reviewed January 20, 2026, indicated that staff were to evaluate the continued need for vascular access during provider visits and care planning. Staff were to remove the peripheral intravenous catheter if vascular access was no longer clinically indicated or it was not used for more than 24 hours. Staff were to document the date and time of procedure, and resident tolerance. Clinical record review revealed that on December 25, 2025, Resident 4 had nausea and vomiting. Review of the Minimum Data Set assessment dated [DATE], revealed that Resident 4 had no cognitive impairment and required supervision/touching assistance for most activities of daily living and transfers. During an interview, January 21, 2026, at 11:25 a.m., Resident 4 stated that she had an IV catheter placed on December 25, 2025, because she had nausea and vomiting, but that the IV was never used and wasn't removed until a couple days later. A physician's order dated December 25, 2025, directed staff to place a peripheral intravenous catheter for hydration. Another physician's order dated December 25, 2025, directed staff to provide sodium chloride solution 0.9% and to use 100 milliliters per hour intravenously every shift for rehydration for one day and to give one liter of normal saline solution. The order's start date was December 25, 2025, at 11:00 p.m. and the order's discontinue date was December 26, 2025, at 11:06 a.m. According to the Medication Administration Record for December 2025, the medication was never provided. A nurse practitioner's note dated December 26, 2025, revealed that the PIVC was available in case of need but was not currently being used. There were no further evaluations or assessments or notes found supporting the need to continue the PIVC. According to the resident and the investigation of the Assistant Director of Nursing, the PIVC line was not removed until December 29, 2025. Review of the clinical record revealed a lack of documentation to support that the resident's peripheral intravenous line was removed and that the condition of the catheter or the skin surrounding the intravenous site was assessed. During an interview January 21, 2026, at 5:30 p.m., the Assistant Director of Nursing confirmed that the peripheral intravenous line was not removed until December 29, 2025, and that the policy should have been followed. 28 Pa. Code: 211.12 (d)(1)(2)(3)(5) Nursing services.

Based on clinical record review, staff interview, and a review of facility documentation, it was determined that the facility failed to implement safety interventions to prevent falls for one of four sampled residents. (Resident 3)Findings include: Clinical record review revealed that Resident 3 had diagnoses that included left and right below the knee amputations. According to the Minimum Data Set assessment dated [DATE], Resident 3 required assistance for transferring from surface to surface (wheelchair to chair). On October 5, 2025, at 3:38 p.m., a nurse noted that Resident 3 was being transferred from his wheelchair to the weight chair by NA1 and NA2. The wheelchair rolled from under the resident and the resident was lowered to the floor. The nurse noted that the cause of the fall from her observation was that the bilateral wheelchair brakes were broken and did not fully engage prior to the transfer. Review of facility documentation dated October 5, 2025, regarding the fall revealed that the bilateral wheelchair brakes were broken. In an interview on January 21, 2026, at 5:00 p.m., the Director of Nursing confirmed that the staff should have ensured that the brakes on the resident's wheelchair were engaged and working and that the wheelchair was not going to roll when they attempted to transfer the resident. CFR 483.25(d) AccidentsPreviously cited 3/12/25 28 Pa. Code 211.12(d)(1)(5) Nursing services.

Based on observation and staff interview it was determined that the facility failed to store food under sanitary conditions in the kitchen. Findings include: Observation of the kitchen on March 9, 2025, at 9:54 a.m., revealed the following: In the walk in refrigerator, there was a rolling storage rack that contained raw meat. There was a pan of raw chicken that was stored above a pan of cooked roast beef. The same rolling storage rack also held pans of raw turkey, cubed beef, whole beef tenderloins, and ground meat. The raw poultry (chicken and turkey) were stored above the raw beef, which required a lower internal cooking temperature than raw poultry. In an interview on March 12, 2025, at 9:33 a.m., the Administrator confirmed that the raw meat was not stored properly and raw poultry should not have been stored above cooked food or raw beef. 28 Pa. Code 201.18(b)(3) Management.

Based on observation, it was determined that the facility failed to dispose of trash and refuse properly. Findings include: Observation during an environmental tour on March 9, 2025, at 9:54 a.m., revealed the following: The trash compactor was overflowing with trash bags from the top and out of the back of the machine, onto the ground. The lid on top of the machine and the cover on the back of the machine were not able to be closed due to the overflow of trash. 28 Pa. Code 201.18(b)(3) Management.

Based on clinical record review and resident and staff interviews, it was determined that the facility failed to provide services to improve activities of daily living (ADLs) for one of 32 sampled residents. (Resident 14) Findings include Clinical record review revealed that Resident 14 had diagnoses that included anxiety, osteoarthritis, and muscle weakness. Review of the care plan revealed that the resident had a self-care deficit and required a restorative nursing program (RNP) for ambulation (walking). The interventions were for staff to assist with ambulation and perform a restorative nursing program with the resident daily. In an interview on March 11, 2025, at 1:11 p.m., the resident stated that she was willing to walk with staff but that staff had not offered to assist her with ambulation regularly. Review of the nurse aide task record revealed no evidence to support that staff offered to assist the resident with the ambulation RNP on February 10, 12, 15, 16, 17, 19, 22, 26, and 27, 2025, and March 1, 2, 5, and 8, 2025. There were no documented refusals. In an interview on March 12, 2025, at 12:26 p.m., the Administrator confirmed that the RNP was to be performed daily and there was a lack of evidence that staff offered to ambulate the resident daily. 28 Pa. Code 211.12(d)(1)(5) Nursing services.

Based on clinical record review, observation, and resident interview, it was determined that the facility failed to implement interventions to prevent a decline in range of motion for one of 32 sampled residents. (Resident 103) Findings include: Clinical record review revealed that Resident 103 had diagnoses that included left wrist contracture. Review of the care plan revealed that the resident required assistance from staff for activities of daily living (ADLs). A physician's order dated April 15, 2024, directed staff to apply a soft pro [NAME] resting hand splint due to a left-hand contracture. The resident was observed on March 9, 10, and 11, 2025, at 12:34 p.m., 1:05 p.m., and 11:06 a.m., respectively. The splint was not in place at any of those times. The resident stated that staff had not applied the hand splint in a while and he had not refused use of the splint. There was a lack of evidence to support that staff had applied the splint; there were no documented refusals. 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 provide adequate supervision to prevent accidents for one of 32 sampled residents. (Resident 99) Findings include: Clinical record review revealed that Resident 99 was admitted to the facility on [DATE], with diagnoses that included dementia, anxiety, and dysphagia (difficulty swallowing). Review of the Minimum Data Set (MDS) assessment dated [DATE], revealed that the resident had moderate cognitive impairment, but could make her needs known. A review of the care plan revealed that the resident had a self-care deficit related to her cognitive disease process and required supervision with eating and drinking. The interventions were for staff to ensure the resident was upright prior to all oral intake, provide supervision of all meals, and have the resident out of bed and in the dining room for meals. On March 5, 2025, staff noted that Resident 99 experienced a choking episode that required mechanical assistance from staff. Review of a speech therapy evaluation dated March 6, 2025, indicated the resident would benefit from proper positioning and supervision with meals. On March 7, 2025, the nurse practitioner noted that Resident 99 was to sit in an upright position for meals and continue with speech therapy. Observations on March 9, 2025, from 12:10 p.m. to 12:35 p.m., and March 11, 2025, from 12:07 p.m. to 12:30 p.m., revealed that the resident was lying in her bed eating her meal with the head of the bed at less than a 45-degree angle; her head was just above the level of the meal tray on the bedside table. On March 12, 2025, from 12:05 p.m. to 12:15 p.m., the resident was again observed lying in her bed while eating her meal. Her chest and head were propped up on her left elbow; she was not sitting upright. Staff did not provide supervision during those meals. In an interview on March 12, 2025, at 1:05 p.m., the Director of Nursing confirmed the resident should have been supervised while eating. 28 Pa. Code 211.12(d)(1)(5) Nursing services.

Based on clinical record review and policy review, it was determined that the facility failed to assess residents who were incontinent of bladder to determine the cause of the incontinence or if normal bladder function could be restored for two of 32 sampled residents. (Residents 9 and 87) Findings include: Review of the facility policy entitled, Urinary Continence and Incontinence - Assessment and Management, last reviewed January 7, 2025, revealed that the facility was to assess residents who were incontinent of bladder, including determining the type of incontinence and any clinical factors contributing to the incontinence, so residents' normal bladder function could potentially be restored. Clinical record review revealed that Resident 9 was admitted to the facility on [DATE], and had diagnoses that included heart failure and muscle wasting. At the time of admission, the physician assessed the resident and noted that he had previously been continent of bladder. According to the Minimum Data Set (MDS) assessment, dated February 18, 2025, the resident had no cognitive impairment, was able to communicate needs, and was always incontinent of bladder. Nurse aide records since admission confirmed that the resident was completely incontinent of bladder. There was no documented evidence that the facility ever assessed the resident for the cause of their incontinence or evaluated to determine if normal bladder function could be restored. Clinical record review revealed that Resident 87 was admitted to the facility on [DATE], and had diagnoses that included a urinary tract infection and muscle wasting. According to a nursing assessment on the day of admission, the resident was continent of bladder. According to her MDS assessment, dated January 24, 2025, the resident was able to communicate her needs, required assistance from staff for mobility, and had become frequently incontinent of bladder. From February 14 through 26, 2025, the resident was hospitalized due to a change in condition. According to a nursing assessment when she was readmitted to the facility, the resident's continence again declined to being completely incontinent. This was confirmed by a review of the nurse aide records. There was no documented evidence that the facility ever assessed the resident for the cause of their incontinence or evaluated to determine if normal bladder function could be restored. 28 Pa. Code 211.12(d)(1)(5) Nursing services.

Based on clinical record review and observation, it was determined that the facility failed to ensure that a call bell was accessible for one of 32 sampled residents. (Resident 3) Findings include: Clinical record review revealed that Resident 3 had diagnoses that included anxiety, dysphagia, and osteoarthritis. Review of the care plan revealed that the resident had a self-care deficit due to physical limitations and the intervention was for staff to encourage her to use the call bell for assistance. On March 9, 2025, at 11:54 a.m. and 1:53 p.m., the resident was observed in bed. The call bell was inside of the drawer to her bedside stand which was positioned away from the bed, out of reach. On March 11, 2025, at 11:02 a.m., the resident was observed in bed; the call bell was again observed in the drawer of the bedside stand, out of reach. 28 Pa. Code 211.12(d)(1)(5) Nursing services.

Based on observation and staff interview, it was determined that the facility failed to post accurate and current nurse staffing information. Findings include: Observation on March 9, 2025, at 9:29 a.m., revealed that staffing information posted in the lobby was dated for March 6, 2025. In an interview on March 12, 2025, at 12:36 p.m., the Director of Nursing confirmed that the incorrect staffing information was posted. 28 Pa. Code 201.18(b)(3) Management.

Based on facility policy review, clinical record review, facility documentation review, and staff interview, it was determined that the facility failed to notify the resident's representative of a 30 day advanced notice of discharge and failed to notify the resident and the resident representative(s) of hospital transfer(s), including the reasons for the moves, Ombudsman information, and how to file an appeal, in writing for four of four sampled residents who had an impending discharge from the facility or who were transferred to the hospital. (Residents 1, 2, 3, 4) Findings include: A review of the facility policy entitled, Transfer or Discharge, Facility-Initiated, last reviewed January 7, 2025, revealed that the resident and resident representative were to be given a 30 day advanced written notice of a planned impending transfer or discharge from the facility and a transfer notice if sent to the hospital. Clinical record review revealed that Resident 1 received a 30 day discharge notice on January 16, 2025. Review of facility documentation revealed that Resident 1 had a revised 30 day advanced written notice of planned discharge date d January 24, 2025, that was to begin that day. There was no documentation to support that the resident's responsible party or legal representative was provided written information regarding the pending discharge. In an interview on January 28, 2025, at 1:05 p.m., the Administrator confirmed that 30 day discharge notifications in writing were not provided to the resident 's responsible party or legal representative. Clinical record review revealed that Resident 2 was transferred to the hospital on January 6, 2025, after a change in condition. There was no documentation to support that the resident and/or the resident's responsible party or legal representative was provided written information regarding the transfer to the hospital. Clinical record review revealed that Resident 3 was transferred to the hospital on January 3, 2025, after a change in condition. There was no documentation to support that the resident and/or the resident's responsible party or legal representative was provided written information regarding the transfer to the hospital. Clinical record review revealed that Resident 4 was transferred to the hospital on January 18, 2025, after a change in condition. There was no documentation to support that the resident and/or the resident's responsible party or legal representative was provided written information regarding the transfer to the hospital. In an interview on January 28, 2025, at 1:05 p.m., the Administrator confirmed that hospital transfer notifications in writing were not provided to the resident and/or the resident's responsible party or legal representative.

Based on clinical record review and staff interview, it was determined that the facility failed to develop a comprehensive care plan to meet each resident's needs identified in the comprehensive assessment for two of 33 sampled residents. (Resident 39, 42) Findings include: Clinical record review revealed that Resident 39 was admitted to the facility on [DATE], and had diagnoses that included muscle weakness and history of a traumatic brain injury. The Minimum Data Set (MDS) assessment dated [DATE], identified that Resident 39 was frequently incontinent of urine and the Care Area Assessment (CAA) summary indicated that it was to be addressed in the care plan. There was no evidence that interventions to address Resident 39's urinary incontinence were included in the current care plan. Clinical record review revealed that Resident 42 was admitted to the facility on [DATE], and had diagnoses that included Parkinson's disease and dementia. The MDS assessment dated [DATE], indicated that Resident 42 was always incontinent of urine and the CAA summary indicated that it was to be addressed in the care plan. There was no evidence that interventions to address Resident 42's urinary incontinence were included in the current care plan. In an interview on February 22, 2024, at 11:35 a.m., the Director of Nursing confirmed that the identified care areas were not addressed in the residents' care plans. 28 Pa. Code 211.12(d)(1)(5) Nursing services.

Based on clinical record review, observation and resident and staff interview, it was determined that the facility failed to ensure that a resident had the call bell accessible for one of 33 sampled residents. (Resident 139) Findings include: Clinical record review revealed that Resident 139 had diagnoses of Parkinson's disease, dysphagia, (difficulty swallowing) and history of mild protein and calorie malnutrition. The Minimum Data Set assessment dated [DATE], indicated that the resident was alert and oriented, was frequently incontinent of bowel and bladder and had limitations in his upper and lower extremities on both sides. The care plan identified that the resident was at risk for falls due to Parkinson's disease. There was an intervention for staff to ensure that the resident had his call bell within reach. On February 20, 2024, at 10:29 a.m., 11:00 a.m., and 12:18 p.m., the resident was observed in bed. His touch pad call bell had been placed near the top of his pillow, completely out of his reach. At 10:29 a.m., the resident stated that he was thirsty and that he needed fresh water in his cup that was on his over the bed table. The cup of water was on the table and was out of his reach. On February 21, 2024, at 9:55 a.m., the resident was observed in bed. The call bell had been placed on his upper right shoulder, but it was upside down. At that time, the resident stated that he could not reach the call bell and that the cord needed to be about four to five inches longer so that he could utilize it to call for assistance from staff. In an interview on February 22, 2024, at 9:56 a.m., the Registered Nurse (RN 2 ) stated that the cord had not been long enough for the resident to reach the call bell and that he was capable of utilizing the call bell to call for assistance from staff. 28 Pa. Code 211.12(d)(1)(5) Nursing services.

Based on clinical record review, observation, and resident interview, it was determined that the facility failed to ensure that appropriate assistance with eating was provided to one of four sampled residents who required assistance with activities of daily living, including eating. (Resident 139) Findings include: Clinical record review revealed that Resident 139 had diagnoses that included Parkinson's disease, cognitive communication deficit, and history of mild protein malnutrition. The Minimum Data Set assesment dated February 5, 2024, indicated that the resident was alert and oriented and had limitations in range of motion of his upper and lower extremities on both sides. The care plan identified that the resident had a self-care deficit in activities of daily living, including eating. There was an intervention that indicated he required hands-on assistance for eating and drinking. Review of a speech language pathology discharge summary dated January 24, 2024, revealed a therapist documented that the resident was totally dependent for feeding assistance. Further review of the summary revealed that the therapist recommended close supervision and feeding assistance as he was totally dependent for eating. Review of a nutrition note dated February 16, 2024, revealed that the resident needed to be fed by staff because of tremors that he had from Parkinson's disease. Observation on February 21, 2024, at 12:20 p.m., revealed that the resident was in his room in bed and a staff member brought in his food tray and placed it on his over the bed table. At 12:40 p.m., the resident was still not eating and had not touched any of the food or drinks on his food tray. He stated that staff usually assisted him with eating his meals; however, today no one had assisted him with eating his meal. He further stated that he was hungry and thirsty. It was not until 12:45 p.m., 25 minutes after receiving his meal, that a staff member went in to the room and sat down to assist him with eating his meal. CFR 483.254(a)(2) ADL Care Provided for Dependent Residents. Previously cited 3/10/23 28 Pa. Code 211.12(d)(1)(5) Nursing services.

Based on facility policy review, clinical record review, and staff interview, it was determined that the facility failed to attempt non-pharmacological interventions to alleviate pain prior to the administration of pain medication prescribed on an as needed basis for four of 33 sampled residents. (Resident 22, 64, 116, 121) Findings include: Review of the facility policy entitled, Pain Management, last reviewed February 1, 2024, revealed that the facility was to provide adequate pain control for the residents. Pain was to be managed through non-pharmacological and pharmacological interventions. Clinical record review revealed that Resident 22 had diagnoses that included neuropathy (nerve pain). A physician's order dated November 2, 2023 directed staff to administer the narcotic pain medication, oxycodone, every four hours as needed for moderate to severe pain. Review of the care plan revealed the resident had pain and interventions included that staff offer relaxation therapy, heat and cold application, muscle simulation, or positioning to assist with pain control. Review of the Medication Administration Records (MARs), revealed that the resident received the oxycodone six times in January and twice in February, 2024, without evidence to support that non-pharmacological interventions were offered prior to the administration of the as needed pain medication. Clinical record review revealed that Resident 64 had diagnoses that included fibromyalgia and muscle wasting and atrophy (shrinking of muscles). A physician's order dated November 17, 2023, directed staff to administer the narcotic pain medication, oxycodone, every six hours as needed for pain. Review of the care plan revealed the resident had chronic pain and interventions included that staff offer relaxation therapy, bathing, heat and cold application, or muscle stimulation to assist with pain control. Review of the MARs, revealed that the resident received the oxycodone 65 times in January and 36 times in February, 2024, without evidence to support that non-pharmacological interventions were offered prior to the administration of the as needed pain medication. Clinical record review revealed that Resident 116 had diagnoses that included lumbago with sciatica (low back pain) and muscle weakness. A physician's order dated July 14, 2023, directed staff to administer the narcotic pain medication, oxycodone, every six hours as needed for pain. Review of the care plan revealed the resident had chronic pain and interventions included that staff offer relaxation therapy, heat and cold application, muscle stimulation, or positioning to assist with pain control. Review of the MARs, revealed that the resident received the oxycodone 54 times in January and 37 times in February, 2024, without evidence to support that non-pharmacological interventions were offered prior to the administration of the as needed pain medication. Clinical record review revealed that Resident 121 had diagnoses that included hemiparesis (weakness one one side of the body), neuropathy, and depression. A physician's order dated August 3, 2022, directed staff to administer the narcotic pain medication, oxycodone, every four hours as needed for severe pain. Review of the care plan revealed the resident had pain and interventions included that staff offer relaxation therapy, heat and cold application, muscle stimulation, or positioning to assist with pain control. Review of the MARs, revealed that the resident received the oxycodone 25 times in January and 20 times in February, 2024, without evidence to support that non-pharmacological interventions were offered prior to the administration of the as needed pain medication. In an interview on February 22, 2024, at 10:42 a.m., the Director of Nursing confirmed that there was no documented evidence that staff 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 policy review, clinical record review, observation, and interview, it was determined that the facility failed to ensure that staff provided services consistent with professional standards of practice for one of three sampled dialysis residents. (Resident 147) Findings include: Review of the facility policy entitled, Hemodialysis Access Emergency Care Policy, dated February 1, 2024, revealed that a smooth clamp should be kept at the bedside of residents with a dialysis catheter in place. Clinical record review revealed that Resident 147 had diagnoses that included end stage renal disease, permacath (tunneled catheter inserted into the blood vessel in the neck or upper chest under the collarbone and into the right side of the heart for dialysis), and dependence on renal dialysis (a process of removing waste products and excess fluid from the body when the kidneys are not able to adequately filter the blood). Review of current physician's orders revealed that there was an order since January 24, 2024, for staff to keep a clamp at bedside at all times and to check for placement every shift. Observation on February 20, 2024, at 11:23 a.m., and February 21, 2024, at 10:00 a.m., revealed there was no clamp available in Resident 147's room as ordered. On February 21, 2024, at 11:00 a.m., LPN 1 confirmed that there was no clamp at the bedside. In an interview on February 22, 2024, at 9:40 a.m., The Director of Nursing confirmed that the facility failed to ensure the availability of necessary emergency supplies at the resident's bedside. 28 Pa. Code 211.12(c)(d)(1)(2)(5) Nursing Services.

Based on observation and interview, it was determined that the facility failed to post accurate and current nurse staffing information. Findings include: Observation on February 20, 2024, at 10:05 a.m., and February 21, 2024, at 9:25 a.m., revealed that nurse staffing information was posted in the lobby and had not been updated since February 16, 2024. In an interview on February 21, 2024, at 1:00 p.m., the Nursing Home Administrator confirmed that incorrect staffing data was posted. 28 Pa Code 201.18(b)(3) Management.