Health inspection·February 2, 2024

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review and staff interview, it was determined that the facility failed to ensure that physicians' orders were implemented for three of 36 sampled residents. (Resident 73, 185, 446) Residents Affected - Few Findings include: Clinical record review revealed that Resident 73 had diagnoses that included dementia and muscle weakness. The Minimum Data Set (MDS) assessment, dated January 10, 2024, indicated that the resident was cognitively impaired and required substantial assistance for toileting. A physician's order dated November 5, 2019, directed staff to administer 30 milliliters (ml) of a laxative (milk of magnesia) if the resident did not have a bowel movement in two days, and then an enema (Fleet's) the next day if the resident still had no bowel movement. A review of the documentation revealed that no bowel movements were recorded from January 17 through 22, and from January 24 through 30, 2024. According to the Medication Administration Record (MAR) there was no documented evidence that laxatives or enemas were given as ordered. Clinical record review revealed that Resident 185 had diagnoses that included a recent joint replacement, anxiety, and depression. The MDS assessment, dated January 6, 2024, indicated the resident was alert and oriented and required assistance for toileting. On January 2, 2024, the physician ordered that staff administer 30 ml of a laxative (milk of magnesia) if the resident did not have a bowel movement in two days, and then an enema (Fleet's) the next day if the resident still had no bowel movement. A review of the documentation revealed that no bowel movements were recorded from January 7 through January 11, from January 11 through January 16, from January 16 through January 21, and from January 25 through January 29, 2024. According to the MAR there was no documented evidence that laxatives or enemas were given as ordered. In an interview on February 2, 2024, at 11:25 a.m., the DON confirmed that staff failed to administer laxatives and enemas as ordered to Residents 73 and 185. Clinical record review revealed that Resident 446 was admitted to the facility on [DATE], and had diagnoses of a recent joint replacement, osteoarthritis, and chronic kidney disease. On the date of admission, the physician ordered that staff administer 650 milligrams (mg) of a pain medication (acetaminophen) every four hours as needed for pain, but not to exceed 3,000 mg in a 24-hour period. On January 25, 2024, the physician also ordered that staff administer 1,000 mg of acetaminophen every eight hours routinely for pain and hydrocodone-acetaminophen 5/325 mg every six hours as needed for severe pain. On January 27, 2024, the physician decreased the routine acetaminophen dose to 650 mg every eight hours. According to the MARs, Resident 446 received more than 3,000 mg of acetaminophen within a 24-hour period on January 27 and 28, 2024. Page 1 of 2 395006 395006 02/02/2024 St Joseph's Manor 1616 Huntingdon Pike Meadowbrook, PA 19046

F 0684 Level of Harm - Minimal harm or potential for actual harm In an interview on February 2, 2024, at 11:14 a.m., the DON confirmed that Resident 446 received over 3,000 mg of acetaminophen on January 27 and 28, 2024, and that this was in excess of the maximum ordered daily dose. 28 Pa. Code 211.12(d)(1)(5) Nursing services. Residents Affected - Few 395006 Page 2 of 2