Health inspection·April 19, 2023

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. Based on a review of facility policies and clinical records, as well as staff interviews, it was determined that the facility failed to ensure that a resident's dignity was maintained for two of 25 residents reviewed (Residents 10, 22). Findings include: The facility's policy regarding call lights indicated that staff members who are alerted of an activated call light are responsible for responding. An annual Minimum Data Set (MDS) assessment (a federally-mandated assessment of a resident's abilities and care needs) for Resident 10, dated March 14, 2023, revealed that the resident was alert and oriented; able to make his needs known; required extensive assistance from staff for daily care needs including toileting, hygiene, and transfers; and was occasionally incontinent of bladder. Interview with Resident 10 on April 17, 2023, at 11:00 a.m. revealed that that he had to wait up to 45 minutes for staff to respond to his call bell. A call bell log for Resident 10, dated March 20 through April 18, 2023, revealed that it took staff 27 to 44 minutes to respond to the resident's call bell. A quarterly MDS for Resident 22, dated February 17, 2023, revealed that the resident was alert and oriented; able to make her needs known; required extensive assistance from staff for daily care needs including toileting, hygiene, and transfers; and was occasionally incontinent of bladder. Interview with Resident 22 on April 17, 2023, at 10:15 a.m. revealed that she had to wait up to an hour or longer for staff to respond to her call bell, which had caused her to be incontinent. A call bell log for Resident 22, dated March 14 through April 18, 2023, revealed that it took staff 22 to 65 minutes to respond to the resident's call bell. Interview with the Director of Nursing and Nursing Home Administrator on April 19, 2023, at 11:51 a.m. revealed that the call bell wait times were excessive and not acceptable. The Director of Nursing stated that she believed 10-15 minutes would be an appropriate wait time. 28 Pa. Code 201.29(j) Resident rights. Page 1 of 3 395012 395012 04/19/2023 Brookview Health Care Center 1000 Northfield Drive Chambersburg, PA 17201

F 0658 Ensure services provided by the nursing facility meet professional standards of quality. Level of Harm - Minimal harm or potential for actual harm Based on review of Pennsylvania's Nursing Practice Act, facility policies and clinical records, as well as staff interviews, it was determined that the facility failed to clarify questionable physician's orders for one of 25 residents reviewed (Resident 20). Residents Affected - Few Findings include: The Pennsylvania Code, Title 49, Professional and Vocational Standards, State Board of Nursing, 21.11 (a)(1)(2)(4) indicated that the registered nurse was to collect complete and ongoing data to determine nursing care needs, analyze the health status of individuals and compare the data with the norm when determining nursing care needs, and carry out nursing care actions that promote, maintain and restore the well-being of individuals. A quarterly Minimum Data Set (MDS) assessment (a mandatory assessment of a resident's abilities and care needs) for Resident 20, dated March 13, 2023, revealed that the resident was alert and oriented, required limited assistance for daily care needs, and had diagnoses that included hypertension (high blood pressure). Physician's orders for Resident 20, dated June 8, 2022, included an order for the resident to receive 10 milligrams (mg) of isosorbide (used to treat high blood pressure) twice a day as needed for a systolic blood pressure (pressure when heart is pumping) greater than 200 mmHg (millimeters/mercury) for hypertension. A physician's order, dated June 20, 2022, included an order to obtain the resident's blood pressure daily every day shift and to give isosorbide for a systolic blood pressure greater than 200 mmHg. However, there was no documented evidence when the resident's blood pressure was to be monitored for the possible administration of the as-needed isosorbide twice a day. Resident 20's Treatment Administration Record (TAR) for March and April 2023 indicated that the resident's blood pressure was taken daily during the day shift, but the resident's blood pressure log revealed that there was no consistency as to when the resident's blood pressure was obtained during the remainder of the day for the possible administration of the as-needed isosorbide twice a day. Interview with the Director of Nursing on April 19, 2023, at 12:48 p.m. confirmed that the physician's order should have been clarified to determine what times the resident's blood pressure was to be monitored twice a day. 28 Pa. Code 211.12(d)(3)(5) Nursing services. 395012 Page 2 of 3 395012 04/19/2023 Brookview Health Care Center 1000 Northfield Drive Chambersburg, PA 17201

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of policies, as well as observations and staff interviews, it was determined that the facility failed to ensure that food was stored in accordance with professional standards for food service safety. Findings include: The facility's policy regarding food handling, dated September 2022, revealed that upon completion of meal service, all suitable prepared foods are covered, labeled, and dated with a prepared date, and a use-by-date. The facility's current policy regarding date marking for food safety revealed that the food shall be clearly marked to indicate the date or day by which the food shall be consumed or discarded. The discard day or date may not exceed the manufacturer's use-by date, or four days, which ever is the earliest. The date of opening or preparation counts as day one. The facility's policy regarding the storage of refrigerated and frozen foods, dated September 2022, revealed that ham slices could be stored in the freezer for a maximum period of up to two months. Observations of a countertop single door freezer in the [NAME] and [NAME] House Pantry on April 17, 2023, at 11:40 a.m. revealed that there was a metal tray with nine meat patties covered with Saran wrap that was not labeled with the name of the product or with a date. There was a plastic bag containing chicken tenders and a plastic bag containing French fries that were opened and not labeled with the date they were opened. Interview with Lead Homemaker 1 on April 17, 2023, at 11:56 a.m. confirmed that the above items should have been labeled with the date they were opened and the name of the product. Observations of an under-the-counter single door freezer in the [NAME] Pantry on April 17, 2023, at 12:08 p.m. revealed a plastic bag that contained three pieces of pureed (cooked food that has been ground, pressed, blended, or sieved to the consistency of a creamy paste or liquid) ham, dated November 24, 2022, and a plastic bag containing three chicken thighs that were not labeled with the date they were opened. Interview with Homemaker 2 on April 17, 2023, at 12:15 p.m. revealed that she was not sure how long the pureed ham could be stored before it needed to be removed and confirmed that the chicken thighs should have been labeled with the date they were opened. Interview with the Nursing Home Administrator on April 19, 2023, at 10:40 a.m. revealed that she spoke with the Culinary Director, and he confirmed that the undated items should have been dated with the date they were opened, the meat patties should have been labeled with the product name, and the pureed ham, dated November 24, 2022, should have been removed. 28 Pa. Code 211.6(f) Dietary services. 395012 Page 3 of 3