Health inspection·December 29, 2022

F 0604 Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy and clinical record review, and resident and staff interview, it was determined the facility failed to identify bilateral leg straps as potential restraint or implement interventions and monitor the use of bilateral leg straps for one of one resident reviewed (Resident R30). Residents Affected - Few Findings include: Review of facility policy Restraints dated 3/2/22, indicated physical restraints are any manual, physical or mechanical device, material, or equipment, attached or adjacent to the resident's body that the individual cannot remove easily which restricts freedom of movement or normal access to the body. Examples include but are not limited to, leg restraints. Review of Resident R30's Minimum Data Set (MDS - periodic assessment of care needs) dated 10/28/22, indicated the resident was admitted to the facility on [DATE], Brief Interview for Cognitive Status indicated little to no impairment, and current diagnosis included high blood pressure, diabetes, and arthritis. During an observation and interview on 12/28/22, at 12:57 p.m., revealed Resident R30 was seated in a wheelchair with both feet placed on the wheelchair leg rests. Long velcro straps were wrapped around each of Resident R30's lower legs and attached to the individual leg rests. Resident R30 stated the straps were to prevent feet from falling off the leg rests while seated and I can not remove them. Review of Resident R30's current physician orders reviewed on 12/28/22, did not include orders for bilateral leg straps. During an interview on 12/28/22, at 2:05 p.m. Physical Therapist Employee E2 revealed that Resident R30 had no recommendation for the use of bilateral leg straps, or being evaluated for legs straps, and the leg straps have been in use since prior to 2021 when he started working at the facility. Therapy Employee E2 confirmed that therapy has not evaluated Resident R30 for the use of the leg straps. Review of Resident R30's plan of care revised 12/22/22, did not include interventions for the use of bilateral leg straps while in the wheelchair. Review of Resident R30's clinical record on 12/28/22, did not include documentation of evaluation, or monitoring for the use of bilateral leg straps. Page 1 of 6 395032 395032 12/29/2022 McMurray Hills Rehabilitation and Healthcare Cente 249 West McMurray Road McMurray, PA 15317

F 0604 Level of Harm - Minimal harm or potential for actual harm During an interview on 12/28/22, at 2:35 p.m., the Director of Nursing confirmed that the facility failed to identify bilateral leg straps as potential restraints or implement interventions and monitor the use of bilateral leg straps for Resident R30. 28 Pa. Code 211.8(e)(f) Use of Restraints. Residents Affected - Few 28 Pa. Code 211.10(d) Resident Care Policies. 395032 Page 2 of 6 395032 12/29/2022 McMurray Hills Rehabilitation and Healthcare Cente 249 West McMurray Road McMurray, PA 15317

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observations and staff interviews, it was determined that the facility failed to properly store biologicals and medications securely on one of four units (C2 Even unit). Findings include: Review of the facility policy Storage of Medications dated 3/2/22, states that drugs and biologicals used in the facility are stored safely, securely and properly and only accessible to licensed personnel, pharmacy personnel, or staff members lawfully authorized to administer medications. During an observation on 12/27/22, at 12:31 p.m. the C2 Treatment cart was noted to be sitting unlocked and unattended across from the resident pantry area. During an interview at that time, License Practical Nurse Employee E3 confirmed the cart was unlocked and accessible to unauthorized personnel. During an observation on 12/29/22, at 9:44 a.m. the C2 Even medication cart was noted to be unlocked and unattended in the hallway. During an interview on 12/29/22, at 9:45 a.m. Registered Nurse Employee E4 confirmed that the cart was unlocked and accessible to unauthorized personnel. 28 Pa Code: 211.9 (a)(1)(h)(1) Pharmacy Services. 28 Pa. Code: 211.12 (d)(1)(2) Nursing Services. 395032 Page 3 of 6 395032 12/29/2022 McMurray Hills Rehabilitation and Healthcare Cente 249 West McMurray Road McMurray, PA 15317

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on review of facility policy, observations and staff interview it was determined that the facility failed to maintain infection control procedures and prevent the potential for cross contamination for one of four nursing units (B-unit) Residents Affected - Few Findings include: The facility Standard precautions infection control policy dated 3/2/22, indicated that the facility has developed a process to be used in the care of residents regardless of their diagnoses. Standard precautions presume blood, body fluids, non-intact skin may contain transmissible infectious agents. During observations of the B-wing nursing unit on 12/27/22, at 12:11 p.m. the nursing station was found with resident refrigerator. On top of the resident refrigerator was observed a specimen refrigerator (refrigerator used to keep human bodily fluids for laboratory testing). To the left of the resident refrigerator was a centrifuge (device used to separate bodily fluids). During an interview on 12/27/22, at 12:20 p.m. the Director of Nursing (DON) stated the specimen refrigerator and centrifuge were still in use and the observed specimen refrigerator was the only one in the facility. During an interview on 12/27/22, at 12:22 p.m. the Director of Nursing (DON) confirmed that the facility failed to maintain infection control procedures and prevent the potential for cross contamination for one of four nursing units (B-unit) 28 Pa. Code: 201.14(a) Responsibility of licensee. 28 Pa. Code: 201.18(b)(1)(e)(1) Management. 28 Pa. Code: 211.10(d) Resident care policies. 28 Pa. Code: 211.12(d)(1)(2)(3)(5) Nursing services 395032 Page 4 of 6 395032 12/29/2022 McMurray Hills Rehabilitation and Healthcare Cente 249 West McMurray Road McMurray, PA 15317

F 0909 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Regularly inspect all bed frames, mattresses, and bed rails (if any) for safety; and all bed rails and mattresses must attach safely to the bed frame. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on policy review, observation, record review and staff interview, it was determined that the facility failed to conduct inspections of bed rails to identify areas of possible entrapment for three of three residents reviewed (Residents R29, R58 and R74). Findings include: Review of the facility's restraint policy, revealed that side rails while having potential benefits also create the risk for entrapment or injury. A review the clinical record revealed that Resident R29 was admitted to the facility on [DATE]. The minimum data Set (MDS- a periodic assessment of care needs) dated 10/18/22 included diagnoses of cancer, hypertension, and dementia. Review the MDS Section G0110 indicated that Resident R29 required extensive assistance of one person for bed mobility. During an observation of Resident 29's bed on 12/28/22, at 12:34 p.m. revealed that one quarter side rails were present on both sides of the bed. Review of Resident 29's clinical record revealed no evidence that ongoing evaluations or inspections of bed rails were conducted to identify areas of possible entrapment. A review the clinical record revealed that Resident R58 was admitted to the facility on [DATE]. The MDS dated [DATE] included diagnoses of diabetes, hypertension, and Alzheimer ' s disease. Review the MDS Section G0110 indicated that Resident R58 required extensive assistance of two persons for bed mobility. During an observation of Resident R58's bed on 12/29/22, at 9:55 a.m. revealed that one quarter side rails were present on both sides of the bed. Review of Resident R58's clinical record revealed no evidence that ongoing evaluations or inspections of bed rails were conducted to identify areas of possible entrapment. Review of the clinical record revealed that resident R74 was admitted to the facility on [DATE]. The MDS dated [DATE] included diagnoses of seizures, Cerebrovascular Accident (stroke), Dementia, and Dyskinesia of the Esophagus (swallowing disorder). Review of section G0100 indicated Resident R74 required extensive assistance of one person for bed mobility. During an observation of Resident R74's bed on 12/27/22, at 12:13 p.m. revealed that one quarter side rails were present on both sides of the bed. Review of the Physician orders indicate the use of a low air loss mattress was implemented on 11/29/22. Review of Resident R74's clinical record revealed no evidence that ongoing evaluations or inspections of bed rails were conducted to identify areas of possible entrapment since 8/24/21, and the facility failed to reassess the use of bed rails upon implementation of a new mattress on 11/29/22. 395032 Page 5 of 6 395032 12/29/2022 McMurray Hills Rehabilitation and Healthcare Cente 249 West McMurray Road McMurray, PA 15317

F 0909 Level of Harm - Minimal harm or potential for actual harm During an interview on 12/28/22, at 2:35 p.m. the Director of Nursing confirmed that the facility failed to perform assessments of the bed rails to identify any areas of possible entrapment. 28 Pa code 201.18(b)(1) Management. Residents Affected - Many 395032 Page 6 of 6