Health inspection·May 5, 2023

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 Based on review of clinical records and staff interviews, it was determined that the facility failed to accurately transcribe and act upon a physician's order to promote normal bowel regimen and/or prevent constipation for one of three residents reviewed (Resident R1). Residents Affected - Few Findings include: Review of Resident R1's clinical record revealed an admission date of 2/23/23, with diagnoses that included diabetes, high blood pressure, and constipation. Review of a physician's progress note dated 2/27/23, at 9:13 a.m. revealed that the resident's appetite was not great, and he/she felt constipated. Physician's action / plan was to add Miralax (laxative) and Senokot-S (stool softener). Review of orders written by Resident R1's physician and signed and dated for 2/27/23, revealed orders for Miralax 17 grams (gm) by mouth every day and Senokot-S take two by mouth every day. Further review of the written order revealed that the nurse indicated that he/she noted (observed and initiated) the order for both the Miralax and Senokot on 3/1/23, or two days later. Review of Resident R1's medication administration record (MAR) revealed he/she received the first dose of Miralax at 8:00 a.m. on 3/2/23, and the first does of Senokot-S at 6:00 p.m. on 3/2/23. During an interview on 5/2/23, at 1:00 p.m. Director of Nursing confirmed that the 2/27/23, physician's order for Miralax and Senokot-S should have been noted on 2/27/23, and not two days later that delayed the administration of both medications. 28 Pa. Code 211.5(f) Clinical Records 28 Pa. Code 211.12(d)(1)(5) Nursing services Page 1 of 2 395042 395042 05/05/2023 Nightingale Nursing and Rehab Center 607 East 26th Street Erie, PA 16504

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Based on review of clinical records and staff interviews, it was determined that the facility failed to maintain accurate and complete documentation related to bowel movements for three of three residents reviewed (Residents R1, R2, and R3) Findings include: Review of Resident R1's clinical record revealed an admission date of 2/23/23, with diagnoses that included diabetes, high blood pressure, and constipation. Review of Resident R1's bowel elimination flow sheet for the time period between 2/23/23, and 3/11/23, lacked documentation to indicate if Resident R1 had a bowel movement 23 of the 50 (46%) documentation opportunities. Review of Nurse Practitioner's progress note dated 3/2/23, indicated Resident R1 had a small bowel movement last night (3/1/23) and review of order administration note dated 3/2/23, indicated that the Milk of Magnesia that was administered earlier in the day was effective. There was no documented evidence on the bowel elimination flow sheet that Resident R1 had a bowel movement on 3/1/23, or 3/2/23. Review of Resident R2's clinical record revealed an admission date of 2/28/23, with diagnoses that included diabetes, high blood pressure, and dementia. Review of Resident R2's bowel elimination flow sheet for the time period between 2/28/23, and 3/31/23, lacked documentation to indicate if Resident R2 had a bowel movement 32 of the 95 (34%) documentation opportunities. Review Resident R3's clinical record revealed an admission date of 3/21/23, with diagnoses that included arthritis, constipation, and chronic obstructive pulmonary disease (respiratory disease that results in difficulty breathing). Review of Resident R3's bowel elimination flow sheet for the time period between 3/21/23, and 3/31/23, lacked documentation to indicate if Resident R3 had a bowel movement 13 of the 33 (39%) documentation opportunities. During an interview on 5/2/23, at 1:53 p.m. the Assistant to the Nursing Home Administrator confirmed that bowel documentation was not accurately completed for Residents R1, R2, and R3, and not only should it be completed every shift to identify if resident had a bowel movement or not, but should also reflect accurate information. 28 Pa. Code 211.5(f)(g)(h) Clinical records 28 Pa. Code 211.12(d)(1)(5) Nursing services 395042 Page 2 of 2