Health inspection·September 8, 2023

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a review of clinical records and resident incident/accident reports, and staff interviews, it was determined that the facility failed to provide adequate staff supervision as planned to monitor a resident with known unsafe behavior to prevent an unsupervised exit from the facility and threat to the resident's safety while ambulating outside the facility for one resident (Resident 1) out of seven reviewed. Findings included: A review of the clinical record revealed that Resident 1 was admitted to the facility on [DATE], with diagnoses of alcohol use and repeated falls. A review of Resident 1's Quarterly Minimum Data Set assessment (MDS- a federally mandated standardized assessment process conducted periodically to plan resident care) dated March 25, 2023, revealed that the resident's cognition was moderately impaired. A review of an admission Elopement assessment dated [DATE], revealed that the resident was assessed to be at high risk for eloping from the facility. A progress note dated June 6, 2023, at 1:29 PM revealed that the facility's director of maintenance saw the resident coming out of the building from the exit near the staff time clock. The resident stated he wanted to go outside and followed the staff in front of him from the time clock. An incident report dated June 6, 2023, at 1:16 PM revealed the Employee 1, the Maintenance Director, witnessed Resident 1 exiting the building. Nursing staff brought the resident back into the facility and assessed for injuries at that time. Further it was indicated the resident exited the facility through a door Employee 2 Housekeeping had just exited out of due to the door not closing all the way shut. Employee 1 followed the resident while Employee 2 went to get nursing staff to help him back into the building. Employee 1's witness statement dated June 6, 2023, indicated that Employee 1 watched the resident walk out of the time clock exit door and started walking down the sidewalk towards the rear of dietary. Employee 1 stated she followed the resident around the building where he had stopped, talking to dietary workers. A written witness statement from Employee 2 dated June 6, 2023, revealed that Employee 2 stated that after she left the building from the time clock door and got into her car, she noticed Resident 1 was outside the facility and went to get staff inside the facility to help bring him back inside. Page 1 of 3 395067 395067 09/08/2023 Green Ridge Care Center 2741 Boulevard Avenue Scranton, PA 18509

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few A written witness statement from Employee 3 LPN (license practical nurse) dated June 6, 2023, indicated that dietary staff approached her to inform her that Resident 1 was outside the building. Employee 3 went outside and brought the resident back into the facility. The facility staff failed to ensure the doors at the staff time clock were secured when staff exited the facility and failed to ensure awareness that a resident with a known risk for elopement was behind them exiting the facility when they were leaving. An interview with the Director of Nursing on September 8, 2023, at approximately 1:00 PM confirmed the facility failed to provide adequate safety measures and supervision of a resident with known high elopement risk placing the resident at risk for accidents and injury. This deficiency is cited as past non-compliance. The facility's corrective action plan included the following: 1. The resident was brought back into the facility. A head to toe assessment was completed with no injuries noted. The resident will be offered to go to the courtyard daily. He was placed on 15 minute checks for 72 hours. A head count was completed to ensure all residents were in the facility. All doors were checked for functioning and locking. All windows were checked to ensure proper functioning. 2. To identify like residents that have the potential to be affected the DON or designee will complete new elopement assessments on all residents. If a resident is at risk for elopement care plans will be updated along with the elopement risk book. To identify like residents that have the potential to be affected the maintenance director or designee will complete door checks for functioning and window checks to ensure no other residents could elope. 3. To prevent this from reoccurring the DON or designee will educate current staff on the elopement policy and to ensure doors are firmly closed when exiting locked doors. When new staff members are hired, they will be educated on the elopement policy. Elopement drills will be held every shift to ensure staff members are aware of what to do in case of an elopement. 4. To monitor and maintain ongoing compliance the nursing home administrator or designee will hold and elopement drill monthly for three months. To monitor and maintain ongoing compliance the nursing home administrator or designee will interview five staff weekly for four weeks then monthly for two months to ensure comprehension of elopement policy and education. To monitor and maintain ongoing compliance the maintenance director or designee will complete an audit weekly for four weeks and then monthly for two months to ensure all doors and windows are locked and functioning appropriately. 5. 395067 Page 2 of 3 395067 09/08/2023 Green Ridge Care Center 2741 Boulevard Avenue Scranton, PA 18509

F 0689 These results of the audits will be forwarded to the facilities QAPI committee for further review and recommendations. Level of Harm - Minimal harm or potential for actual harm The facility's plan of correction was completed on June 7, 2023 Residents Affected - Few 28 Pa Code: 201.18 (e)(1) Management 28 Pa. Code: 211.12 (d)(3)(5) Nursing Services 395067 Page 3 of 3