Health inspection·July 25, 2023

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm Based on review of resident grievances, clinical record review, and resident and staff interview, it was determined that the facility failed to assist a dependent resident with bathing assistance consistent with resident preferences for two of six residents reviewed for concerns with activities of daily living (Residents 1 and 3). Residents Affected - Few Findings include: Review of a resident complaint/grievance form dated May 26, 2023, revealed that Resident 1 reported that he was not receiving a shower at least weekly. The facility's resolution to the grievance dated June 8, 2023, was that an additional shower day was added, and Resident 1 was happy with the corrective action. Interview with Resident 1 on July 25, 2023, at 10:50 AM revealed that he is to receive a shower twice a week; however, this does not happen. Clinical record review for Resident 1 revealed an annual MDS assessment (Minimum Data Set, an assessment tool completed at specific intervals to determine resident care needs) dated April 26, 2023, that assessed Resident 1 as totally dependent on the physical assistance of one staff for bathing. Task list documentation (electronic documentation of resident care preferences and completion) for Resident 1 revealed that he preferred the following care schedule: March 24, 2023, through June 18, 2023, shower every Wednesday evening. June 19, 2023, through July 3, 2023, shower every Wednesday evening and Saturday dayshift. July 4, 2023, to current, shower every Tuesday and Friday from night shift staff (e.g., 5:00 AM). Bathing records dated June 1 through July 25, 2023, indicated that Resident 1 did not receive a shower per his preferred schedule on the following dates: Saturday, June 24, 2023 Saturday, July 1, 2023 Tuesday, July 4, 2023 Interview with the Nursing Home Administrator, the Director of Nursing, and Employee 1 (registered Page 1 of 4 395101 395101 07/25/2023 Sayre Health Care Center 151 Keefer Lane Sayre, PA 18840

F 0677 Level of Harm - Minimal harm or potential for actual harm nurse), on July 25, 2023, at 4:35 PM confirmed that Resident 1 did not receive bathing assistance on the three dates noted above without a documented rationale. Clinical record review for Resident 3 revealed quarterly MDS assessments dated April 13, 2023, and July 14, 2023, that assessed her as totally dependent on the physical assistance of two staff for bathing. Residents Affected - Few Task list documentation for Resident 3 revealed that she was to receive a shower every Tuesday and Thursday evening. Bathing records dated June 1 through July 25, 2023, indicated that Resident 3 did not receive a shower on Thursday, June 1, 2023, or Tuesday, July 11, 2023. Interview with the Nursing Home Administrator and the Director of Nursing on July 25, 2023, at 3:15 PM confirmed that the documentation above indicated Resident 3 did not receive her scheduled shower without a documented rationale. 28 Pa. Code 211.12(d)(1)(5) Nursing services 395101 Page 2 of 4 395101 07/25/2023 Sayre Health Care Center 151 Keefer Lane Sayre, PA 18840

F 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm Based on clinical record review and resident and staff interview, it was determined that the facility failed to provide nutritional supplementation as prescribed by the physician for one of six residents reviewed for food concerns (Resident 6). Residents Affected - Few Findings include: Clinical record review for Resident 6 revealed the following weight assessments: April 27, 2023, 169 pounds May 17, 2023, 159 pounds (a 10-pound, 5.9 percent, significant weight loss in less than one month) May 31, 2023, and June 1, 2023, 153.6 pounds (a 15.4-pound, 9.11 percent, significant weight loss in less than three months) June 28, 2023, 145.8 pounds (a 7.8-pound, 5.08 percent, significant weight loss in one month) (a 23.2-pound, 13.73 percent, significant weight loss in less than three months) July 4, 2023, 144.2 pounds July 19, 2023, 146.6 pounds Dietary documentation dated May 15, 2023, at 1:24 PM revealed that staff reviewed food preferences with Resident 6, and he requested chocolate Glucerna (a nutritional supplement shake with less sugar for diabetic consumers) with his lunch meal. The documentation indicated that staff would update his plan of care. Dietary documentation dated May 23, 2023, at 9:55 AM noted that upon review of Resident 6's weight assessments, staff determined that Resident 6 had sustained an 11-pound weight loss since his admission. The documentation indicated that Resident 6's diagnoses list included lung cancer with chemotherapy treatments that ended in April 2023. The writer indicated that Resident 6 received, and had good acceptance of, an eight-ounce Glucerna with his lunch meal. The documentation indicated that Resident 6 reported that he drank two to three Glucerna shakes a day when he was at home; and the writer indicated a recommendation to add Glucerna to Resident 6's breakfast and dinner. Dietary documentation dated June 8, 2023, at 12:31 PM revealed staff identified further weight loss. Staff determined that Resident 6's appetite was good, he usually consumed 75 to 100 percent of his meals and had good acceptance of the Glucerna shake three times daily. Resident 6 requested double portions of meat with his meals; and that he, .especially likes to eat a good breakfast. Interview with Resident 6 on July 25, 2023, at 1:00 PM revealed that he was trying to gain weight as he lost a significant amount of weight secondary to his cancer diagnosis and chemotherapy treatments. Resident 6 stated that he was to receive Glucerna; however, he had, not seen it for three weeks. Resident 6 repeated his comment regarding not receiving the Glucerna supplement in the presence of Employee 4 (dietary manager) on July 25, 2023, at 1:10 PM. Resident 6 added that he did not receive his double-portion of eggs that morning for breakfast. Resident 6 reported to the surveyor and to Employee 4 that he received toast and cereal that morning for breakfast, but he did not receive any 395101 Page 3 of 4 395101 07/25/2023 Sayre Health Care Center 151 Keefer Lane Sayre, PA 18840

F 0692 orange juice or eggs although they were listed on the planned menu that day. Level of Harm - Minimal harm or potential for actual harm Interview with Employee 4 on July 25, 2023, at 1:10 PM revealed that the dietary staff stock the Glucerna supplement in the resident pantry refrigerator for nursing staff to provide with meals. Dietary staff do not send the Glucerna supplement on the meal trays. Observation of the pantry refrigerator with Employee 4 revealed no Glucerna in the resident pantry refrigerator. Residents Affected - Few Clinical record review for Resident 6 revealed a physician's order dated May 23, 2023, for staff to provide an eight-ounce chocolate Glucerna supplement three times daily with meals. Interview with Employee 2 (registered nurse) on July 25, 2023, at 1:15 PM confirmed that nursing staff are to provide the Glucerna supplement to Resident 6, and that nursing staff initial when the supplement is provided. Review of Resident 6's MAR/TAR (medication administration record/treatment administration record, electronic documentation of the administration of medications and treatments) dated July 2023, with Employee 2, revealed that Employee 3 (licensed practical nurse) initialed the administration of the supplemental shake for the breakfast and lunch meal on July 25, 2023. Interview with Employee 3 on July 25, 2023, at 1:20 PM revealed that she did not provide Resident 6 his Glucerna supplement at all on this date. Employee 3 stated that she believed that dietary staff sent supplemental shakes on residents' meal trays during meal service. Employee 3 confirmed that although she initialed she provided the supplement, she never saw Resident 6 receive any nutritional supplement shake on July 25, 2023. Review of Resident 6's MAR/TAR dated July 2023, revealed that Employee 3 initialed the administration of the Glucerna shakes for the meals on the following dates: All three meals July 1, 4, 6, 7, 10, 11, 17, 21, and 24, 2023 Breakfast and dinner on July 2, 2023 (documented Resident 6 was not in the building for the lunch meal) Breakfast and lunch on July 3 and 12, 2023 The surveyor reviewed the above findings regarding Resident 6's Glucerna supplement during an interview with the Nursing Home Administrator, the Director of Nursing, and Employee 4 on July 25, 2023, at 1:25 PM. 28 Pa. Code 211.5(f) Medical records 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services 395101 Page 4 of 4