Inspection·March 1, 2024

F 0759 Ensure medication error rates are not 5 percent or greater. Level of Harm - Minimal harm or potential for actual harm Based on facility policy review, clinical record review, observation, and staff interview, it was determined that the facility failed to maintain a medication error rate less than five percent on one of three nursing units. (West Unit) Residents Affected - Few Findings include: A review of the facility policy entitled, Medication Administration, last reviewed January 30, 2024, revealed that staff were to administer medications as ordered by the physician. Medications were to be administered 60 minutes prior to or after the scheduled times unless otherwise specified by the physician. Clinical record review revealed that Resident 1 had diagnoses that included stroke, hypertension (HTN), and arthritic pain. A review of physician's orders dated January 5, 2024, and February 8, 2024, revealed that staff were to administer the following medications at 8:00 a.m. daily: tramadol (a pain medication) 50 mg, and metoprolol (a blood pressure medication) 25 mg. Observation of the medication pass on March 1, 2024, revealed that licensed practical nurse (LPN) 1 administered Resident 1's medications at 9:40 a.m. Clinical record review revealed that Resident 2 had diagnoses that included gastroesophageal reflux disease (GERD), anxiety, seizures, and diabetes. A review of physician's orders dated January 8, 2023, March 14, 2023, June 16, 2023, December 11, 2023, and January 10, 2024, revealed that staff were to administer the following medications at 8:00 a.m. daily: lamotrigine (an anticonvulsant medication) 150 mg, levetiracetam (an anticonvulsant medication) 500 mg, Ativan (an antianxiety medication) 0.5 mg, Novolog (insulin) based on sliding scale parameters, Novolog 70/30 14 units, and omeprazole (a stomach acid reducing medication) 20 mg. Observation of the medication pass on March 1, 2024, revealed that LPN 1 administered Resident 2's medications at 10:00 a.m. The Novolog based on sliding scale parameters was administered at 10:18 a.m. Clinical record review revealed that Resident 4 had diagnoses that included HTN, GERD, urinary retention, and depression. A review of physician's orders dated October 14, 2022, revealed that staff were to administer the following medications at 8:00 a.m. daily: amlodipine (a medication for high blood pressure) 5 mg, and lisinopril (a medication for high blood pressure) 10 mg. A review of physician's orders dated October 14, 2022, July 28, 2023, and January 19, 2024, revealed that staff were to administer the following medications at 9:00 a.m. daily: ferrous sulfate (iron) 325 mg, finasteride (a medication for enlarged prostate) 5 mg, Prozac (an antidepressant medication) 20 mg, and famotidine (a stomach acid reducing medication) 20 mg. Observation of the medication pass on March 1, 2024, revealed that LPN 1 administered Resident 4's medications at 10:36 a.m. (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 2 Event ID: 395188 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 395188 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/01/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Buckingham Valley Rehabilitation and Nursingcenter 820 Durham Road Buckingham, PA 18912 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)