Inspection·August 7, 2025

F 0554 Allow residents to self-administer drugs if determined clinically appropriate. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on facility policy review, observation, clinical record review, and resident and staff interview, it was determined that the facility failed to assess a resident's capability to self-administer medications for one of 26 sampled residents. (Resident 7) Findings include:Review of facility policy entitled, Resident Self-Administration of Medication, last reviewed January 20, 2025, revealed that a resident may only self-administer medications after the facility's interdisciplinary team has determined which medications may be self-administered safely. The resident's preference will be documented on the appropriate form and placed in the medical record. The results of the interdisciplinary team assessment are recorded on the Medication Self-Administration Assessment Form which is placed in the resident's medical record. When the interdisciplinary team determines that bedside or in-room storage of medications would be a safety risk to other residents, the medications of residents permitted to self-administer are stored in the medication cart or medication room.Clinical record review revealed that Resident 7 had diagnoses that included limitation of activities due to disability, [NAME]-Danlos Syndrome (a disease that affects the skin, joints, and blood vessel walls), and anxiety disorder. Review of the Minimum Data Set (MDS) assessment, dated April 18, 2025, revealed that Resident 7's cognitive ability was intact.Observations on August 5, 2025, at 11:15 a.m., and on August 6, 2025, at 11:40 a.m., revealed that there were two bottles of Fluticasone nasal spray (a medication used to treat symptoms caused by allergies), one bottle of artificial tears, and one bottle of saline nasal spray unsecured on the bedside table in Resident 7's room. Additionally, there was one bottle of gummy vitamins on the shelving next to Resident 7's bed and unsecured in the resident's room during the observation periods.In an interview on August 5, 2025, at 11:10 a.m., Resident 7 stated that she self-administered the medications daily.There was no documentation to indicate that the facility had assessed Resident 7 for the ability to self-administer the Fluticasone nasal spray, artificial tears, saline nasal spray, and gummy vitamins. The medications were not secured in her room.In an interview on August 7, 2025, at 10:45 a.m., the Director of Nursing confirmed that Resident 7 was not assessed to self-administer the medications as per the facility policy.28 Pa. Code 211.12(d)(1)(3)(5) Nursing Services. Residents Affected - Few 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 3 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 08/07/2025 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)