Health inspection·February 1, 2024

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review and interviews with staff, it was determined that the facility failed to develop a comprehensive care plan related to psychotropic medications and behavior management for one of 14 residents reviewed (Resident R27). Findings include: Review of Resident R27's admission MDS (Minimum Data Set - a mandatory periodic resident assessment tool), dated December 19, 2023, revealed that the resident was admitted to the facility on [DATE], and had diagnoses including dementia (decline in memory or other thinking skills severe enough to reduce a person's ability to perform everyday activities), anxiety disorder (intense, excessive, persistent worry or fear) and sleep disorder. Review of progress notes for Resident R27 revealed a nurses note, dated December 15, 2023, at 6:49 a.m. which indicated that the resident exhibited several behaviors, including agitation, verbal aggression, inability to be re-directed and disrobing. Continue review of progress notes for Resident R27 revealed a nurses note, dated December 15, 2023, at 9:00 a.m. which indicated that the physician was notified of the resident's behaviors and prescribed Ativan (a benzodiazepine medication used to treat anxiety) to be given at bedtime. Continue review of progress notes for Resident R27 revealed a nurses note, dated December 17, 2023, at 9:27 a.m. which indicated that the resident was noted with increased anxiety behaviors, including constantly looking for his wallet and expressing that he needed to get to the train station. Multiple non-pharmacological interventions were attempted and unsuccessful. The resident's spouse was also unable to console the resident. The physician prescribed to increase the Ativan to every twelve hours daily. Continue review of progress notes for Resident R27 revealed a physician's note, dated January 10, 2024, at 3:11 p.m. which indicated that the resident continued to display behaviors related to increased anxiety and depression. The physician recommended to start Lexapro (medication used to treat depression and anxiety) twice per day. Further review of progress notes for Resident R27 revealed a nurses note, dated January 24, 2024, at 11:13 a.m. which indicated that the resident was currently taking psychotropic medications including Ativan, Lexapro and mirtazapine (an antidepressant medication). The resident continued to display behaviors including anxiety, screaming and wandering and was not easily re-directable. The GDR Page 1 of 7 395193 395193 02/01/2024 Rosemont Center 35 Rosemont Avenue Rosemont, PA 19010

F 0656 Level of Harm - Minimal harm or potential for actual harm (Gradual Dose Reduction) committee recommended no changes to the resident's psychotropic medications at that time. Review of Medication Administration Records for December 2023 and January 2024 revealed that Resident R27 was administered Ativan, Lexapro and mirtazapine as prescribed. Residents Affected - Few Review of Resident R27's care plan, dated initiated December 13, 2023, revealed that no care plan had been developed related to the resident's behaviors or use of psychotropic medications. Interview on January 31, 2024, at 11:30 a.m. the Director of Nursing confirmed that no care plan had been developed for Resident R27 related to his behaviors and use of psychotropic medications. 28 Pa Code 211.12(d)(5) Nursing services 395193 Page 2 of 7 395193 02/01/2024 Rosemont Center 35 Rosemont Avenue Rosemont, PA 19010

F 0694 Provide for the safe, appropriate administration of IV fluids for a resident when needed. Level of Harm - Minimal harm or potential for actual harm Based on observations, reviews of clinical records, facility policies and procedures, and interviews with staff and resident, it was determined that the facility failed to provide adequate treatment and care for a peripherally inserted central catheter (PICC) line in accordance with professional standards of practice for one of 30 residents reviewed (Resident R354). Residents Affected - Few Findings include: According to the standards of nursing practice guidelines in the Journal of the American Nurse's Association, dated November 2013, complications of a PICC line includes, but is not limited to catheter-tip migration (assessed by external length of the catheter-amount of catheter tubing that is visible outside of the vein moves from original insertion and may cause medical complications). Review of this facility policy Peripherally Inserted Central Catheter (PICC's) , dated May 18, 2020, revealed that Must be assessed using sterile technique with the maintenance of positive pressure. PICC's are to be capped when not in use. The extension tubing attached to the PICC at the time of the insertion must not be removed with routine IV tubing changes. Observation of Resident R354 on January 30, 2024, at 12:16 p.m. with Employee E4, Licensed Practical Nurse, revealed that the resident had a right upper extremity PICC line insertion. There was no documentation on the dressing to indicate the date and time the dressing last changed. It was also revealed that the extension tube and the cap for both lumens were missing which exposed the PICC line. Review Resident R354's physician order dated January 16, 2024, revealed an order to change PICC line dressing weekly and measure external catheter length during weekly dressing change. A review of the treatment administration record (TAR) for the month of January 2024 indicated that order was signed off by the staff on January 23, 2024. Continued review of the TAR revealed that the external catheter length measurement was not completed for January 23, 2024, as ordered by the physician. An interview with Director of Nursing, Employee E2, on February 1, 2024, at 11:00 a.m. confirmed that that the PICC line external catheter length should be measured and documented with each dressing change, and PICC line should have caps and connecter when not in use. 28 Pa. Code: 211.10 (c) Resident care policies 28 Pa. Code: 211.10 (d) Resident care policies 28 Pa. Code: 211.12 (d)(1) Nursing services 28 Pa. Code: 211.12(d)(5) Nursing services 395193 Page 3 of 7 395193 02/01/2024 Rosemont Center 35 Rosemont Avenue Rosemont, PA 19010

F 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being. Based on the review of clinical records, facility documentation, observations, interview with staff, it was determined that the facility failed to ensure that nursing staff possessed the appropriate competencies and skill sets related to the care of residents with PICC line ( a tube placed in a large vein in the neck, chest, groin, or arm to give fluids, blood, or medications or to do medical tests quickly). Two of two employee records reviewed. (Employee E4 and E5). Findings Include: Observation of a PICC line medication administration for Resident R354 on January 30, 2024, at 12:16 p.m. with the extension tube and the cap for both lumens were missing which exposed the PICC line. Employee E4 was preparing medication to be administered via PICC line. It appeared that the staff was given instruction by Employee E5 during the medication preparation, setting up of IV pump, and medication administration. Employee E4 worn gloves when preparing medication in the hallway, using the same gloves touched medication cart, IV pump pole and the resident. Further observation revealed that the extension tube and the cap for both lumens were missing which exposed the PICC line. Employee E5 tried to connect the IV set to the PICC line catheter without a connector. But was unable to connect The IV set without a connecter and he administration was not completed during the observation. Employee E5 stated it appeared the connecter was missing, and it was unable to connect without a connector. Interview with Employee E4 and E5 on January 30, 2024, at 12:30 p.m. stated they did not receive any training or competency evaluation of the care and management of residents with PICC line. A request for PICC line care and management competency for Employee E4 and E5 was requested to the Director of Nursing. Facility did not submit the PICC line care and management competency for Employee E4 and E5 during the survey. 28 Pa. Code: 211.12 (d)(1) Nursing services 28 Pa. Code: 211.12(d)(5) Nursing services 395193 Page 4 of 7 395193 02/01/2024 Rosemont Center 35 Rosemont Avenue Rosemont, PA 19010

F 0867 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action. Based on the review of Quality Improvement Program (QUAPI) plan, facility documentation, and interview with staff, it was determined that the facility failed to demonstrate and maintain an effective Quality Improvement Program with systems and reports demonstrating systematic identification, reporting, investigation, analysis, and prevention of adverse events and performance indicators. Findings include: Review of the facility policy QUAPI, revealed, Our organization's written QAA/QAPI plan provides guidance for our overall quality improvement program. Quality assurance performance improvement principles will drive the decision making within our organization. Decisions will be made to promote excellence in quality of care, quality of life resident choice person directed care, and resident transitions. Focus areas will include all systems that affect resident and family satisfaction, quality of care and services provided, and all areas that affect the quality of life for persons living and working in our organization. The facility's QUAPI policy failed to address the following required information. (i) How they will use a systematic approach to determine underlying causes of problems impacting larger systems; (ii) How they will develop corrective actions that will be designed to effect change at the systems level to prevent quality of care, quality of life, or safety problems; and (iii) How the facility will monitor the effectiveness of its performance improvement activities to ensure that improvements are sustained. The administrator will assure that the QAA/QAPI plan is reviewed minimally on an annual basis by the QAA committee. Revisions will be made to the plan ongoing, as the need arises, to reflect current practices within our organization. These revisions will be made by the QAA committee. Revisions to the QAA/QAPI plan will be communicated as they occur to residents, families, and staff through meetings and electronic messaging. Major revisions will also be reflected in the facility assessment as appropriate. A review of facility QUAPI program review was conducted with the administrator and medical director on February 1, 2024, at 11:18 a.m. which revealed that the facility's QUAPI projects dated January 16, 2024, contained topic of the improvement activities facility plan to conduct. Further review of the QUAPI information did not contain evidence of identifying, reporting, tracking, monitoring and evaluation of performance indicators. A request for the previous QUAPI was requested to the administrator on February 1, 2024. However, facility did not submit any previous QUAPI information including evidence of identifying, reporting, tracking, monitoring and evaluation of performance indicators. Interview with Regional Nurse, Employee E11 on February 1, 2024, at 12:00 p.m. confirmed that the facility QUAPI policy provided at the time of the survey did not contain required information 395193 Page 5 of 7 395193 02/01/2024 Rosemont Center 35 Rosemont Avenue Rosemont, PA 19010

F 0867 according to the regulation. Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 201.18(b)(1) Management Residents Affected - Few 395193 Page 6 of 7 395193 02/01/2024 Rosemont Center 35 Rosemont Avenue Rosemont, PA 19010

F 0947 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention. Based on a review of facility documentation and staff interview, it was determined that the facility failed to ensure its nurse aide staff was receiving in-service training to be proficient and competent and that the training be no less than 12 hours annually for five of five nurse aide staff training information reviewed (E6. E7, E8, E9 and E10). Findings Include: Review of the nurse aide annual training information provided during the survey revealed that there were no training logs/tracking to review for nurse aides E6. E7, E8, E9 and E10 Review of the nurse aide training/in-service information provided during the survey revealed that nurse aides training logs did not contain evidence that the training met the twelve hours of annual training requirement. An interview with the Director of Nursing on February 1, 2024, at 11:00 a.m. confirmed that the facility did not track the in-service training for their nurses' aides and the facility documentation did not contain evidence of that the training for E6. E7, E8, E9 and E10 met the twelve hours of annual training requirement. 28 Pa. Code 201.14(a) responsibility of licensee. 395193 Page 7 of 7