Health inspection·December 12, 2024

F 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy, clinical records, and staff interview, it was determined that the facility failed to provide a written summary of the baseline care plan and order summary to the resident and/or representative for three of eight residents reviewed (Residents R8, R15, and R60). Findings include: A facility policy entitled, Care Plans dated 2/15/24, stated [NAME] will provide the resident and/or responsible party a copy of the baseline care plan at the new admission care plan meeting, which is typically held within 48 hours of admission. The provision of this will be documented on the New admission Care Plan summary sheet. In addition, the nursing staff will provide the resident/responsible person with: a. A summary of the resident's medications and dietary instructions b. Any services and treatments to be administered by [NAME] or its staff. Resident R8's clinical record revealed an admission date of 11/12/24, with diagnoses that included heart failure, atrial fibrillation (irregular heartbeat), and anxiety. Resident R8's clinical record lacked evidence that a written summary of the baseline care plan and order summary was provided to Resident R8 and/or his/her representative. Resident R15's clinical record revealed an admission date of 8/05/24, with diagnoses that included dementia (a disease that affects short term memory and the ability to think logically), osteoarthritis (a joint disease that causes tissues in the joint to break down over time which can cause stiffness in the joint), and hypothyroidism (a condition when the thyroid produces low amounts of thyroid hormones). Resident R15's clinical record lacked evidence that a written summary of the baseline care plan and order summary was provided to Resident R15 and/or his/her representative. Resident R60's clinical record revealed an admission date of 6/22/24, with diagnoses that included hypertension (high blood pressure), hypothyroidism, and congestive heart failure (the inability of the heart to maintain an adequate supply of blood to organs and tissues). Resident R60's clinical record lacked evidence that a written summary of the baseline care plan and Page 1 of 6 395206 395206 12/12/2024 Sarah Reed Senior Living 227 West 22nd Street Erie, PA 16502

F 0655 order summary was provided to Resident R60 and/or his/her representative. Level of Harm - Minimal harm or potential for actual harm During an interview on 12/11/24, at 12:30 p.m. the Nursing Home Administrator confirmed that the clinical records of Residents R8, R15, and R60 lacked evidence that a written summary of the baseline care plan and order summary were provided the resident and/or his/her representative upon admission to the facility. Residents Affected - Few 28 Pa. Code 211.10(c) Resident care policies 28 Pa. Code 211.12(d)(3)(5) Nursing services 395206 Page 2 of 6 395206 12/12/2024 Sarah Reed Senior Living 227 West 22nd Street Erie, PA 16502

F 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. Based on review of facility policies and clinical records, observations, and staff interviews, it was determined that the facility failed to ensure that a resident with limited range of motion received physician ordered treatment and services to prevent further decrease in range of motion for one of two residents reviewed regarding range of motion (Resident R15). Findings include: Review of facility policy dated 2/15/24, entitled Range of Motion/Contracture Management indicated To increase flexibility and strength, also to prevent and/or decrease contractures. Review of facility policy dated 2/15/24, entitled Splinting indicated Splinting is used to protect joints and surrounding soft tissue. There must be a physician's order for splinting. Resident R15's admission record revealed an admission date of 8/05/24, with diagnoses that included dementia (a disease that affects short term memory and the ability to think logically), osteoarthritis (a joint disease that causes tissues in the joint to break down over time which can cause stiffness in the joint), and hypothyroidism (a condition when the thyroid produces low amounts of thyroid hormones). Resident R15's clinical record revealed a physician's order dated 9/07/24, that identified Left palm protector on at all times except hygiene per patient tolerance. Observations on 12/09/24, at 2:28 p.m. and at 3:10 p.m. revealed Resident R15 lying in bed with no palm protector (a soft round device placed in the palm of the hand to help with contractures and prevent fingers from pushing into the palm causing sores) to left hand. Observations on 12/10/24, at 8:04 a.m. and 10:00 a.m. revealed Resident R15 lying in bed with no palm protector to left hand. Observations on 12/11/24, at 11:35 a.m., at 11:55 a.m., and at 1:10 p.m. revealed Resident R15 lying in bed with no palm protector to left hand. Review of Resident R15's clinical record nursing progress notes lacked evidence that Resident R15 was not tolerating the palm protector. Review of Resident R15's therapy documentation dated 9/06/24, revealed that education was provided to staff upon occupational therapy discharge to make sure resident was wearing the palm protector daily. During an interview on 12/12/24, at 9:30 a.m. the Director of Therapy Employee E3 revealed that Resident R15's palm protector is considered a form of a splint. He/she also confirmed that Resident R15 should be wearing his/her palm protector daily per physician's orders. During an interview on 12/11/24, at 1:10 p.m. Restorative Nurse Employee E1 confirmed that Resident R15 did not have a palm protector on his/her left hand. Employee E1 also confirmed that Resident R15 should wear his/her palm protector daily per physician's orders. 395206 Page 3 of 6 395206 12/12/2024 Sarah Reed Senior Living 227 West 22nd Street Erie, PA 16502

F 0688 28 Pa. Code 201.18 (b)(1) Management Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code 211.10 (d) Resident care policies 28 Pa. Code 211.12 (d)(1)(3)(5) Nursing services Residents Affected - Few 395206 Page 4 of 6 395206 12/12/2024 Sarah Reed Senior Living 227 West 22nd Street Erie, PA 16502

F 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. Based on review of facility policy, clinical records, and staff interview, it was determined that the facility failed to have the required 14-day stop date or provide a clinical rationale for the continued use of a PRN (as needed) psychotropic (affecting the mind) medication beyond 14 days for two of 21 residents reviewed (Residents R8 and R15). Findings include: A facility policy entitled Psychoactive Medication Policy dated 2/15/24, stated that Orders for psychotropic drugs are limited to 14 days. If the attending physician or prescribing practitioner believe that it is appropriate for the PRN order to be extended beyond 14 days, he or she should document their rationale in the resident's medical record and indicate the duration for the PRN order. PRN orders for anti-psychotic drugs are limited to 14 days and cannot be renewed unless the attending physician or prescribing practitioner evaluated the resident for appropriateness of the medication. Resident R8's clinical record revealed an admission date of 11/12/24, with diagnoses that included heart failure, atrial fibrillation (irregular heartbeat), and anxiety. A physician's order dated 11/12/24, identified to administer Lorazepam (anti-anxiety medication) 0.25 milliliters (ml) by mouth every 2 hours as needed for anxiety, and lacked the required stop date within 14 days or a clinical rationale for continued use beyond 14 days. Resident R15's clinical record revealed an admission date of 8/5/24, with diagnoses that included dementia (a disease that affects short term memory and the ability to think logically), osteoarthritis (a joint disease that causes tissues in the joint to break down over time which can cause stiffness in the joint), and hypothyroidism (a condition when the thyroid produces low amounts of thyroid hormones). A physician's order dated 11/15/24, identified to administer Lorazepam 0.25 milligrams (mg) by mouth every 12 hours as needed for anxiety, and lacked the required stop date within 14 days or a clinical rationale for continued use beyond 14 days. During an interview on 12/11/24, at 12:08 p.m. the Nursing Home Administrator confirmed that Resident R8 and Resident R15's Lorazepam orders lacked the required stop date within 14 days or a clinical rationale for continued use beyond 14 days. 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services 395206 Page 5 of 6 395206 12/12/2024 Sarah Reed Senior Living 227 West 22nd Street Erie, PA 16502

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy, manufacturer's recommendations, observations, and staff interview, it was determined that the facility failed to ensure an expired medication was discarded in a timely manner and failed to ensure that a medication was properly dated when opened in one of three medication carts reviewed ([NAME] medication cart). Findings include: Review of a facility policy entitled Medication Storage in the Facility dated [DATE], indicated Medications and biologicals are stored safely, securely, and properly, following manufacturer's recommendations or those of the supplier. Insulin vials are stored in the refrigerator until opened. Then dated and placed in the med cart once opened. Manufacturer's recommendations for Humalog insulin (a fast-acting insulin used to manage blood sugar levels in people with diabetes), indicated that after opened, vials and pre-filled pens should be discarded after 28 days. Manufacturer's recommendations for Lantus insulin (a long-acting insulin used to manage blood sugar levels in people with diabetes), indicated that after opened, vials and pre-filled pens should be discarded after 28 days. Observations of drug storage on [DATE], at approximately 3:33 p.m. of the [NAME] medication cart revealed Humalog insulin with an opened date of [DATE], and an opened Lantus insulin without an open date. During an interview at that time, Registered Nurse Employee E2 confirmed that the Humalog insulins opened date was past 28 days, therefore the expired medication should have been discarded, and that the open Lantus insulin lacked an open date, therefore the staff were unable to determine the discard date. 28 Pa. Code 211.9(a)(1) Pharmacy services 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services 395206 Page 6 of 6