Health inspection·November 2, 2023

F 0697 Provide safe, appropriate pain management for a resident who requires such services. 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, clinical record review, observation, and resident and staff interview, it was determined that the facility failed to assess and treat pain for two of 21 sampled residents. (Resident 47, 309) Residents Affected - Few Findings include: Review of the facility policy entitled, Pain Assessment and Management, last reviewed August 9, 2023, revealed that the multidisciplinary care team would identify, appropriately assess, and treat pain based on professional standards of practice, the comprehensive care plan, and the resident's choices related to pain management. The policy directed staff to further assess a resident when there was a suspicion of new pain or worsening of existing pain by using a consistent approach and a standardized pain assessment instrument appropriate to the resident's cognitive level. Clinical record review revealed that Resident 47 had diagnoses that included history of a stroke, bilateral knee contractures, and left sided weakness. Review of the Minimum Data Set (MDS) assessment, dated September 18, 2023, revealed that Resident 47 was alert and oriented. A physician's order, dated May 2, 2022, directed staff to conduct a pain assessment of Resident 47 every shift. A physician's order, dated January 19, 2023, directed staff to administer a pain medication (acetaminophen) every 6 hours, as needed, for mild pain. Review of the care plan revealed Resident 47 had a potential for alteration in comfort related to impaired mobility. The interventions were for staff to assess for signs and symptoms of pain, attempt non-pharmacological interventions prior to medication, and reposition as needed for pain relief. On October 30, 2023, at 11:55a.m., Resident 47 was observed in a tilted back wheelchair in the hallway. The resident complained of pain in his left leg and stated that Licensed Practical Nurse (LPN) 2 was aware of the pain. In an interview on October 30, 2023, at 12:23 p.m., LPN 2 stated that she would assess the resident for pain and would provide interventions accordingly. In an interview on October 31, 2023, at 9:46 a.m., Resident 47 stated that staff did not assess his pain or provide interventions on October 30, 2023. A review of the progress notes and the Medication and Treatment Administration Records (MAR and TAR) for October 30, 2023, revealed lack of evidence that staff assessed or treated the resident's pain. In an interview on November 2, at 8:56a.m., the Administrator confirmed that no pain assessment was done, and no interventions were offered to Resident 47 for his reported pain. Clinical record review revealed that Resident 309 had diagnoses that included a history of spine surgery, spinal stenosis (a narrowing of the spinal canal which could cause pressure on the spinal cord and nerves within the spine), and difficulty walking. Review of the MDS assessment dated [DATE], Page 1 of 8 395227 395227 11/02/2023 Brookside Healthcare & Rehabilitation Center 2630 Woodland Road Roslyn, PA 19001

F 0697 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few revealed that the resident was alert and oriented. Physician's orders, dated October 27, 2023, directed staff to assess Resident 309's pain every shift, administer a pain medication (oxycodone) every four hours, as needed, for severe pain, and administer a pain medication (acetaminophen) every six hours, as needed, for mild pain. A review of the care plan revealed that Resident 309 was at risk for discomfort and pain was to be managed with interventions of assessing pain, repositioning, or administering pain medications, as ordered, to relieve pain. Observation on October 31, 2023, at 9:10 a.m., revealed that Resident 309 notified LPN 1 of pain and requested pain medication. LPN 1 stated that the resident's order for oxycodone, the medication for severe pain, was not to be administered until 11:00 a.m. LPN 1 did not assess Resident 309's pain to determine the location or pain level. LPN 1 did not offer non-pharmacological interventions or determine if the alternate medication (acetaminophen) was available as an appropriate intervention upon Resident 309's report of pain. In an interview on November 1, 2023, at 1:15p.m., the NHA confirmed that LPN 1 did not follow the facility's policy on pain assessment and management and did not assess or provide interventions to address Resident 309's pain. 28 Pa. Code 211.12(d)(1)(5) Nursing services. 395227 Page 2 of 8 395227 11/02/2023 Brookside Healthcare & Rehabilitation Center 2630 Woodland Road Roslyn, PA 19001

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on policy review, clinical record review, and staff interview, it was determined that the facility failed to ensure that a resident was administered medication as prescribed by the physician for one of 21 sampled residents. (Resident 309) Findings include: Review of the facility policy entitled, Unavailable Medications, last reviewed August 9, 2023, revealed that the facility used Pharmscript (an on-line pharmacy supplier) for medication orders. If a medication was unavailable from the pharmacy, the pharmacy would notify nursing staff that the ordered product was unavailable, when they anticipated the drug would become available, and would suggest an alternate or comparable drug and dosage of drug that was available. Nursing staff would notify the attending physician, the facility's nursing supervisor or the medical director of the situation, a new order would be obtained, and the order for the non-available medication would be cancelled or discontinued. Clinical record review revealed that Resident 309 had diagnoses that included vitamin D deficiency and osteoarthritis. A physician's order, dated October 28, 2023, directed staff to administer a medication for psoriasis (acitretin) once daily. Review of a memo from Pharmscript dated November 1, 2023, revealed that the pharmacy received the order for acitretin on October 27, 2023, but the medication was not in stock at that time. The pharmacy did not inform the facility that the medication was unavailable. In an interview on November 2, 2023, at 8:58 a.m., the Administrator confirmed that the medication was unavailable since October 28, 2023, and the resident missed scheduled doses of the acitretin on October 28, 29, and 30, 2023. 28 Pa. Code 201.14(a) Responsibility of licensee. 28 Pa. Code 211.10(c) Resident care policies. 28 Pa. Code 211.12(d)(1)(3)(4) Nursing services. 395227 Page 3 of 8 395227 11/02/2023 Brookside Healthcare & Rehabilitation Center 2630 Woodland Road Roslyn, PA 19001

F 0808 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure therapeutic diets are prescribed by the attending physician and may be delegated to a registered or licensed dietitian, to the extent allowed by State law. Based on review of the facility menu and diet manual, clinical record review, and observation, it was determined that the facility failed to provide therapeutic diets as ordered by the physician for four of 21 sampled residents. (Residents 39, 69, 142, 311) Findings include: Review of the facility diet manual revealed that residents who were ordered a dysphagia advanced texture diet were to avoid potato skins. Review of the facility menu extensions revealed that residents who were ordered a dysphagia mechanical soft texture diet were to receive pureed peas. Clinical record review revealed that Resident 39 had diagnoses that included multiple sclerosis, diabetes, and dysphagia (difficulty with swallowing). Review of the care plan revealed a potential for nutritional problems related to chewing and swallowing difficulty and a need for a mechanically altered diet. The intervention was for staff to provide the diet as ordered. A physician's order dated April 7, 2023, directed staff to provide a dysphagia advanced textured diet. Observation on October 30, 2023, at 12:46 p.m. revelaed that Resident 39 was served and ate a meal that included large pieces of cooked potatoes. The skin remained on the potatoes. Clinical record review revealed that Resident 69 had diagnoses that included multiple sclerosis, muscle weakness, and traumatic brain injury. Review of the care plan revealed a potential for nutritional problems related to chewing and swallowing difficulty and a need for a mechanically altered diet. The intervention was for staff to provide the diet as ordered. A physician's order dated January 13, 2022, directed staff to provide a dysphagia advanced texture diet. Observation on October 31, 2023, at 12:26 p.m., revealed that Resident 69 was served a meal that included large pieces of cooked potatoes. The skin remained on the potatoes. Clinical record review revealed that Resident 142 had diagnoses that included Parkinson's disease, diabetes, chronic obstructive pulmonary disease, and dysphagia. Review of the care plan revealed a potential for nutritional problems related to chewing and swallowing difficulty and a need for a mechanically altered diet. The intervention was for staff to provide the diet as ordered. A physician's order dated August 21, 2023, directed staff to provide a dysphagia mechanical soft textured diet. Observation on October 30, 2023, at 12:44 p.m. revealed that Resident 142 was served and ate a meal that included whole peas. Clinical record review revealed that Resident 311 had diagnoses that included end stage renal disease, history of a stroke, and dysphagia (difficulty with swallowing). Review of the care plan revealed a potential for nutritional problems related to chewing and swallowing difficulty and a need for a mechanically altered diet. The intervention was for staff to provide the diet as ordered. A physician's order dated August 1, 2023, directed staff to provide a dysphagia advanced textured diet. Observation on October 30, 2023, at 1:24 p.m., revealed that Resident 311 was served and ate a meal that included large pieces of cooked potatoes. The skin remained on the potatoes. 201.14(a) Responsibility of licensee. 395227 Page 4 of 8 395227 11/02/2023 Brookside Healthcare & Rehabilitation Center 2630 Woodland Road Roslyn, PA 19001

F 0808 211.12(d)(3)(5) Nursing services. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 395227 Page 5 of 8 395227 11/02/2023 Brookside Healthcare & Rehabilitation Center 2630 Woodland Road Roslyn, PA 19001

F 0809 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure meals and snacks are served at times in accordance with resident’s needs, preferences, and requests. Suitable and nourishing alternative meals and snacks must be provided for residents who want to eat at non-traditional times or outside of scheduled meal times. Based on review of the facility's meal schedule, observation, and resident interview, it was determined that the facility failed to ensure that meals were served at regularly scheduled times in accordance with resident needs on one of two nursing units and in the main dining room. (Susquehanna Unit) Findings include: Review of the facility's meal schedule revealed that the scheduled time for lunch on the Susquehanna nursing unit, short hall was 11:15 a.m., and the scheduled time for lunch in the main dinning room was 12:00 p.m. During a group interview on October 31, 2023, at 10:30 a.m., Residents 17, 36, 59, 71, and 89, stated that the meals were frequently delivered late. Observation on November 1, 2023, on Susquehanna nursing unit, short hall, revealed the meal cart arrived on the nursing unit at 11:41 a.m., 26 minutes after the scheduled delivery time. Observation of the main dining room on November 1, 2023, at 12:27 p.m., revealed that the lunch meal had not yet been served. In interviews at the time, Resident 39 stated that she was waiting for her tray and that the lunch was late. Residents 15 and 59 stated that lunch was typically served late in the main dining room. Further observation revealed that the residents seated in the main dining room were served their lunch trays at 12:45 p.m. through 1:00 p.m., 45 minutes after the scheduled meal time. 28 Pa. Code 201.14(a) Responsibility of licensee. 395227 Page 6 of 8 395227 11/02/2023 Brookside Healthcare & Rehabilitation Center 2630 Woodland Road Roslyn, PA 19001

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on facility policy review, observation, and staff interview, it was determined that the facility failed to properly store food and maintain sanitary conditions in the dietary department and on one of two unit pantries. (Susquehanna) Findings include: Review of the policy entitled, Food: Preparation, last reviewed August 9, 2023, revealed that food was to be prepared with procedures that avoid contamination by potentially harmful physical, biological, and chemical contamination. Food contact equipment was to be cleaned after every use. The temperatures of hot and cold foods at meals were to be checked to ensure proper food holding temperatures were maintained. Staff were to record the temperatures for the food items at the time of service onto the Service Checklist Form. Review of the policy entitled, Food Storage: Dry Goods, Cold Foods, last reviewed August 9, 2023, revealed all packaged foods were to be kept clean, dry, and properly sealed. Cold foods were to be stored, wrapped or in a covered container, labeled and dated, and arranged in a manner to prevent cross-contamination. Review of the policy entitled, Food: Safe Handling for Food from Visitors, last reviewed August 9, 2023, revealed staff were to assist residents with proper food storage and safe food consumption with foods stored in the unit pantry. Staff were to ensure food was stored in a sealed container to prevent cross-contamination. Staff were to properly maintain the refrigerator and freezer for storage of food brought in by visitors for residents. Observations during the kitchen tour on October 30, 2023, at 11:15 a.m., and on November 1, 2023, at 9:35 a.m., revealed the following: In dry storage, there was an unlabeled clear bag of what the Dietary Manager (DM) 1 identified as yellow cake mix. There was powdered food debris on an opened cornbread mix box that was opened to air. Next to this box was a box of thickened water covered with the same debris. In the cooks' cooler, there was a package of opened swiss cheese that was not dated. In the walk-in cooler, under the shelves that stored the milk crates, there was a gelled white liquid on the floor that had an odor. There were various pieces of dried food debris on the floor and a blackened piece of food with white spots on it under the shelves. In a box of butter, one stick was partially opened to air and had multiple brown spots on the exposed area. It was touching the other sticks of butter. There was an accumulation of dust on two fan shields and both fans were running. There was an opened bottle of mustard with no open date and an illegible use-by date. There was an opened package of turkey lunch meat that was not dated. In the freezer, there were multiple peas on the floor by the door and an opened box of fish fillets that was not dated and was open to air. In the cook's preparation area, the can opener had dried black food debris on the piece that pierced the cans. There were two plastic containers containing chicken and beef base that were covered with dried food debris. The lid to the beef base was opened and the beef base was not being used at that time. 395227 Page 7 of 8 395227 11/02/2023 Brookside Healthcare & Rehabilitation Center 2630 Woodland Road Roslyn, PA 19001

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many In the trayline cooler, there was dried food debris along the length of the bottom. The temperature was 50 degrees Farenheit (F) on October 30, 2023, at 11: 50 a.m., and on November 1, 2023, at 9:41 a.m., which was above the safe refrigeration temperature of 41 degrees F. There was no meal preparation occurring in that area at those times and milk was stored in the cooler. In the trayline area during both tours, the platform that the juice machine was stored on was covered with a white substance with raised edges and rust along the length of the area below the machine. The Regional Manager identified the white substance as lime. Observation on both dates revealed there was peeling paint on two door frames in the food preparation areas of the kitchen. One door was adjacent to Susquehanna unit hallway and the other door was adjacent to the cooks food preparation area. Review of Service Line Checklists that were to be used by the cooks to record the temperatures of the food served at each meal from October 16, 2023, through October 31, 2023, revealed no documented evidence that food temperatures were obtained to ensure safe cooking and holding temperatures for 29 of 48 meals reviewed. In an interview on October 30, 2023, at 12:00 p.m., DM 1 confirmed food items should have been dated and those observed during the tour were not. In an interview conducted on November 1, 2023, at 12:15 p.m., DM 2 confirmed the Service Line Checklist should have been completed with each meal. Observation of the Susquehanna unit pantry on October 30, 2023, at 1:10 p.m., revealed the inside of the microwave was dirty with multiple areas of dried food splatter, a used paper towel, and a burnt piece of food debris in the corner. There were multiple rust areas along the top inside of the microwave. In the refrigerator, there was dried liquid debris underneath an opened container of almond milk. In the freezer, there were four packages that were encrusted in ice and unable to be identified. In the cabinet, there was an opened large jar of peanut butter with an expiration date of May 4, 2023. In an interview conducted on October 30, 2023, at 1:20 p.m., the Director of Nursing confirmed the microwave and refrigerator were used to store items for residents. 28 Pa. Code 201.14(a) Responsibility of licensee. 395227 Page 8 of 8