Health inspection·September 28, 2023

F 0698 Provide safe, appropriate dialysis care/services 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 review of facility policy and clinical record and staff interview it was determined that the facility failed to make certain consistent dialysis communication was maintained for two of four dialysis residents. (Resident R58 and R61). Residents Affected - Few Findings include: Review of CMS guidelines, 483.25(1) states the facility assures that each resident receives care and services for the provision of dialysis (a machine filters wastes, salts and fluid from your blood when your kidneys are no longer healthy enough to do this work adequately) including the ongoing assessment of the resident's condition and monitoring for complications before and after dialysis treatments. Review of the admission record indicated Resident R58 was admitted to the facility on [DATE]. Review of Resident R58's Minimum Data Set (MDS - a periodic assessment of care needs) dated 8/11/23, indicated the diagnoses of anemia (the blood doesn't have enough healthy red blood cells), high blood pressure, and renal failure (condition where the kidneys lose the ability to remove waste and balance fluids) with dialysis. Review of R58's physician order dated 9/15/23, indicated that Resident R58 goes to dialysis on Monday, Wednesday and Friday. Review of Resident R58's care plan dated 7/17/23, indicated dialysis: Monday, Wednesday, and Friday to be picked up at 12:00 p.m. for 12:30 p.m. chair time. Review of the clinical record did not include complete communication forms on twelve occasions from the period of 7/21/23 -9/15/23 (7/21/23, 8/21/23, 8/23/23, 8/25/23, 8/28/23, 8/30/23, 9/1/23, 9/4/23, 9/8/23, 9/11/23, 9/13/23, and 9/15/23). Interview on 9/28/23, at 1:00 p.m. the Director of Nursing confirmed the above dates did not include complete communication forms as required for Resident R61. Review of the admission record indicated Resident R61 was admitted to the facility on [DATE]. Review of Resident R61's MDS dated [DATE], indicated the diagnoses of anemia, high blood pressure, and renal failure with dialysis. Page 1 of 10 395266 395266 09/28/2023 Beaver Valley Rehabilitation and Healthcare Center 257 Georgetown Road Beaver Falls, PA 15010

F 0698 Level of Harm - Minimal harm or potential for actual harm Review of R61's physician order dated 9/15/23, indicated that Resident R61 goes to dialysis on Monday, Wednesday and Friday. Review of Resident R61's care plan dated 7/17/23, indicated dialysis: Monday, Wednesday, and Friday to be picked up at 5:30 a.m. for 6:00 a.m. Residents Affected - Few Review of the clinical record did not include complete communication forms on twelve occasions from the period of 7/3/23 -9/18/23 (7/3/23, 7/5/23, 7/7/23, 7/10/23, 7/12/23, 7/14/23, 8/14/23, 8/25/23, 9/4/23, 9/6/23, 9/11/23, and 9/18/23). Interview on 9/28/23, at 1:00 p.m. the Director of Nursing confirmed the above dates did not include complete communication forms as required for Resident R61. Interview on 9/28/23, at 1:05 p.m. the Director of Nursing (DON) confirmed that the facility failed to make certain consistent dialysis communication was maintained for two of four dialysis residents. (Resident R58 and R61). 28 Pa. Code:211.12(d)(1)(3)(5) Nursing services. 28 Pa. Code:201.18(b)(1) Management. 395266 Page 2 of 10 395266 09/28/2023 Beaver Valley Rehabilitation and Healthcare Center 257 Georgetown Road Beaver Falls, PA 15010

F 0700 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, review of federal regulations, facility policy, clinical record review, and staff interview, it was determined that the facility failed to conduct ongoing accurate assessments to ensure that bedrails were used to meet residents' needs and the risks associated with bedrail usage for four of four residents (Residents R4, R13, R20, and R69). Findings include: Review of Title 42 Code of Federal Regulations (CFR) §483.25(n) - Bed Rails states that the facility must assess the resident for risk of entrapment from bed rails prior to installation. Additionally, there should be evidence in the resident's records that the facility performed ongoing assessments to assure that the bed rail is used to meet the resident's needs and that there is an ongoing evaluation of risks associated with bed rail usage. Review of facility policy Bed Safety dated 3/1/22, and 7/13/23, indicated side rails may be used if assessment and consultation with the Attending Physician has determined that they are needed to help manage and medical symptom or condition, or to help the resident reposition or move in bed and transfer, and no other reasonable alternatives can be identified. When using side rails for any reason, the staff shall take measures to reduce related risks. Review of the clinical record indicated Resident R4 was admitted to the facility on [DATE]. Review of Resident R4's Minimum Data Set (MDS - a periodic assessment of care needs) dated 8/1/23, indicated diagnoses of hemiplegia (paralysis on one side of the body), hypertension (high blood pressure in the arteries), and diabetes (too much sugar in the blood). Review of Resident R4's MDS dated [DATE], Section G: Functional Status, Question G0110 indicated that Resident R4 required extensive assistance with resident involved in activity and staff to provide weight-bearing support of one to perform bed mobility. Review R4's physician order dated 9/15/23, indicated to apply enabler bars to promote bed mobility. Review of Resident R4's clinical record revealed the most current In Bed Positioning/Side Rail Evaluation was completed on 11/30/21, and indicated bilateral bed rails were to be applied to allow the resident to contribute to bed mobility. An observation on 9/28/23, at 11:49 a.m. revealed side rails on both sides of Resident R4's bed. Review of the clinical record indicated Resident R13 was admitted to the facility on [DATE]. Review of Resident R13's MDS dated [DATE], indicated diagnoses of hemiplegia (paralysis on one side of the body), hypertension (high blood pressure in the arteries), and muscle weakness. Review of Resident 13's MDS dated [DATE], Section G: Functional Status, Question G0110 indicated that Resident R13 required extensive assistance with resident involved in activity and staff to 395266 Page 3 of 10 395266 09/28/2023 Beaver Valley Rehabilitation and Healthcare Center 257 Georgetown Road Beaver Falls, PA 15010

F 0700 provide weight-bearing support of two to perform bed mobility. Level of Harm - Minimal harm or potential for actual harm Review of a physician order dated 9/15/23, indicated to apply enabler bars to promote bed mobility. Residents Affected - Some Review of Resident R13's clinical record revealed the most current In Bed Positioning/Side Rail Evaluation was completed on 12/2/22, and indicated bilateral bed rails were to be applied to allow the resident to contribute to bed mobility. An observation on 9/28/23, at 11:40 a.m. revealed side rails on both sides of Resident R13's bed. Review of the clinical record indicated Resident R20 was admitted to the facility on [DATE]. Review of Resident R20's MDS dated [DATE], indicated diagnoses of hypertension, Parkinson's Disease (a neuromuscular disorder causing tremors and difficulty walking), and muscle weakness. Review of Resident 20's MDS dated [DATE], Section G: Functional Status, Question G0110 indicated that Resident R20 required extensive assistance with resident involved in activity and staff to provide weight-bearing support of two to perform bed mobility. Review of a physician order dated 9/15/23, indicated to apply enabler bars to promote bed mobility. Review of Resident R20's clinical record revealed the most current In Bed Positioning/Side Rail Evaluation was completed on 8/19/22, and indicated bilateral bed rails were to be applied to allow the resident to contribute to bed mobility. An observation on 9/28/23, at 11:45 a.m. revealed side rails on both sides of Resident R20's bed. During an interview on 9/28/23, at 11:47 a.m. Licensed Practical Nurse (LPN) Employee E5 confirmed that bilateral (both sides) side rails were applied to Resident R13 and R20's beds. Review of the clinical record indicated Resident R69 was admitted to the facility on [DATE]. Review of Resident R69's MDS dated [DATE], indicated diagnoses of anemia (the blood doesn ' t have enough healthy red blood cells), diabetes, and obstructive uropathy (urinary tract disorder that occurs due to obstructed urinary flow). Review of Resident 69's MDS dated [DATE], Section G: Functional Status, Question G0110 indicated that Resident R69 required extensive assistance with resident involved in activity and staff to provide weight-bearing support of two to perform bed mobility. Review of a physician order dated 9/15/23, indicated to apply enabler bars to promote bed mobility. Review of Resident R69's clinical record revealed the most current In Bed Positioning/Side Rail Evaluation was completed on 2/2/22, and indicated bilateral bed rails were to be applied to allow the resident to contribute to bed mobility. An observation on 9/28/23, at 11:50 a.m. revealed side rails on both sides of Resident R69's bed. Interview on 9/28/23, at 11:55 a.m. Registered Nurse (RN) Employee E1 confirmed that bilateral 395266 Page 4 of 10 395266 09/28/2023 Beaver Valley Rehabilitation and Healthcare Center 257 Georgetown Road Beaver Falls, PA 15010

F 0700 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some (both sides) side rails were applied to Resident R4 and R69's beds and that the most recent In Bed/Positioning/Side Rail Evaluation was completed for R4 on 11/20/21 and Resident R69 on 2/2/22. During an interview on 9/28/23, at 12:36 p.m. the Director of Nursing (DON) confirmed the most recent In Bed Positioning/Side Rail Evaluation was completed for Resident R13 on 12/2/22, and for Resident R20 on 8/3/22 and that the facility failed to conduct ongoing accurate assessments to ensure that bedrails were used to meet residents' needs and the risks associated with bedrail usage. 28 Pa. Code: 201.14 (a) Responsibility of licensee. 28 Pa. Code: 211.12 (d) (1) Nursing services. 395266 Page 5 of 10 395266 09/28/2023 Beaver Valley Rehabilitation and Healthcare Center 257 Georgetown Road Beaver Falls, PA 15010

F 0730 Observe each nurse aide's job performance and give regular training. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy, personnel records and staff interview it was determined that the facility failed to complete annual performance evaluations for three out of five nurse aide personnel records (Nurse aides (NA) Employee E2, NA Employee E3, and NA Employee E4). Residents Affected - Some Findings include: The facility Performance evaluations policy last reviewed on 7/13/23, indicated that the job performance of each employee shall be reviewed and evaluated at least annually. Review of Nurse Aide (NA) Employee E2's personnel record indicated she was hired to the facility on [DATE]. Review of Nurse Aide (NA) Employee E3's personnel record indicated she was hired to the facility on [DATE]. Review of Nurse Aide (NA) Employee E4's personnel record indicated she was hired to the facility on 7/3/06. Review of personnel records did not include an annual performance evaluations based on the date of hire for Nurse Aide (NA) Employee E2, Nurse Aide (NA) Employee E3, and Nurse Aide (NA) Employee E4. During an interview on 9/27/23, at 1:12 p.m. the Nursing Home Administrator (NHA) confirmed that the facility failed to complete annual performance evaluations for Nurse aides (NA) Employee E2, Nurse aide (NA) Employee E3, and Nurse aide (NA) Employee E4 as required. 28 Pa Code: 201.20 (a)(b)(c)(d) Staff development. 395266 Page 6 of 10 395266 09/28/2023 Beaver Valley Rehabilitation and Healthcare Center 257 Georgetown Road Beaver Falls, PA 15010

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. Based on review of facility policy, observations and staff interview it was determined that the facility failed to date opened medications and properly store medications in one of three medication carts observed (North Hall second floor cart). Findings include: Review of facility policy Storage of Medications reviewed on 7/13/23, indicated resident medications are stored separately from each other to prevent the possibility of mixing medications between residents. Review of facility policy Medication Labeling and Storage reviewed on 7/13/23, indicated multi-dose vials that have been opened or accessed are dated and discarded within 28 days unless the manufacturer specifies a shorter or longer date for the open vial. Observation on 9/27/23, at 11:07 a.m. the second floor North Hall medication cart indicated the following medications stored in one compartment without individual packaging or separation from other residents medications: -Resident R73's Basaglar Pen (prefilled pen to inject long acting insulin under the skin) and vial of NovoLog (rapid acting insulin) not in a box or individual bag. -Resident R99's Lantus Pen (prefilled pen to inject long acting insulin under the skin) and Novolog Pen (prefilled pen to inject rapid-acting insulin under the skin) not in a box or individual bag. -Resident R93's Lantus pen and Basaglar pen not in a box or individual bag. -Resident R88's Levemir Pen (prefilled pen to inject long acting insulin under the skin) not in a box or individual bag. Continued observation indicated the following medications not dated upon opening: -Resident R53 Lantus pen, no date opened. -Resident R73 Albuterol (medication inhaled for better breathing) and Ellipta (inhaler for breathing) no date opened. -Resident R35 Albuterol no date opened. -Resident R46 Albuterol no date opened. -Resident R12 Ipratropium (broncho dilater to make breathing easier) and Latanoprost eye drops no date opened. Interview on 9/27/23, at 11:15 a.m. Licensed Practical Nurse (LPN) Employee E10 verified the findings noted above. 395266 Page 7 of 10 395266 09/28/2023 Beaver Valley Rehabilitation and Healthcare Center 257 Georgetown Road Beaver Falls, PA 15010

F 0761 Level of Harm - Minimal harm or potential for actual harm Interview on 9/27/23, at 12:06 p.m. the Director of Nursing confirmed that the facility failed to date opened insulin pens and properly store medications in one of three medication carts observed (North Hall second floor cart). 28 Pa. Code 211.9(a)(1) Pharmacy services. Residents Affected - Few 28 Pa. Code 211.12(d)(1)(5) Nursing services. 395266 Page 8 of 10 395266 09/28/2023 Beaver Valley Rehabilitation and Healthcare Center 257 Georgetown Road Beaver Falls, PA 15010

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 a review of policy, observation and staff interview, it was determined that the facility failed to properly maintain kitchen equipment in a sanitary condition creating the potential for cross contamination in the main kitchen of the facility (Main Kitchen). Findings include: A review of facility policy Sanitization dated 7/13/23, indicated that the food service area is maintained in a clean and sanitary manner. All equipment, food contact surfaces and utensils are cleaned and sanitized using heat or chemical sanitizing solution. During an observation conducted on 9/25/23, at 10:40 a.m., of the walk-in cooler in the designated main kitchen of the facility revealed that cold air condenser fan covers and the ceiling immediately forward of these cooler fans had a build-up of dust, grime, and debris. During an interview conducted on 9/25/23, at 10:41 a.m., Food Service Manager (FSM) Employee E11 confirmed that the walk-in cooler fan covers and the ceiling immediately forward of the cooler fans had a built-up of dust, grime, and debris as observed with surveyor. During an interview conducted on 9/25/23, at 10:42 a.m., Food Service Manager (FSM) Employee E11 confirmed that the facility failed to maintain clean and sanitary equipment creating the potential for cross contamination in the Main Kitchen. 28 Pa. Code: 201.14(a) Responsibility of licensee. 28 Pa. Code: 201.18(b)(1) Management. 395266 Page 9 of 10 395266 09/28/2023 Beaver Valley Rehabilitation and Healthcare Center 257 Georgetown Road Beaver Falls, PA 15010

F 0923 Have enough outside ventilation via a window or mechanical ventilation, or both. Level of Harm - Minimal harm or potential for actual harm Based on review of facility policy, a resident council group interview, observations and staff interview it was determined that the facility failed to maintain proper ventilation for two out of two Resident Central Shower Rooms (First and Second Floors). Residents Affected - Many Findings include: The facility Resident rights policy, last reviewed on 7/13/23, indicated that the residents have the right to a comfortable environment. The resident council group interview on 9/26/23, at 11:00 a.m. indicated two of the eleven residents present stated that they can't breathe easily in the shower rooms on the first and second floor due to the lack of ventilation and air circulation. Observations on 9/26/23, at 1:00 p.m. of the second floor shower room indicated three shower stalls with three separate vents at the ceiling level. The vents were not on. Observations on 9/28/23, at 11:00 a.m. of the first floor shower room indicated three shower stalls with three separate vents at the ceiling level. The vents were not on. Interview on 9/28/23, at 11:35 a.m. Nursing Assistant (NA) Employee E6 indicated the vents haven't worked since the construction several months ago and it's hard to breathe in the Central Shower room on second floor while assisting residents. Interview on 9/28/23, at 11:38 a.m. Housekeeping Employee E7 indicated the central shower rooms are stuffy and there is no air circulation when residents are showering or during cleaning of the room. Interview on 9/28/23, at 11:45 a.m. Licensed Practical Nurse (LPN) Employee E8 indicated the shower rooms are hot and the fans haven't worked in months. Observation and interview on 9/28/23, at 12:00 p.m. of the first floor shower room, the Regional Nurse Employee E9 indicated the three vents at ceiling level, they were not on and there was not a switch to turn them on. Interview on 9/28/23, at 12:10 p.m. the Nursing Home Administrator indicated that two of two shower rooms were without working fans. She indicated that the motors were removed for repair and have not yet been re-installed. They have not been working since the construction and that the facility failed to maintain proper ventilation for two out of two Resident Central Shower Rooms (First and Second Floors). 28 Pa. Code 207.2(a) Administrator's responsibility 28 Pa Code: 201.18 (e)(1)(2) Management 28 Pa Code: 201.29 (a )(c)(d) Resident Rights 28 Pa. Code: 201.14(a) Responsibility of Licensee 395266 Page 10 of 10