Health inspection·October 17, 2023

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. Based on review clinical records and resident and staff interviews it was determined that the facility failed to provide care in a manner and environment, which promotes each resident's quality of life by failing to respond timely to residents' request for assistance as evidenced by experiences reported by seven residents out of 15 interviewed (Residents 8, 21, 22, 23, 73, 74, and 102). Findings include: A review of resident clinical record and a facility provided BIMS (brief interview mental status - a tool that assesses cognitive status) report and random interviews conducted on October 17, 2023, with 15 alert and oriented residents, to include 8 residents residing on the 100 unit, and 7 residents residing on the 300 unit, revealed that 7 residents' interviews voiced concerns regarding staff's failure to respond to their requests for assistance and provide needed care and services in a timely manner. During interviews, the residents relayed that they feel the facility is not adequately staffed because they wait extended periods of time for staff to respond to their requests for assistance, including untimely responses to their requests via the nurse call bell system. Of those residents interviewed on October 17, 2023, 4 of 8 residents residing on the 100 unit, and 3 of 7 residents residing on the 300 unit, expressed similar concerns as described above. Interview with Resident 23 on October 17, 2023, at approximately 9:09 AM, revealed that he feels that short staffing is a problem in the facility because he waits up to 45 minutes to an hour for staff to answer his call bell. The resident stated that these waits occur mostly on 2nd shift (evening shift) of nursing duty, and that there have been times he has soiled himself while waiting for the call bell to be answered. Interview with Resident 22 on October 17, 2023, at approximately 9:14 AM, revealed he waits up to 45 minutes for staff to answer his call bell. The resident stated that these waits occur mostly on 2nd shift (evening shift) of nursing duty, and believes the facility could use more help. He further stated that there have been times he has soiled himself while waiting for the call bell to be answered. Interview with Resident 21 on October 17, 2023, at approximately 9:20 AM, revealed that the resident stated that she waits 30 minutes for staff to answer her call bell, and these waits occur on all shifts of nursing duty. Page 1 of 5 395286 395286 10/17/2023 Broad Mountain Health and Rehabilitation Center 500 West Laurel Street Frackville, PA 17931

F 0550 Level of Harm - Minimal harm or potential for actual harm Interview with Resident 8 on October 17, 2023, at approximately 10:08 AM, revealed that she waits 30 minutes for staff to answer her call bell. The resident stated that these waits occur mostly on 1st shift (dayshift), and 2nd shift (evening shift) of nursing duty. She further stated she feels that short staffing is a problem in the facility that creates these long waits for residents to receive personal assistance when requested. Residents Affected - Some Interview with Resident 73 on October 17, 2023, at approximately 10:10 AM, revealed that she waits 30 minutes or longer for staff to answer her call bell and that she has observed wait times exceeding one hour for her roommate's call bell to be answered. She also expressed concern that staff do not have time to answer call bells while passing out or picking up meal trays because they are short staffed. Interview with Resident 74 on October 17, 2023, at approximately 10:20 AM, revealed that she has waited two hours for staff to answer her call bell and has soiled herself while waiting. She reported this has happened on numerous occasions. She also reported that, since she needs a sit to stand mechanical lift for transfers, which required the assistance of two staff members, she had to wait to use the bathroom or get out of bed because two staff members were not available to assist at the time of her request for assistance. Interview with Resident 102 on October 17, 2023, at approximately 10:45 AM, revealed that the resident has soiled himself two days in a row because he needed to use the bathroom while staff were passing meal trays. He stated, when they're passing trays, you can't get any help-you could be hanging by your neck or falling out of bed, and you won't' get any help. He further stated that he frequently waits 45 minutes or longer for his call bell to be answered because they don't have enough staff. He continued to report that he has asked his roommate to push his wheelchair into the bathroom so he could toilet himself because he just could not wait any longer. According to the resident's clinical record, Res 102 requires extensive assist of two staff members to safely perform transfers. Interview on October 17, 2023, at approximately 3:15 PM with the Nursing Home Administrator (NHA) verified that it is her expectation that all residents be treated with dignity and respect. The NHA was unable to explain why multiple residents are reporting untimely staff response times, resulting in the residents' feelings that the facility is not adequately staffed, which was negatively affecting the residents' quality of life in the facility. 28 Pa. Code 201.29 (a) Resident Rights 28 Pa. Code 201.18 (e)(1) Management 395286 Page 2 of 5 395286 10/17/2023 Broad Mountain Health and Rehabilitation Center 500 West Laurel Street Frackville, PA 17931

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, resident and staff interviews, it was determined that the facility failed to provide housekeeping and maintenance services to maintain a clean and orderly environment on three of the three nursing units (Nursing Units 1, 2 and 3). Findings include: During an environmental tour of the facility on October 17, 2023, at approximately 2:35 PM, the front face panel of the heating unit located in resident room [ROOM NUMBER] was off the unit and on the floor, resting against the unit, exposing the inner workings, coils with surrounding aluminum fins and electrical wiring. Interview with Employee 1, Licensed Practical Nurse (LPN), on October 17, 2023, at approximately 2:40 PM, stated that the panel came off in the recent past, and is known to happen. Employee 1 stated that resident passes by the heating unit with her wheelchair and hits the unit and the face panel falls off. Staff then notifies maintenance staff to reapply the face panel to the unit. An observation on October 17, 2023, at 9:10 AM in resident room [ROOM NUMBER] revealed large yellow urine-like circular stains and multiple brown feces-like substance stains and residue on the white fitted sheets on the window-side bed. Multiple brown stains were observed on the bed pillow. Small and large flies were observed, flying about the resident's room and observed on the television, walls, and bed in resident room [ROOM NUMBER]. A brown fecal like substance was observed on the floor below the window in resident room [ROOM NUMBER]. The walls to the left of the resident's bathroom in resident room [ROOM NUMBER] revealed over 25 white unfinished plaster patches. The floor in resident room room [ROOM NUMBER] was observed was sticky and an audible sound heard when lifting feet from the floor. Brown stains were observed on privacy curtains surrounding the window-side bed in resident rooom 215. During an additional observation of resident room [ROOM NUMBER] on 12:25 PM on October 17, 2023, the conditions remained the same, with flying insects, fecal and urine-like stains on the linens and privacy curtains, and the floor remained sticky. An observation on October 17, 2023, at 8:50 AM revealed a strong smell of urine outside resident room [ROOM NUMBER] and near the Unit 2 Nursing Station. An additional observation on the same date at 12:10 PM revealed the strong smell of urine remained outside of resident room [ROOM NUMBER] and the Unit 2 Nursing Station. An observation on October 17, 2023, at 9:00 AM of the bathroom in resident room [ROOM NUMBER] 395286 Page 3 of 5 395286 10/17/2023 Broad Mountain Health and Rehabilitation Center 500 West Laurel Street Frackville, PA 17931

F 0584 revealed gray discolorations and rusted and bent panels on the heating unit. Level of Harm - Minimal harm or potential for actual harm An observation on October 17, 2023, at 9:30 AM of resident room [ROOM NUMBER] revealed dirt and debris on the floor near the door-side bed, gray stains on the wall of the door-side bed, and flies flying near the window. Residents Affected - Some An observation on October 17, 2023, at 9:40 AM of resident room [ROOM NUMBER] revealed heating unit in the resident bathroom was missing a face plate cover, exposing metal fins, and several white, unfinished plaster marks on the wall above the heating unit. An observation on October 17, 2023, at 9:45 AM of resident room [ROOM NUMBER] revealed the heating unit in the bathroom was missing a face plate cover, exposing the metal fins. An interview with the Nursing Home Administrator (NHA) on October 17, 2023, at approximately 3:10 PM confirmed the resident environment was to be maintained in a clean, safe, and orderly manner. Refer to F925 28 Pa. Code 201.18 (e)(2.1) Management 395286 Page 4 of 5 395286 10/17/2023 Broad Mountain Health and Rehabilitation Center 500 West Laurel Street Frackville, PA 17931

F 0925 Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, facility provided documents and staff interview, it was determined that the facility failed to maintain an effective pest control program. Residents Affected - Some Findings include: An observation on October 17, 2023, at 9:00 AM in resident room [ROOM NUMBER] revealed flying insects on the side wall of the resident bathroom and flying about the room. An observation on October 17, 2023, at 9:10 AM in resident room [ROOM NUMBER] revealed a cylindrical standing fly trap with several flies attached and free-flying insects flying around the trap. Flies were also observed on the window-side bed, on the resident privacy curtains, on the window-side wall, and on the resident's television. An observation on October 17, 2023, at 9:30 AM of resident room [ROOM NUMBER] revealed a white fly trap with flies adhered inside. Flies were observed on the windowsill and flying about the room. An observation on October 17, 2023, at 11:00 AM revealed flies in the Unit 1 hallway outside of the facility conference room. A review of monthly pest management service records dated for services provided from August 2022 through August 2023 recommended that the trees and vegetation touching the building be trimmed in order to prevent pest entry to the facility. An observation on October 17, 2023, at 11:50 AM of the facility exterior revealed a large conifer tree growing near the kitchen exterior exit doors. The tree branches had multiple points of contact with the building. A review of the pest management service records revealed that on September 18, 2023, miscellaneous fly activity was identified in the building's main common areas. The records indicated that 82 flies were removed from common areas and 167 flies were removed from the kitchen. During an interview on October 17, at approximately 2:30 PM, the Nursing Home Administrator failed to provide evidence that the facility promptly addressed the recommendations documented in the pest management services records and that its current pest control program failed to effectively manage the insect activity at the facility. 28 Pa. Code 201.18 (e)(2.1) Management 395286 Page 5 of 5