Health inspection·August 31, 2023

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 a review of clinical records, facility policy and procedures and interviews with residents and staff, it was determined that the facility failed to develop and implement comprehensive person-centered care plans related to a diagnosis of Post Traumatic Stress Disorder, and communication for two of 38 residents reviewed. (Resident R189, Resident 72 and Resident R76). Findings include: Review of facility policy Care Planning Process and Care Conference dated July 2017 and last revised July 3, 2023; revealed the care plan is a working tool that provides a profile of needs of the individual resident. Further review of this policy revealed that each care plan need must have a goal and interventions to address the need of the resident. A review of Resident R189's clinical record revealed that the resident was admitted to the facility on [DATE], with diagnoses including but not limited to dementia (decline in cognitive abilities) and cognitive communication deficit (difficulties with thinking and how someone uses language). Observations of the C- Wing Nursing Unit conducted on August 28, 2023, at 10:34 a.m. revealed Resident R189 was speaking Spanish to another resident across the hall. During an interview with Resident R189, resident did not understand the questions posed by the surveyor. Observations failed to reveal a communication board was available to communicate with Resident R189. A review of Resident R189's current Care Plan indicated resident has a communication problem related to language barrier. Review of interventions included, availability and functioning of adaptive communication equipment message board, hearing aids, telephone amplifier, computer, pocket talker and telephone translator. Interview conducted on August 31, 2023, at 12:00 p.m. with Licensed Nurse, Employee E30, assigned to Resident R189, revealed that she was not aware Resident R189 required translator assistance or adaptive equipment for communication. During an interview held with Resident R189 and Employee E30 shortly after revealed that Employee E30 did not understand the resident during the conversation. Another interview conducted at 12:10 p.m. with Nurse Aide, Employee E31, assigned to Resident R189, revealed that she was not aware Resident R189 required translator assistance or adaptive equipment. During an interview held with Resident R189 and Employee E31 shortly after revealed that Employee E31 did not understand the resident during the conversation. Page 1 of 13 395296 395296 08/31/2023 Meadowview Rehabilitation and Nursing Center 9209 Ridge Pike White Marsh, PA 19128

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview with the Unit Manager, Employee E32, at approximately 12:15 p.m. revealed she had never utilized a communication board or translator line when communicating with Resident E189. Employee E32 stated she does not have the translator number line and would have to contact social services for assistance. During this interview, Employee E33 confirmed Resident R189 was never provided with adaptive communication equipment message board, hearing aids, telephone amplifier, computer, pocket talker, and telephone translator. An interview with Social Services Director, Employee E33, on August 30, 2023, at 1:12 p.m. revealed she was not aware Resident R189 was not accommodated with adaptive communication equipment, I didn't know he didn't have it; I didn't look. Residents who do not speak English should have received a communication board. Review of Resident R 76's clinical record revealed that Resident R 76 was admitted to the facility with diagnoses that included post-traumatic stress disorder. (Also called PTSD, a disorder in which a person has difficulty recovering after experiencing or witnessing a terrifying event. This condition may last months or years, with triggers that can bring back memories of the trauma accompanied by intense emotional and physical reactions.) Review of Resident R76's care plan revised April 7, 2023, states Resident R76 has ineffective coping related to past traumatic events, post-traumatic stress disorder. Further review of Resident R76 care plan revealed the interventions are to provide him with outside support from outside services. Receiving counseling services from supportive care and psychiatry. Review of Resident R76 Psychosocial evaluation dated December 14, 2022, revealed the treatment plan for Resident R76 was supportive counseling and individual psychotherapy to reduce emotional symptoms. Review of resident's clinical record revealed that there are no counseling or psychiatry notes. There was no documentation in Residents R76 records that confirmed that Resident R76 was not receiving any counseling services per as indicated in the resident's care plan. Interview with Director of nursing on August 31, 2023, at 2:30 p.m. revealed that there was a nurse practitioner that was in the building four days a week to see all residents. Notes from this provider were requested. The Director of Nursing believed that the notes are available, they were just not scanned into the chart. Review of Resident R72's clinical record revealed the resident was admitted [DATE], with diagnoses that included post-traumatic stress disorder. (Also called PTSD, a disorder in which a person has difficulty recovering after experiencing or witnessing a terrifying event. This condition may last months or years, with triggers that can bring back memories of the trauma accompanied by intense emotional and physical reactions.) Review of Residents R72's care plan revealed no care plan was developed related to Resident R72's diagnosis of post-traumatic stress disorder. Interview with Social Services, Employee E33 on August 31, 2023 at 11:10 a.m. confirmed that the resident has a diagnosis or post-traumatic stress disorder and was not care planned for any interventions relating to this disorder. 395296 Page 2 of 13 395296 08/31/2023 Meadowview Rehabilitation and Nursing Center 9209 Ridge Pike White Marsh, PA 19128

F 0656 28 Pa. Code 211.10(d) Resident care policies Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code 211.11(d) Resident care plan 28 Pa. Code 211.12(d)(1) Nursing Services Residents Affected - Few 28 Pa. Code 211.12(d)(5) Nursing services 395296 Page 3 of 13 395296 08/31/2023 Meadowview Rehabilitation and Nursing Center 9209 Ridge Pike White Marsh, PA 19128

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, review of facility policies, clinical record review and interviews with staff, it was determined that the facility failed to ensure that oxygen therapy was administered per physician's orders for one of 38 residents reviewed (Residents R75). Residents Affected - Few Findings include: Review of facility policy, Oxygen Administration revised March 27, 2023, revealed that oxygen therapy will be administered according to physician orders. Review of Resident R75's clinical record indicated that Resident R7 was admitted to the facility on [DATE], with diagnoses of asthma (condition in which airways narrow and swell and may produce extra mucus) and Chronic Obstructive Pulmonary Disease (progressive breathlessness and cough). Review of physician orders revealed an order dated January 21, 2022, for Oxygen at 2L (liters)/min continuous. Observations conducted on August 28, 2023, at 10:51 a.m. revealed that Resident R75 was receiving an oxygen flow rate of 3.5 liters per minute. Resident R75 was observed coughing. Follow-up observations conducted on August 29, 2023, at 10:01 a.m. revealed that Resident R75 was receiving an oxygen flow rate of 3.5 liters per minute. Follow-up observations conducted on August 30, 2023, at 11:45 a.m. revealed that Resident R75 was receiving an oxygen flow rate of 3.5 liters per minute. Resident R75 was observed sitting in his chair, coughing. Interview with the Unit Manager, Employee E32, held on August 30, 2023 at 11:45 a.m. confirmed the above-mentioned findings. 28 Pa. Code 201.18(b)(1) Management 28 Pa. Code 211.12(d)(1) Nursing services 28 Pa. Code 211.12(d)(5) Nursing services 395296 Page 4 of 13 395296 08/31/2023 Meadowview Rehabilitation and Nursing Center 9209 Ridge Pike White Marsh, PA 19128

F 0740 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure each resident must receive and the facility must provide necessary behavioral health care and services. Based on review of facility policies, clinical record review and interviews with staff, it was determined that the facility failed to implement psychiatry recommendations for one of three residents reviewed (Resident R76). Findings include: Review of Facility's policy Care Planning Process and Care Conference dated July 2017 and last revised July 3, 2023; revealed that the care plan is a working tool that provides a profile of needs of the individual resident. All resident/patient care and interventions must be carried out per the care plan. Review of Resident R76's clinical record revealed that Resident R76 was admitted to the facility with a diagnosis of post-traumatic stress disorder. (a disorder in which a person has difficulty recovering after experiencing or witnessing a terrifying event. This condition may last months or years, with triggers that can bring back memories of the trauma accompanied by intense emotional and physical reactions.) Review of Resident R76's care plan revised April 7, 2023, stated Resident R76 has ineffective coping related to past traumatic events, post-traumatic stress disorder. Further review of Resident R76's care plan revealed the interventions are to provide him with outside support from outside services. Receiving counseling services from supportive care and psychiatry. Review of Resident R76's psychosocial evaluation dated December 14, 2022, revealed the treatment plan for Resident R76 was supportive counseling and individual psychotherapy to reduce emotional symptoms. Review of Resident R76' clinical record revealed that there are no documented evidence in the resident's clinical record of counseling or psychiatry notes available for review. 28 Pa. Code 211.11(d) Resident care plan 28 Pa. Code 211.12(d)(1) Nursing Services 395296 Page 5 of 13 395296 08/31/2023 Meadowview Rehabilitation and Nursing Center 9209 Ridge Pike White Marsh, PA 19128

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 observation, review of facility policy and procedure, and review of manufactures guidelines, it was determined the facility failed to ensure that all drugs and biologicals used in the facility were dispose and properly stored in a locked medication room and in accordance with professional standards on two of five nursing units. (Unit A and Unit B) Findings include: Review of facility policy titled Medication Storage created date July 2018 and last revised March 2021 revealed the medication supply is accessible only to nursing personnel, pharmacy personal, or staff member lawfully authorized to administer medications. only persons authorized to prepare and administer medications shall have access to the medication room, including keys. Further review of the facility policy of medication storage states that all compartments (including but not limited to drawers, cabinets, rooms, refrigerators, carts and boxes) containing drugs and biologicals shall be locked when not in use. The facility shall not use discontinued, outdated, or deteriorated drugs or biologicals. All such drugs shall be returned to the dispensing pharmacy or destroyed. Review of Facility policy titled Medication disposition discharge created August 10, 2021 revealed that the nurse will reconcile pre-discharge medications with the resident's post discharge medications. The medication reconciliation will be documented and if the medications are being returned to the pharmacy or destroyed at the facility, The Medication disposition form should include the name and dose of each medication and quantity, or amount being returned or destroyed. Observation on August 29, 2023 9:35 a.m. at nursing unit A nurse's station revealed that the medication room, located behind the nurses' station, was not securely locked. The door was unlocked and accessible to all. Interview with Licensed nurse, Employee E20 on August 29, 2023 at 9:35 a.m. confirmed that the door to the medication should be locked. Employee E20 states that it is only left open while she is sitting at the nurse's station. Observation on August 29, 2023 at 10:26 a.m. of nursing unit A revealed Employee E20 left the nurse station without locking the medication room door. Observation of nurses' station A on August 30,2023 revealed Licensed nurse, Employee E20 not on the unit and was on a different unit while the door to the medication room was unlocked. Observation of Unit B nurses' station on August 29, 2023 9:54 a.m. revealed that the medication room door was left unlocked and wide open. Observation of Nursing Unit B August 30, 2023 1:50 p.m. revealed a nurse entering the medication room without a key. Observation during tour of Unit B's medication room on August 29, 2023 at 9:55 a.m. revealed that 395296 Page 6 of 13 395296 08/31/2023 Meadowview Rehabilitation and Nursing Center 9209 Ridge Pike White Marsh, PA 19128

F 0761 Level of Harm - Minimal harm or potential for actual harm the medication refrigerator that contained facility's medication was left unlocked with direct access to all medications stored inside the refrigerator. Interview with Licensed nurse Employee E21 at the time of the observation confirmed that the door the medication refrigerator storage should be kept locked. Residents Affected - Few Observation of medication refrigerator, (which stored all refrigerated medications) was found to have an expired opening date on the vial of Tubersol (Tubersol also called tuberculin is a purified protein derivative to aid in diagnosis of tuberculosis). The date on the box revealed the medication was opened on April 2023, four months prior to the surveys date. Review of Manufacture Sanofi Pasteur's information and guidelines for Tuberculin (dated October 2021) states a vial of Tubersol which has been entered and in use for 30 days , should be discarded. Observation August 29, 2023 at 10:00 a.m. reveled a medication blister card (a card that packages doses of medication within a small clear plastic bubble. Each pack is secured by a strong paper backed foil that protects the pills until dispensed) stored in a cabinet behind covid tests and next to stored food (cereal, raisin bread and English muffins) The medication blister card contained a controlled medication, Tramadol (a pain medication used to treat moderate or severe pain) and prescribed for a resident that had been discharged in June 2023. Interview with Licensed nurse, Employee E21 confirmed that the medication blister card did not belong in the cabinet, and it is unknown why or how it was there. Licensed nurse, Employee E 21, witness by Licensed nurse Employee E 22, promptly destroyed all content of the medication card. Interview with Director of nursing on August 31, 2023, at 2:30 p.m. confirmed the facility policy and standards of professional practice were not followed and confirmed all findings on the medication room located on the nursing unit B. 28 Pa. Code b 201.18 (b)(1) Management 28 Pa. Code 211.9(a)(1) Pharmacy Services 28 Pa. Code 211.12 (c) Nursing Services 28 Pa. Code 211.12 (d)(1) Nursing Services 395296 Page 7 of 13 395296 08/31/2023 Meadowview Rehabilitation and Nursing Center 9209 Ridge Pike White Marsh, PA 19128

F 0810 Provide special eating equipment and utensils for residents who need them and appropriate assistance. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews and clinical record review, it was determined that the facility failed to provide a scoop dish and built-up utensils for one out of 38 residents reviewed. (Resident R213.) Residents Affected - Few Findings include: A review of Resident R213's clinical record revealed that the resident was admitted to the facility on [DATE], with a diagnosis including but not limited to cerebral vascular accident (stroke), with right sided weakness. A review of the five day MDS (Minimum Data Set- a periodic review of the residents' needs) dated July 27, 2023, revealed that the resident was moderately impaired in decision making skills. A review of physician orders dated August 7, 2023, revealed an order for a scoop dish (a dish with high sides) and built-up utensils (fork, spoon and knife with thicker handles for easier grip) for all meals. An observation of Resident R213 on the following dates and times revealed no scoop dish or built-up utensil available for the resident: August 28, 2023, at 9:00 a.m. and 11:50 a.m. August 29, 2023, 11:45 a.m. August 30, 2023, at 11:50 a.m. Interview conducted with Resident R213's family member on August 30, 2023, at 9:50 a.m. confirmed that the resident never had a scoop dish or built-up utensil on any of his meal trays. An observation of the residents' meal ticket on August 28, 2023, at 12: 15 p.m. revealed no scoop dish or built-up utensils listed on the residents' meal ticket. An interview with Registered Dietician, Employee E17, on August 30, 2023, at 2:00 p.m. confirmed that there was no scoop dish or built-up utensils listed on the residents' meal ticket. 28 Pa. Code 211.10 (d) Resident care policies 28 Pa. Code 211.12 (d)(1)(5) Nursing services 395296 Page 8 of 13 395296 08/31/2023 Meadowview Rehabilitation and Nursing Center 9209 Ridge Pike White Marsh, PA 19128

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 observations of the operation and services of the Food and Nutrition Department, review of temperature logs, interviews with staff and residents and review of facility policy, it was determined that the facility failed to provide foods that were palatable, attractive, and at safe and appetizing temperatures on the main dining room(Second Floor). The failed to ensure that dishes were cleaned under sanitary conditions in accordance with professional standards for food service safety. Findings include: Review of the undated facility policy titled, Important Temperatures for Food Safety revealed, the process of cooking is to raise the temperature of food to kill bacteria and other types of harmful pathogens/microorganisms/bacteria to a level where food is safe to eat. If the temperature of a food does not reach the temperature needed to kill the pathogens, person consuming the food may become ill from foodborne illness. Further review indicated that foods that are ground, chopped or minced must reach a temperature 155 degrees Fahrenheit for 15 seconds. Review of facility policy titled, Dishwashing Policy, revised July 2020, indicated that the Low Temperature dish machine must use a chlorine test strip after each use using 50 parts per million solutions. Review of facility policy titled, Pot Washing Policy indicated that the third sink solution must be tested with the test strip. Lunch observations in the main dining room conducted on August 28, 20234 at 12:20 p.m. revealed Resident R38 was eating a burger patty, pink in color. Resident R38 requested another burger to be cooked well done. Further observations revealed Resident R38 was eating a bright pink burger patty. Observations at the steam table revealed two out of five burgers were bright pink; all patties varied in size. Review of the cooking temperature log titled, Temperature Log and Checklist, failed to reveal documented temperatures of the ground beef patties. Further interview with the Cook, Employee E36 confirmed that the patties should not have been pink and stated he forgot to temp some burger patties which resulted in the burger patties to be undercooked. Interview with the Food Service Manager, Employee E34; [NAME] Supervisor, Employee E35; and the Cook, Employee E36 conducted at approximately 12:40 p.m. confirmed the above-mentioned findings. A tour of the Food Service Department conducted on August 28, 2023, at 9:01 a.m. with Employee E34, Food Service Manager, revealed the following concerns: Observations in the dish room revealed staff were utilizing the low temperature dish machine to wash dishes. Subsequent testing of the dish machine chlorine solution revealed inadequate levels of 395296 Page 9 of 13 395296 08/31/2023 Meadowview Rehabilitation and Nursing Center 9209 Ridge Pike White Marsh, PA 19128

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many chlorine solution. When the dish machine solution was tested, the test strip had not changed color, indicating that the chlorine solution was at zero parts per million. Observations of the 3-compartment sink revealed a dietary employee had just finished utilizing the sink to wash, rinse, and sanitize large pots. Subsequent testing of the sanitizing solution revealed that the sanitizing sink did not have adequate levels of sanitizing solution. When the sanitizing compartment was tested with the sanitizing strips, the solution was 500 ppm (parts per million). Interview with the Food Service Manager, Employee E34, on August 28, 2023 at 12:40 p.m. confirmed that the chemical solution in the third sink should be between 150 and 400 ppm. Review of the facility contracted dietary department company's report, dated August 28, 2023, revealed that the dish machine chemical pump and the 3-compartment sink metering tip needed to be replaced. Observations were confirmed by Employee E34, Food Service Manager, along the duration of the tour of the dietary department. 28 Pa. Code 201.18(b)(1) Management 28 Pa. Code 211.6 (f) Dietary Services 395296 Page 10 of 13 395296 08/31/2023 Meadowview Rehabilitation and Nursing Center 9209 Ridge Pike White Marsh, PA 19128

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Based on observations, review of facility policy, interviews with staff, and review of clinical records it was determined the facility failed to ensure complete and accurate documentation were maintained related to resident refusal and weights were for two of 35 residents reviewed. (Residents R152 and R13) Findings include: Review of facility policy title Refusal of Care states it is a policy of this facility to recognize and honor the resident's right to refuse medications, care, treatments and services. The procedure states, The nurse will monitor for recurring refusals of medication, treatments, care and services. The nurse will notify the appropriate interdisciplinary team members (IDT), the physician and family/responsible party of refusal trends. The IDT team will meet with resident/family/responsible party to ascertain the reasons why they are refusing care and services. a. Review the benefits, consequences (risks), and alternative methods of care and services with the resident or family. b. Review and offer alternative interventions as appropriate. 4. Notify physician and family/responsible part of resident wishes. 5. Document in the medical record and include in the individualized plan of care. Observation on August 28, 2023 at 10:09 a.m. revealed that Resident R152 was seen in the day room without her sling on her arm. Review of the clinical record it was revealed a staff member had completed charting for resident R152 that the resident sling was put on for the shift. Observation on August 29, 2023 at 12:02 p.m. of Resident R152 was seen in the day room without her sling on her arm. Review of the clinical record it was revealed a staff member had completed charting for Resident R152 that the resident sling was put on for the shift. Interview with Unit Manager, Employee E13 on August 29, 2023 at 1:42 p.m. revealed the resident refuses the sling daily. Employee E13 stated that the staff will attempt to put the sling on Resident R152 but Resident R152 will refuse or will take it off within five minutes. Unit manager, Employee E13 confirmed staff has been documenting that she is wearing it although she mostly refuses. Further review of Resident R152's clinical record it was noted that the resident refusals were not being documented in the resident's clinical record. Review of Resident R13's clinical record revealed a physicial order obtained on July 5, 2023 for weekly weights. Review of Resident R13's weight record revealed weights were not obtained or recorded for August 9, 2023 or August 16, 2023. Interview with Unit Manager, Employee E13 on August 29, 2023 at 1:42 p.m. revealed she was unaware that weights were not obtained for Resident R13. Employee E13 stated a weight was not obtained on August 16, 2023 due to Resident R13 having a medical appointment this day. A weight was not obtained upon the resident returning from the appointment. 395296 Page 11 of 13 395296 08/31/2023 Meadowview Rehabilitation and Nursing Center 9209 Ridge Pike White Marsh, PA 19128

F 0842 Review of the clinical record revealed no documented evidence stating why weights were not obtained for resident R13 on August 9, 2023 and August 16, 2023. Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code 211.5 (f) Clinical records Residents Affected - Few 28 Pa .Code 211.12(d) (5) Nursing services 395296 Page 12 of 13 395296 08/31/2023 Meadowview Rehabilitation and Nursing Center 9209 Ridge Pike White Marsh, PA 19128

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, staff interviews and a review of pest control logs, it was determined that the facility did not maintain a effective pest control log on three of five nursing units. (B wing, D wing, E wing) Residents Affected - Few Findings include: Observation on B wing, room [ROOM NUMBER]b on August 28, 2023, at 11:30 a.m. revealed a fly on the residents' bed, room [ROOM NUMBER]a, at 11:00 a.m. revealed a fly on the residents' bed, Observation on D wing on August 28, 2023, at 12:16 p.m. a fly was observed in the dinning room. Observation on E wing on August 28, 2023, at 9:30 a.m. revealed a fly and gnats in the panty room. An observation on August 30, 2023, at 11:50 a.m. a fly was observed near the food truck near the nurse's station. room [ROOM NUMBER]b gnats were observed in the residents room on August 30, 2023, 10:00 a.m. The resident was observed in bed. A review of pest control logs for A wing on August 31, 2023, revealed that on July 31, 2023, a mouse was sighted in room [ROOM NUMBER]. A review of pest control logs for unit B on August 31, 2023, revealed, fly's and gnats sighted on August 2, 2023, and August 28, 2023. A review of pest control logs for C wing on August 31, 2023, revealed fly's, roaches and fruit fly's were sighted on July 18, July 20, July 25 and July 28, 2023 and on August 2, and August 28, 2023. An interview with Employee E18, the Director of Housekeeping on August 30, 2023, at 12:30 p.m. revealed he is aware that there is a fly problem but the pest control company treats the problem areas, but pest still get in. 28 PA Code 207.2 (a) Administrator's responsibility 395296 Page 13 of 13