Health inspection·April 11, 2025

F 0622 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Not transfer or discharge a resident without an adequate reason; and must provide documentation and convey specific information when a resident is transferred or discharged. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on the review of closed clinical records, facility policies and interview with staff, it was determined that the facility failed to ensure that an appropriate discharge was documented in the resident's clinical record for one of four closed records reviewed. (Resident R523) Findings Include: Review of Resident R523's Minimum Data Set (MDS - federally mandated resident assessment and care screening) assessment dated [DATE] revealed that the resident was discharged from the facility and the resident was not anticipated to return to the facility. It was revealed that the discharge was unplanned and the resident was discharged to the hospital. Review of clinical record for Resident R523 on April 8, 2025 revealed that there was no documentation available in the clinical record to indicate a reason for residents discharge. Review of a discharge summary completed by the nurse practitioner dated March 3, 2025 but signed as completed on April 9, 2025 revealed that resident was not seen within the 72 hours from admission, because the resident was admitted during the weekend. The resident was transferred back to the hospital before the resident was able to be assessed. Interview with the admission Director, Employee E8, on April 8, 2025 at 2:00 p.m. stated resident was admitted to the facility on [DATE] after business hours. Employee E8 stated resident was discharged to the hospital because he did not have proper insurance paperwork and insurance. Interview with the Nursing Home Administrator, on April 8, 2025 at 2:30 p.m. confirmed that the resident's transfer to the hospital was not due to imminent safety risk of the resident or medical concern. Nursing Home Administrator confirmed that the physician oversees resident's care and a physician order or notification was required prior to the transfer to the hospital. Review of clinical record for Resident R523 on April 8, 2025 revealed that there was no physician order for hospital transfer. There was no evidence in the clinical record that the physician was aware or the transfer or notified of the transfer. 28 Pa. Code 201.29(f) Resident rights 28 Pa. Code 210.25 Discharge policy Page 1 of 15 395296 395296 04/11/2025 Meadowview Rehabilitation and Nursing Center 9209 Ridge Pike White Marsh, PA 19128

F 0622 28 Pa. Code 211.5(a)(c)(3) Medical records. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 395296 Page 2 of 15 395296 04/11/2025 Meadowview Rehabilitation and Nursing Center 9209 Ridge Pike White Marsh, PA 19128

F 0623 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility documentation, review of clinical records, and interviews with staff, it was determined that the facility failed to notify the Office of the State Long-Term Care Ombudsman of facility-initiated transfers to the hospital and that a resident's representative was made aware of a facility-initiated transfer in writing, for one of four clinical records reviewed. (Residents R136) Findings Include: Review of Minimum Data Set (MDS - federally mandated resident assessment and care screening) assessment dated [DATE] revealed that the resident was discharged from the facility and the resident was not anticipated to return to the facility. It was revealed that the discharge was unplanned and he was discharged to the hospital. Review of clinical record for Resident R523 on April 8, 2025 revealed that there was no documentation available in the resident's clinical record to indicate a reason for residents discharge. Review of a discharge summary completed by the nurse practitioner dated March 3, 2025 but was signed until April 9, 2025 revealed that resident was not seen within the 72 hours from admission, because he was admitted during the weekend. The resident as transfer back to the hospital. Further interview with the Administrator on April 8, 2025 at 2:30 p.m. confirmed that the facility failed to notify the resident/resident's representative of the transfer and reasons for the move in writing and in a language and manner they understand. 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 201.18(b)(2) Management 395296 Page 3 of 15 395296 04/11/2025 Meadowview Rehabilitation and Nursing Center 9209 Ridge Pike White Marsh, PA 19128

F 0645 PASARR screening for Mental disorders or Intellectual Disabilities Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review, review of facility policies and staff interview, it was determined that the PASRR (Preadmission Screening and Resident Review) was not appropriately completed according to the resident assessment for one of five residents reviewed (Residents R184). Residents Affected - Few Findings include: The PASRR (Preadmission Screening Resident Review) was created in 1987 through language in the Omnibus Budget Reconciliation Act (OBRA) and it has three goals: to identify individuals with mental illness and/or intellectual disability, to ensure they are placed appropriately, whether in the community or in a nursing facility, and to ensure they receive the services they require for their mental illness or intellectual disability. The PASRR Level 1 must be completed on all persons who are considering admission to a Medicaid certified nursing facility. A Level II PASRR evaluation must be completed if the Level 1 PASRR determined that the person is a targeted person with mental illness or an intellectual disability. The Level II PASRR would determine if placement or continued stay in the requested or current nursing facility is appropriate. Review of facility policy, Social Service Assessment - PASRR dated revised June 28, 2024, revealed, The PASRR Level I form is completed by the hospital, the facility, or the Area Agency on Aging (AAA) office no later than the day of admission. Family members may assist in this process. The PASRR Level I form is to be used as a worksheet. You are to make any additions or corrective changes directly on the PASRR Level I form itself. Date and initial/ sign to indicate that a change has been made to the form. Nursing Facilities are responsible to make sure the form is filled out correctly at the time of admission. Review of Resident R184's Significant Change MDS (Minimum Data Set - a mandatory periodic resident assessment tool), dated January 6, 2025, revealed that the resident was admitted to the facility on [DATE], and has diagnoses including schizophrenia (mental illness associated with loss of reality contact, delusions and hallucinations), dementia (decline in memory or other thinking skills severe enough to reduce a person's ability to perform everyday activities), depression (mood disorder characterized by low mood, a feeling of sadness, and a general loss of interest in things) and anxiety disorder (intense, excessive, persistent worry or fear). Review of psychiatric notes for Resident R184 revealed a progress note, dated March 28, 2025, which indicated that the resident requires antipsychotic medication for the ongoing management of schizophrenia. Review of Resident R184's PASRR Level I revealed that the facility completed it on November 2, 2023, and indicated that Resident R184 did not have a neurocognitive disorder (such as dementia) and that the resident did not have a serious mental illness diagnosis (such as schizophrenia, depression and anxiety). Interview on April 10, 2025, at 9:43 a.m. Employee E6, social worker, confirmed that Resident R184's PASRR assessment did not include the mental health diagnoses that were noted in the resident's clinical record. 395296 Page 4 of 15 395296 04/11/2025 Meadowview Rehabilitation and Nursing Center 9209 Ridge Pike White Marsh, PA 19128

F 0645 28 Pa Code 201.14(a) Responsibility of licensee Level of Harm - Minimal harm or potential for actual harm 28 Pa Code 211.10(c) Resident care policies Residents Affected - Few 395296 Page 5 of 15 395296 04/11/2025 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 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 clinical record review and review of facility documentation, it was determined that the facility failed to developed a comprehensive care plan with measurable objectives for a resident who exhibited aggressive behaviors towards other residents for one of 35 clinical records reviewed. (Resident R325) Findings include: Review of Resident R325's clinical record revealed that the resident was admitted to the facility on [DATE] with the diagnosis of history of transient ischemic attack (mini stokes), cerebral infraction, depression (major loss of interest in pleasurable activites), schizophrenia (mental disease characterized by loss of reality), and bipolar disorder (condition in which a person has periods of depression and periods of being extremely happy). Review of Resident R325's admission Minimum Data Set (MDS- assessment of resident needs) dated February 12, 2025 revealed that the resident had a BIMS (Brief Interview of Mental Status) score 11, which indicated moderate impairment. The resident was assessed with no upper and lower physical impairments. Review of Resident R72 's quarterly MDS dated [DATE] revealed that the resident was assessed with a BIMS of 14 which indicated that the resident was cognitive intact. Continue review of the MDS revealed that the resident had no upper or lower physical impairments. Resident R72's diagnosis included anxiety and cerebral vascular accident (stroke). Review of R325's nursing note dated March 20, 2025 at 2:36 p.m. revealed that the resident was observed with behaviors in supervised lounge area on unit. As another resident was walking by with walker, this resident stood up out of wheelchair, yelled out words in Spanish, staff went to altercation to intervene by the time staff approached residents, this resident then slapped resident that was walking by and then resident punched this resident in L (left) eye. Residents were immediately separated, full body assesment completed. Redness to L (left) eye noted, resident c/o (complain) pain, PRN (as needed) Tylenol administered Review of staff statement obtained from nurse aide, Employee E15 revealed both residents were in the TV Room where they stated arguing, that's when [Resident R325] hit [Resident R72] and [Resident R72] responded back hitting [Resident R325]. Review of Resident R46 March 2025 physician orders revealed the resident was admitted to the facility on [DATE] with the diagnoses of morbidly obesity, difficulty walking, connective communication deficit, Type 2 diabetes (failure of the body to produce insulin), anxiety, depression and post traumatic stress disorder (a mental condition that's caused by an extremely stressful or terrifying event). Review of Resident R46's incident documentation dated March 26, 2025 noted nursing observed resident getting struck in the face unprovoked by another resident. Staff immediately intervene and separated resident, supervisor was made aware, full body assessment completed, bruising to R (right) eye noted, c/o (complain) pain .Resident stated that the other resident was in his way while trying to go out for smoke break and when asked to move, stood over hitting 3-4 times in face. 395296 Page 6 of 15 395296 04/11/2025 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 Review of staff statements revealed an statement from nurse aide, Employee E14 noted that Resident R325 and Resident R46 exchanged words and Resident R325 stood up and hit Resident T46 multiple times myself and other employee broke it up and he got wheeled away then he stood up and tried to fight an employee and nurses came and got the situation under control. Review of Resident R325's care plan revealed that a care plan was developed on March 21, 2025 I am potential to be physically aggressive r/t (related to) history of harm to others. The only two approaches listed to address the resident physical aggressiveness towards residents were I will be monitored by nursing staff throughout the day and I will be redirected to ensure I am not in the lounge area at same time as the other resident whom I had an altercation with. The facility failed to developed a comprehensive care plan with measurable objectives to address Resident 325's aggressive behavior towards other residents. 28 Pa. Code 211.10(d) Resident care policies 28 Pa. Code 211.12(d)(5) Nursing services 395296 Page 7 of 15 395296 04/11/2025 Meadowview Rehabilitation and Nursing Center 9209 Ridge Pike White Marsh, PA 19128

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policies, clinical record reviews and interviews with staff, it was determined that the facility failed to revise a resident's care plans, related to accuracy of information, for one of 35 residents reviewed (Resident R184). Findings include: Review of facility policy, Care Planning Process and Care Conference dated revised March 19, 2025, revealed, Care plan development, renewal and revision will be based upon the results of the resident assessment. Review of Resident R184's care plan, dated April 3, 2024, revealed that the resident had an indwelling suprapubic catheter (a tube that has been surgically inserted into the bladder to drain urine). Review of Resident R184's Significant Change MDS (Minimum Data Set - a mandatory periodic resident assessment tool), dated January 6, 2025, revealed that the resident was admitted to the facility on [DATE]. Continued review revealed that the resident did not have a urinary catheter. Continued review of Resident R184's care plan, dated April 3, 2024, revealed that the resident takes anticoagulant (blood thinning) medication secondary to atrial fibrillation (an irregular, often rapid heart rate that commonly causes poor blood flow). Continued review of Resident R184's Significant Change MDS, dated [DATE], revealed that the resident did not have a diagnosis of atrial fibrillation and did not take an anticoagulant medication. Further review of Resident R184's care plan, dated June 24, 2024, revealed that the resident was dependent on staff for activity participation and had diagnoses including post-traumatic stress disorder (a mental health condition that develops following a traumatic event characterized by intrusive thoughts about the incident, recurrent distress/anxiety, flashback and avoidance of similar situations) and head injury. Further review of Resident R184's Significant Change MDS, dated [DATE], revealed that the resident did not have diagnoses of post-traumatic stress disorder or head injury. Interview on April 10, 2025, at 10:20 a.m. Employee E5, licensed nurse, confirmed the above findings and stated that Resident R184's care plan needed to be revised. 28 Pa Code 211.10(a) Resident care policies 395296 Page 8 of 15 395296 04/11/2025 Meadowview Rehabilitation and Nursing Center 9209 Ridge Pike White Marsh, PA 19128

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm Based on the review of clinical records, interviews with staff, it was determined that the facility failed to administer medication as ordered by the physician for one of 35 residents reviewed. (Resident R175). Residents Affected - Few Findings Include: Review of Resident R175's nursing notes dated March 7, 2025 revealed that unit manager spoke to resident regarding his low hemoglobin, in the past was on Epoetin alfa injection which the resident was refusing. Per resident, he would take the shot if it prevented him from going to emergency for transfusions. Physician was aware and had new order to place injection. Review of physician order for Resident R175 dated March 9, 2025 revealed an order for Epoetin Alfa-epbx Injection Solution 10000 UNIT/ML, inject 1ML subcutaneously one time a day every Tuesday Thursday and Sunday for anemia. Review of medication administration record for Resident R175 revealed that the resident did not receive the medication on March 16, 2025 and March 23, 2025. Review of practitioner progress note dated March 20, 2025 revealed that the resident was seen for discussion of lab results, and chronic disease condition. Hemoglobin trending down 7.2 on March 20, 2025. Patient agreed to Epoetin Alfa-epbx after multiple discussion with patient and nursing. Interview with Employee E9, unit manager on April 10 2025 at 12:07 p.m. confirmed that the resident missed two doses on March 16, 2025 and March 23, 2025. Employee E9 stated there was there were no documented reason for not administering the medication for these days. 28 Pa. Code 211.12(d)(1)(5) Nursing services. 395296 Page 9 of 15 395296 04/11/2025 Meadowview Rehabilitation and Nursing Center 9209 Ridge Pike White Marsh, PA 19128

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 clinical record review, a review of facility policies and resident and staff interviews, it was determined that the facility failed to make certain the highest practicable level of pain management was maintained for two of 35 residents reviewed (Resident R9 and R132). Residents Affected - Few Findings include: Review of facility policy Administering Medications revealed that Medications must be administered within one (1) hour of their prescribed time, unless otherwise specified (for example, before and after meal orders). Review of Resident R9's clinical record revealed the resident was admitted to the facility on [DATE], with diagnosis to include but not limited to chronic ulcer to the left ankle with fat layer exposed. Continued review of medical records for Resident R9 including the quarterly assessment MDS (an assessment of care needs) dated March 9, 2025, revealed a Brief Interview for Mental Status evaluation which revealed that resident had a BIMS score of 15 indicating he was cognitively intact. Interview with Resident R9 on April 7, 2025, at 11:30 a.m., revealed that the resident was rocking in pain holding his left leg and pull the bandage on the wound on his left ankle exposing an open woud that was red. He said that he is always in pain and counts on his pain medication. He said that a few weeks back they ran out of his 10 mg scheduled pain medication and he does not know how they can let this happen, that he counts on this every day and when he did not get it he really suffered only getting 5 mg pain meds for breakthrough pain. He said that this had happened on several occasions and he does not know how this could happen, that when they get down to the last 10 pills they should place the order for more. A review of Resident R9's physician orders revealed a December 28, 2024, physician's order for Oxycodone HCl 10 MG tablet, give 1 tablet by mouth every six hours for severe wound pain. A review of Resident R9's electronic medication administration record (EMAR) for March 8, 2025, revealed a 9 code, which means see nurses note, on the midnight dose, on the midnight, noon and 5 p.m. doses. Further review of the EMAR for March 9, 2025, revealed a 9 code on the midnight dose. A review of the following nurse's notes for Resident R9 revealed the following: March 8, 2025, at 1:16 a.m. for Oxycodone 10 mg was awaiting delivery from the pharmacy. March 8, 2025, at 2:25 p.m. Resident R9 approached the nursing station asking if his Oxycodone 10 mg arrived from the pharmacy. The nurse checked the narc drawer and let the resident know it had not arrived. The resident was advised that the script was faxed over to the pharmacy and that the medication should be here tonight. A review nursing notes of the March 9, 2025, at 4:29 a.m. for oxycodone 10 mg was awaiting pharmacy delivery. Interview on April 10, 2025, at 11:15 a.m. with the Director of Nursing, Employee E2, who physically checked the narc book on the unit and confirmed that the Oxycodone 10 mg medication for Resident R9 was not delivered until 5:00 a.m. on March 9, 2025. And that Resident R9 missed these four doses of the Oxycodone 10 mg. 395296 Page 10 of 15 395296 04/11/2025 Meadowview Rehabilitation and Nursing Center 9209 Ridge Pike White Marsh, PA 19128

F 0697 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of Resident R132's clinical record revealed the resident was admitted to the facility on [DATE], with diagnosis to include but not limited to intervertebral disc degeneration of the lumbar region (a common condition characterized by the breakdown (degeneration) of one or more of the discs that separate the bones of the spine (vertebrae), causing pain in the back or neck and frequently in the legs and arms). Continued review of medical records for Resident R132 including the quarterly assessment MDS dated [DATE], revealed a Brief Interview for Mental Status evaluation which revealed that resident had a BIMS score of 14 indicating she was cognitively intact. Interview with Resident R132 on April 7, 2025, at 12:05 p.m., during resident screening revealed that she was in pain from her bad back and her hip, and that she was still waiting for her pain medication which had run out the other day. A review of Resident R132's physician orders revealed an April 2, 2025, physician's order for Oxycodone HCl 10 MG tablet, give 1 tablet by mouth every eight hours for pain. A review of Resident R132's EMAR for Oxycodone 10 milligrams revealed a code of 9 on the following dates: April 3, 2025, at 2:00 p.m., April 4, 2025 at 10:00 p.m., April 5, 2025 at 2:00 p.m., and 10 p.m. dose, April 6, 2025, at on the 6:00 a.m., and 10 p.m.; April 7, 2027 at 6:00 a.m., 2:00 p.m. and 10:00 p.m. and on April 7, 2025, at 6:00 a.m. A review of the following nurse's notes for Resident 132 revealed the following under Oxycodone 10 mg: April 3, 2025, at 2:46 p.m. waiting for MD to fax new prescription to pharmacy, MD is aware; April 3, 2025, at 9:34 p.m. awaiting pharmacy, April 4, 2024, at 1:56 p.m. awaiting a new script; April 4, 2025, at 9:36 p.m. awaiting pharmacy; April 5, 2025, at 5:34 a.m. awaiting pharmacy; April 5, 2025, at 8:45 p.m. awaiting order from pharmacy; April 6, 2025, at 7:06 a.m. awaiting order from pharmacy; April 6, 2025, at 2:16 p.m. awaiting arrival; April 6, 2025, at 9:43 p.m. on order from pharmacy; and April 7, 2025, at 6:15 a.m. awaiting order from pharmacy. Interview on April 10, 2025, at 11:15 a.m. with the Director of Nursing, Employee E2, who physically checked the narc book on the unit and confirmed that the Oxycodone 10 mg medication for Resident 132 was not delivered until 10:00 a.m. on April 7, 2025. and that Resident R132 missed these ten doses of the Oxycodone 10 mg. 28 Pa Code:201.14(a) Responsibility of licensee. 28 Pa. Code: 211.10(c)(d) Resident care policies. 28 Pa. Code: 211.12(d)(1)(2)(3)(5) Nursing services 395296 Page 11 of 15 395296 04/11/2025 Meadowview Rehabilitation and Nursing Center 9209 Ridge Pike White Marsh, PA 19128

F 0804 Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. Level of Harm - Minimal harm or potential for actual harm Based on observations, resident and staff interviews, and a review of facility documentation, it was determined that the facility failed to provide food and drink that was palatable and served at palatable temperatures for eight of 35 residents reviewed (Residents R169, R91, R178, R25, R131C, R45, R199 and R110). Residents Affected - Some Findings include: A review of the Food and Nutrition Services Test Tray and Accuracy Evaluation form Revised November 19, 2019, revealed that the standard for cold food is 45 degrees or less and for hot food 135 degrees or more. Interview with Resident R169 on April 7, 2025, at 10:35 a.m. revealed that he thinks that the food sucks, that it is not always hot, you should try it. Interview with Resident R91 on April 7, 2025, at 10:41 a.m. revealed that he does not like the food, that it is too soft and mushy. Interview with Resident R178 on April 7, 2025, at 10:50 a.m. revealed the meals are bad, the food is never right, doesn't taste right, it's the kitchen not the nursing staff. Interview with Resident R131 on April 7, 2025, at 11:05 a.m. revealed that the food here tastes like garbage. Interview with Resident R25 on April 7, 2025, at 11:09 a.m. revealed that they serve crappy food, it's all the same for everyone, how can that be good for you. Interview on April 7, 2025, at 11:53 a.m. Resident R45 stated that the food was not tasteful and often served cold. Interview on April 7, 2025, at 11:55 a.m. Resident R199 stated that the food was often served cold. Interview on April 7, 2025, at 1:34 p.m. Residents R110 and R106 stated that the food does not taste good and that it is often served cold. Observations during a test tray conducted on April 8, 2025, revealed that the tray cart left the kitchen at 12:08 p.m. and the last tray was passed at 12:28 p.m. Temperatures were taken by the Food Service Director (FSD), Employee E3, revealed that the turkey was only 109 degrees, the sweet potato was only 103.5 degrees, the corn was only 116 degrees, the mixed fruit cup was 61 degrees and the skim milk was 53.5 degrees all outside the acceptable temperature range for palatability. An interview with the FSD, on April 8, 2025, at 12:35 p.m. confirmed that these food items were outside the acceptable temperature range and therefore not palatable. 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 201.18(b)(3) Management 395296 Page 12 of 15 395296 04/11/2025 Meadowview Rehabilitation and Nursing Center 9209 Ridge Pike White Marsh, PA 19128

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 observations,staff interviews and review of facility documentation, it was determined that the facility failed to ensure that the recommended therapeutic diet that she made, was provided to a resident for 1 out of 35 residents reviewed (Resident R210). Findings include Review of the facility policy, Therapeutic diets, with a revision date of January 7, 2025. The policy stated that therapeutic diets are prepared and served according to written orderS from the attending physician. Review of the April 2025 physician orders for Resident R210 indicated that the resident was admitted into the facility on December 19, 2024 from a local hospital with diagnosis that included the following: cerebral infarction (a stroke), hypertension (high blood pressure); aphasia (a disorder that affects how you communicate usually after a stroke or head injury) an dysphagia (difficulty swallowing). Continued review of the physician orders for the resident included a physician's order dated December 19, 2024 and monthly thereafter for the resident to have a mechanical soft texture diet with nectar consistency beverages. Mechanical Soft texture, Nectar consistency. During an observation on April 9, 2025 at 12:22 p.m. Nurse aide (Employee E12) was observed serving the resident his lunch tray. The resident was then eating ground pork, chopped broccoli, one MightyShake that was a thin liquid and not nectar thick, and a cup of milk that was in the form of a thin liquid. Review of the resident's meal ticket dated April 9, 2025 indicated Regular-Mechanical Soft Nectar Thickened. Nurse aide (Employee E13) came over to the table, removed the items and reported that she would obtain the correct beverage consistencies for the resident. Review of the resident's discharge assessment from the speech language pathologist (Employee E11) completed on January 10, 2025 indicated that the resident was discharged on puree diet with nectar thick liquids. During an interview with the Director of Rehabilitation (DOR, Employee E10) on April 11, 2025 at 10:44 a.m. the resident's discharge summary from the speech language pathologist confirmed that the resident's current diet order should not be a mechanical soft diet and that his current diet should be puree consistency food and nectar thick consistency beverages. It was discussed with the DOR that the resident was observed eating a mechanical soft meal during lunch on April 9, 2025 and the current diet order. It was also discussed with the DOR that the residnt was observed drinking a shake and milk that was served during the lunch meal that was of a nectar thick consistency. The DOR indicated during interview that the resident was showing moderate signs of aspiration (happens when something an individual swallow enters their airway or lungs, and can lead to infections or breathing problems) at the time of resident was discharge from speech therapy. The safest diet texture for the resident was a puree diet with nectar thick liquids. During the interview the DOR confirmed that the current physician order should reflect a puree diet with nect thick liquids. 395296 Page 13 of 15 395296 04/11/2025 Meadowview Rehabilitation and Nursing Center 9209 Ridge Pike White Marsh, PA 19128

F 0808 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview with the speech language pathologist (Employee E11) on April 11, 2025, 11:08 a.m. with the DOR present, the speech language pathologist who was the only treating speech pathologist for the resident could not provide information during the interview regarding the correct diet the resident should be on. The discharge summary, along with her recommendations were reviewed with her. When she was asked who notifies facility staff (e.g.nursing, dietary), and asked if she inputs the physician order in for the change in diet after she makes a diet recommendation for a resident, she responded, it depends, but provided no other information regarding that statement. When asked if the resident's diet should be puree and nectar thick liquids, as she recommended on her discharge summary, she stated I don't know. There are three other speech pathologists there. 28 Pa. Code 211.12(c)Nursing services 28 Pa. Code 211.12(d)(1) Nursing services 28 Pa. Code 211.12(d)(3) Nursing services 28 Pa. Code 211.12(d)(5) Nursing services 28 Pa Code 201.18 (b)(1) Management 28 Pa Code 201.29 (a) Resident rights 395296 Page 14 of 15 395296 04/11/2025 Meadowview Rehabilitation and Nursing Center 9209 Ridge Pike White Marsh, PA 19128

F 0847 Inform resident or representatives choice to enter into binding arbitration agreement and right to refuse. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on the review of facility documents and resident clinical record and staff interviews, it was determined that the facility failed to ensure a resident had the capacity to understand the terms of a binding arbitration agreement for one of three residents reviewed (Resident R89). Residents Affected - Few Findings Include: Review of Resident R89's admission Minimum Data Set (MDS - federally mandated resident assessment and care screening) dated September 1, 2022, revealed the resident was admitted to the facility on [DATE], and had a diagnosis of altered mental status. Further review of the MDS, Section C - Cognitive Patterns (items in this section are intended to determine the resident's attention, orientation, and ability to register and recall new information - these items are crucial factors in many care-planning decisions), indicated that Resident R49 scored a 0 on the Brief Interview for Mental Status (BIMS), which indicated the resident had severe cognitive impairment. Review of an admission note dated August 30, 2022 revealed that the resident was noted alert with confsuion, resident was spanish speaking and understood some English. Review of nurse practitioner's progress note dated September 6, 2022, revealed was alert and oriented x 2 (person and time) which indicated that the resident was not completely oriented to person, time, place, and situation. Review of Resident R89's Binding Arbitration Agreement (Arbitration is an alternative way of resolving disputes outside the traditional court system. It is intended to reduce the time, expense, and formalities associated with that system. Rather than having a judge and/or jury determine the outcome of the dispute, a neutral third party, known as an arbitrator, will render his or her decision. Each party will have the opportunity to present his or her side of the case through witnesses and evidence. The arbitrator will then render a decision in favor of one party based on the facts, the law, fairness, common sense and the rules of procedure established under this Agreement. The arbitrator will be chosen by the parties, and his or her decision will be final, binding on all parties, and not subject to appeal in the court system, unless otherwise stated in the Agreement.) indicated the resident signed the document on September 8, 2022. Further review of the Binding Arbitration Agreement revealed it was also signed by facility employee, admission Director, Employee E7, (Former Employee). There was no documented evidence in the clinical record that the facility establised resident's discision making capacity prior to the signing of arbitration agreement Interview on April 10, 2025, at 2:00 p.m. with Employee E8, admission DIrector, confirmed that she usually ask the staff about residents mental status and she stated residents should have a BIMS score of 13 or above to sign arbitration agreement. 28 Pa. Code 201.14 (a) Responsibility of licensee. 395296 Page 15 of 15