Health inspection·October 22, 2025

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. Based upon review of resident records, and interviews with residents and staff determined the facility failed to follow a resident's care plan consistent with the resident's rights that meets a resident's mental and psychosocial needs by failing to ensure one resident does not receive male care givers as indicated of 15 resident records reviewed (Resident R2). Findings include:Resident R2 was initially admitted to the facility June 2019 diagnosed with post traumatic stress disorder (a mental health condition that's caused by an extremely stressful or terrifying event).Resident R2's care plan dated September 23, 2023, for ineffective coping due to past traumatic events that triggers include male care givers. Per the sister's request is not to have a male aide.Review of documentation received from the facility stated on May 1, 2025, Resident R2 made allegations of abuse when a male aide, Employee E9 was assigned to the resident.Interview with Employee R9 on October 21, 2025, at 3:00 p.m. confirmed the aide was assigned Resident R2 on May 1, 2025, and stated he was aware Resident R2 was not to receive care from male aides. Interview with Resident R2 on October 22, 2025, at 10:00 a.m., confirmed the resident did not want male aides to assist with care. 28 Pa Cre 211.109d) Resident care policies28 PA. Code 211.12(d)(1)(5) Nursing services Page 1 of 5 395296 395296 10/22/2025 Meadowview Rehabilitation and Nursing Center 9209 Ridge Pike White Marsh, PA 19128

F 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record reviews, interviews with staff, reviews of facility policies and procedures, and hospital records, it was determined the facility failed to assess, monitor, and implement intervention to ensure that nutritional and hydration needs were met for one of 11 residents reviewed. (Resident R1). This failure resulted in actual harm to Resident CL1 who did not consume sufficient fluid and caloric intake resulting in abnormal blood values, requiring transfer, and admission to the hospital for the treatment of dehydration/electrolyte imbalance. (Resident CL1) Findings include:Review of facility policy titled nutrition assessment dated [DATE], revealed the facility staff were responsible for ensuring each resident maintained acceptable parameters of nutritional and hydration status. The policy indicated the facility staff were responsible for recognizing and addressing the nutritional and hydration needs of each resident. The facility staff were to provide a diet based on the resident's clinical condition when there was a nutritional indication. If the resident was unable to provide food and beverage preferences; then the necessary information will be obtained from the resident's representative. Continue review of the policy revealed that a registered dietitian would complete a nutritional assessment for each resident to determine if the resident was at risk for inadequate nutrition or hydration. The registered dietitian was responsible for assessing each resident's height, weight, food and fluid intake and collaborating this assessment with other facility staff members (nurse practitioner, nursing staff, physician, speech pathologist, social worker, psychiatrist, pharmacist) to identify risk factors for nutrition and hydration issues. The registered dietitian would be responsible for observing, assessing and monitoring the food and fluid intake of each resident. Nursing staff were to document and observe each resident daily and able to provide the registered dietitian with each resident's daily nutritional intake. The registered dietitian was responsible for developing interventions and care planning to meet each resident's medical and nutritional needs. Review of Resident CL1's comprehensive assessment (MDS-assessment of care needs) dated August 4, 2025, indicated Resident CL1 had diagnoses of Coronary Artery Disease (narrowing of the blood vessels which supply the heart with blood and oxygen), Dementia (irreversible, disease of the of the brain resulting in loss of reality), Chronic Obstructive Pulmonary Disease (disease process that causes decreased ability of the lungs to perform) and Malnutrition. Review of Resident CL1's psychiatric evaluation dated August 13, 2025, revealed the resident thought process was illogical, tangential (thinking is fractured), and delusional with poor concentration abilities. Review for Resident CL1's September 2025 physician orders revealed an order dated May 22, 2025, for regular diet and Mighty Shake (liquid nutritional supplement) four ounce, three times a day with meals. Continued review of physician's orders revealed an order dated September 15, 2025, for Boost (nutritional supplement) eight-ounce, three times a day. Review of Resident CL1's nursing documentation dated September 19, 2025, and September 24, 2025, revealed Resident CL1 continued to refuse the nutritional supplements. Clinical record review for September 24, 2025, for Resident CL1 revealed the nurse practitioner was asked by the nursing staff to evaluate Resident CL1 due to poor oral intake. The nurse practitioner documented Resident CL1 was refusing the nutritional supplement (Boost), because the resident did not like milk. The nurse practitioner's plan was to have the registered dietitian evaluate, assess, monitor, and nutrition care plan for Resident CL1's poor by mouth intake and declining to drink the nutritional supplement. Interview conducted with the Registered Dietitian, Employee E5, at 10:30 a.m., on October 21, 2025, confirmed that the last nutritional assessment complete by a Registered Dietitian was August 5, 2025. Further interview with the Registered Dietitian, Employee E5 revealed the food and nutrition department was not notified about the dietary Residents Affected - Few 395296 Page 2 of 5 395296 10/22/2025 Meadowview Rehabilitation and Nursing Center 9209 Ridge Pike White Marsh, PA 19128

F 0692 Level of Harm - Actual harm Residents Affected - Few consult that was requested by the nurse practitioner on September 24, 2025, related to Resident CL1's poor by mouth intake and declining to consume nutritional supplement. Review of nutritional assessment dated [DATE], revealed Resident CL1 was 69 inches in height, weighed 123 pounds with an ideal body weight was 160 pounds +/- 10%. The dietary progress note indicated that Resident CL1 was at risk for malnutrition and dehydration. The nutritional care plan was for Resident CL1 was to gain 1 to 2 pounds of weight a week toward a healthy BMI (body mass index). The nutritional care plan revealed, nutritional supplementation would be provided and the resident would be monitored and encouraged to eat greater than 75% of most meals. Based on Resident CL1's weight of 123 pounds and height of 69 inches Resident CL1 had a body mass index of 18.1 which placed the resident in a category of being under weight. Based on Resident CL1's weight of 123 pounds and ideal body weight of 160 pounds +/- 10%. This resident's caloric needs were 1500 to 1950 calories a day. Based on Resident CL1's weight of 123 pounds and goal weight of 160 +/- 10% this resident's baseline fluid needs without fluid restriction were 1500 milliliters (ml) to 1800 milliliters a day. Review of the Resident CL1 food consumption records from September 24, 2025, through October 9, 2025, revealed the nursing staff documented Resident CL1 refused either the lunch or dinner meal on September 24, 25, 26, 27, and September 28, 2025, as well as the follow dates on October 1, 2, 3, 4, 5, and October 8, 2025. All three meals were documented as refused on October 6, and October 7, 2025. Clinical record review for September 24, 2025, through October 9, 2025, revealed the nursing staff documented poor fluid intake for Resident CL1. Resident CL1 was consuming less than 1500 to 1800 ml of fluid a day of the nutritional supplements as ordered by the physician as follows:-September 24, 2025, 557ml-September 25, 2025, 536 ml-September 26, 2025, 437 ml -September 27, 2025, 951 ml -September 28, 2025, 634 ml -September 29, 2025, 694 ml -September 30, 2025, 664 ml-October 1, 2025, 399 ml -October 2, 2025, 457 ml-October 3, 2025, 279 ml -October 4, 2025, 634 ml -October 5, 2025, 288 ml -October 6, 2025, 467 ml -October 7, 2025, 240 ml -October 8, 2025, 634 ml -October 9, 2025, 240 ml Clinical record review revealed on October 8, 2025, the facility staff received notification from the laboratory services of elevated blood levels as follows: chloride level- 128 (normal 99 to 109 milliequivalents per liter-MEQ/L), sodium- 170 normal was (135 to 145 MEQ/L) and BUN 48 normal was 10 to 26 MG/DL. Review of nursing notes dated October 8, 2025, revealed, the licensed practical nurse contacted the nurse practitioner about the elevated laboratory studies received at the facility on October 8, 2025. The licensed nurse indicated, the nursing staff was waiting for a call back from the nurse practitioner about the elevated chloride, sodium and blood urea nitrogen levels (Blood urea nitrogen (BUN) is a medical test that measures the amount of urea nitrogen in your blood, which helps assess kidney function and overall health). Review of physician notes dated October 9, 2025, revealed that the nurse practitioner examined the resident at the request of the nursing staff who were reporting that Resident CL1 had poor by mouth intake, dry lips and mouth. The nurse practitioner gave an order for Intravenous hydration. The nurse was unable to insert the IV line for Resident CL1. The nurse practitioner gave an order for the resident to be sent to the hospital emergently. Interview with nurse practitioner, Employee E7, on October 21, 2025, at 2:00 p.m., confirmed that on October 9, 2025, the nurse practitioner became aware of the elevated blood levels of chloride, sodium, and blood urea nitrogen that were drawn and available for review on October 8, 2025. On October 9, 2025, the nurse practitioner ordered (IV fluids) intravenous glucose solution be placed for Resident CL1 to provide D5W (Dextrose- a form of glucose) at 80 ml/hour. Review of Resident CL1's nursing note completed by Licensed nurse, Employee E6 dated October 9, 2025, at 8:25 a.m. revealed UM (Unit Manager) received call from NP (Nurse Practitioner) regarding resident lab results. Order given to start line administer D5E @ 80ml/hr (hour). This 395296 Page 3 of 5 395296 10/22/2025 Meadowview Rehabilitation and Nursing Center 9209 Ridge Pike White Marsh, PA 19128

F 0692 Level of Harm - Actual harm Residents Affected - Few nurse as well as another UM attempted to insert line, resident resistive to receiving line placed. Resident continuously pulled away and became combative. Nursing attempted to re-educate resident on the need of fluids and risk of refusal/ resident stated understanding and continued to pull back . HOB (Head of the bed) elevated to prevent SOB (shortness of breath). Re-position ineffective .STAT (immediate) Potassium per NP order and resident spit out medication. NP made aware of above and gave verbal order to send resident to [hospital]. Interview with the Licensed nurse, Employee E6, at 11:00 a.m., on October 21, 2025, confirmed the nursing staff were not able to follow the nurse practitioner's orders. The licensed nurse confirmed that the nurse practitioner then gave orders for Resident CL1 to be sent to the hospital emergently. Review of Resident CL1's hospital record for October 9, 2025, revealed Resident CL1 presented from the facility with hypernatremia (high sodium level in the blood) and dehydration. The facility failed to assess, monitor, and implement interventions to ensure Resident CL1 maintained optimal nutrition and hydration. This failure resulted in actual harm to Resident CL1 who was not receiving sufficient fluid and caloric intake resulting in abnormal blood values, requiring transfer to hospital and admission with diagnoses of hypernatremia and dehydration. 28 PA. Code:201.14(a)(b) Responsibility of licensee28 PA. Code: 201.18(b)(1) Management28 PA. Code:211.10(c) Resident care policies28 PA. Code:211.12(c)(d)(1)(2)(3)(5) Nursing services 395296 Page 4 of 5 395296 10/22/2025 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews with residents and staff, review of clinical records, facility documentation and in accordance with accepted professional standards and practices, the facility failed to maintain medical records that were accurately documented for one of 15 resident records reviewed (Resident R1).Findings include:Review of Resident R1's clinical records revealed the resident was alert and oriented and admitted to the facility on [DATE], diagnosed with atherosclerotic heart disease.Review Resident R1's nursing note dated October 13, 2025, indicated the resident said the aide pushed her while putting her in bed. The resident was noted with a large hematoma (blood leaks outside the blood vessels, usually due to injury) to her forehead and was given an icepack.Review of documentation received from the facility indicated the resident's skin was intact with no discoloration.Interview on October 22, 2025, at 4:00 p.m. unit supervisor, registered nurse, Employee E14 worked the night of the incident and assessed Resident R1 immediately afterwards. E14 confirmed the injury on the resident's forehead. 28 Pa. Code 211.12(d)(1) Nursing services 395296 Page 5 of 5