Inspection·December 30, 2024

F 0625 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave. Based on a review of clinical records, the facility's bed-hold policy, and staff and family interviews, it was determined the facility failed to provide written notice of the specifics of the facility's bed-hold policy, including the duration and reserve bed payment policy, to a resident's representative upon the resident's transfer to the hospital for one of six sampled residents (Resident 2). Findings include: A review Resident 2's clinical record revealed admission to the facility on December 14, 2024. The resident was cognitively intact with a BIMS score of 15 (brief interview for mental status, a tool to assess the resident's attention, orientation, and ability to register and recall new information a score of 13-15 equates to being cognitively intact) and a diagnosed intellectual disability. Resident 2 was transferred to the hospital on December 29, 2024. Interview with the resident's representative on December 30, 2024, revealed that while a copy of the facility's bed-hold policy was provided at admission, no written notification or explanation of the bed-hold policy, including the duration, reserve bed payment requirements, or procedures for the resident's return, was provided at the time of the hospital transfer. There was no documented evidence that the facility provided the resident or the representative of the resident written information about the facility's bed-hold policy (an agreement for the facility to hold a bed for an agreed upon rate during a hospitalization) at the time of transfer, or within 24 hours, detailing the duration of bed-hold, if any, and the reserve bed payment policy and addressing permitting the return of residents to the next available bed. The Business Office Manager (BOM), interviewed on December 30, 2024, at 2:15 PM, stated that she provides written bed-hold notifications to residents or their representatives during business hours. She indicated that nursing staff is responsible for providing the notifications when she is unavailable. However, she acknowledged no documentation existed to confirm this process was completed for Resident 2. The Nursing Home Administrator (NHA), interviewed on December 30, 2024, at approximately 3:00 PM, confirmed the facility failed to provide the required written notice of the bed-hold policy to Resident 2 or the resident's representative upon transfer to the hospital. The NHA stated it is the facility's standard practice to send a copy of the bed-hold policy with the resident during transfers but admitted this practice was not documented in this instance. The failure had the potential to affect the resident's right to understand the bed-hold process, secure their bed during hospitalization, and plan for their return to the facility, potentially compromising the resident's rights and ability to plan for continuity of care. 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa Code 201.29 (a)Resident rights FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395298 If continuation sheet Page 2 of 3 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 395298 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/30/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lakewood Rehabilitation & Healthcare Center 147 Old Newport Street Nanticoke, PA 18634 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0770 Provide timely, quality laboratory services/tests to meet the needs of residents. 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 and staff interview, it was determined the facility failed to ensure timely completion of prescribed laboratory services for one resident out of six sampled (Resident 1). This failure resulted in a delay in the monitoring and management of the resident's elevated potassium levels as ordered by the prescribing practitioner. Residents Affected - Few Findings included: Clinical record revealed that Resident 1 was admitted to the facility on [DATE], with diagnoses to include diabetes, heart failure and morbid obesity. The resident's potassium levels (K+ normal range: 3.5-5.1 mmol/L Potassium is a mineral found in the foods you eat. It ' s also an electrolyte. Electrolytes conduct electrical impulses throughout the body. They assist in a range of essential body functions, including blood pressure, normal water balance, muscle contractions, nerve impulses, digestion, and heart rhythm) were documented as follows: November 15, 2024: 5.4 mmol/L (elevated) November 19, 2024: 5.4 mmol/L (elevated) November 20, 2024: 5.5 mmol/L (elevated) On November 20, 2024, at 1:31 PM, nursing documentation revealed the facility's physician assistant reviewed the lab results and noted the elevated potassium level of 5.5 mmol/L. New orders were written for Kayexalate ( a medication used to treat a high level of potassium in the blood) to treat hyperkalemia (high potassium) and to repeat a BMP (Basic Metabolic Panel a laboratory test that measures several important aspects of the blood, like electrolytes and blood sugar) on November 22, 2024. A review of Resident 1's clinical record revealed no evidence the ordered BMP was collected on November 22, 2024, as prescribed. During an interview on December 30, 2024, at 2:00 PM, the corporate nurse confirmed that she contacted the hospital lab and verified that the BMP lab test was not drawn. She was unable to provide an explanation as to why the nursing staff did not follow up to ensure the BMP was completed or why there was no notification to the prescribing practitioner regarding the missed laboratory study. There was no documented evidence that facility staff attempted to reobtain the BMP after the lab test was missed or that the prescribing practitioner was notified of the failure to complete the ordered diagnostic testing in a timely manner. The failure to monitor and address elevated potassium levels in a timely manner poses significant risks, including the potential for cardiac arrhythmias or other complications related to hyperkalemia. The facility failed to adhere to physician orders for prescribed laboratory testing and did not implement appropriate follow-up actions to ensure the resident's care needs were met. 28 Pa. Code 211.12 (c)(d)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395298 If continuation sheet Page 3 of 3