Inspection·February 5, 2025

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview on February 5, 2025, at approximately 12:30 PM, the Nursing Home Administrator (NHA) and Corporate Nurse Consultant (CNC) indicated the pharmacy drops off medications for the facility at approximately 1:00 AM and 1:00 PM Monday through Friday. The CNC explained that medication needs to be ordered prior to 9:30 AM and 10:00 PM to be available for the respective pharmacy medication delivery times. The CNC confirmed Resident 1's oxycodone-acetaminophen (Percocet) 5/325 mg would not have been delivered until the scheduled 1:00 AM drop-off time. The NHA and CNC indicated that oxycodone-acetaminophen (Percocet) 5/325 mg is available in an emergency supply but could not provide documented evidence explaining why Resident 1 did not receive the medication with a reported pain level of 8 out of 10. The DON and CNC confirmed it is the facility's responsibility to ensure pharmaceutical services are in place to meet resident's needs. A review of Resident 1's controlled substance record for oxycodone-acetaminophen (Percocet) 5/325 mg showed that two tablets were signed out by nursing staff on January 11, 2025, at 8:30 PM and January 13, 2025, at 5:00 PM. However, there was no corresponding documentation on the MAR confirming administration of the medication to the resident at those times. A review of Resident 1's controlled substance record for oxycodone-acetaminophen (Percocet) 5/325 mg revealed 2 tablets of oxycodone-acetaminophen (Percocet) 5/325 mg showed that two tablets were signed out by nursing staff on January 11, 2025, at 8:30 PM and January 13, 2025, at 5:00 PM. However, there was no corresponding documentation on the Medication Administration Record confirming administration of the medication to the resident at those times. During an interview on February 5, 2025, at approximately 12:30 PM, the NHA and CNC confirmed the facility failed to ensure procedures were implemented to promote accurate accounting of narcotic medications. A clinical record review revealed Resident 2 was admitted to the facility on [DATE], with diagnoses that included anxiety disorder (a condition in which excessive worry causes clinically significant distress or impairment in social, occupational, or other areas of functioning) and spondylosis (a degenerative condition of the spine that affects the joints and discs). A review of an admission MDS assessment dated [DATE], revealed that Resident 2 was cognitively intact with a BIMS score of 14 (a score of 13-15 indicates cognition is intact). A progress note dated January 28, 2025, revealed Resident 2 was admitted to the facility on [DATE], at 4:00 PM. A review of the community hospital discharge instructions dated January 28, 2025, indicated Resident 2 was prescribed Effexor 300 mg daily. However, a review of the physician's orders showed Effexor 300 mg was not ordered until February 4, 2025, with a start date of February 5, 2025. There was no documentation explaining the delay in ordering the medication, and Resident 2 did not receive Effexor from January 28, 2025, through February 4, 2025. A review of Resident 2's clinical record revealed a physician's orders for the following: trazodone 100 mg (a medication used to treat depression and aid in sleep), clonazepam 0.5 mg (a medication used to treat anxiety), and lamotrigine 200 mg (a medication used to prevent seizures) to begin on January 28, 2025, at 9:00 PM. A review of Resident 2's January 2025 MAR indicated these medications were not administered on January 28, 2025, at 9:00 PM, and there was no documentation explaining why they were held. (continued on next page) 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 02/05/2025 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview on February 5, 2025, at 9:25 AM, Resident 2 reported experiencing delays in receiving prescribed medications upon admission. The resident specifically mentioned delays in receiving Effexor and her nighttime medications. During an interview on February 5, 2025, at approximately 12:30 PM, the NHA and CNC confirmed the facility failed to ensure the timely acquisition and administration of medications necessary to meet residents' needs. The facility failed to ensure pharmaceutical services were provided to meet the needs of residents, resulting in delays in medication administration and improper accounting of controlled substances. 28 Pa Code 211.9 (k) Pharmacy services. 28 Pa Code 211.10 (c) Resident care policies. 28 Pa Code 211.12 (d)(3) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395298 If continuation sheet Page 3 of 3