Health inspection·October 5, 2023

F 0760 Ensure that residents are free from significant medication errors. Level of Harm - Minimal harm or potential for actual harm Based on a review of the facility's policy, clinical records, facility documentation, and staff interview, it was determined that the facility failed to ensure the correct dose of medication was administered for one of the 14 residents reviewed (Resident 17). Residents Affected - Few Findings include: Review of the facility's policy titled, General Policies for Administration and Documentation of Medications and Treatments last review date January 2017, revealed medications and treatments will be administered by a licensed nurse, in accordance with the Pennsylvania Nursing Code, physician orders and principles of safe medications administration. The Eight Rights will be observed during each medication/treatment administration: Right person; Right drug; Right dose; Right route; Right frequency; Right time; Right reason; and Right documentation. Review of Resident 17's diagnosis includes Epilepsy (neurological disorder marked by a sudden recurrent episode of sensory disturbance, loss of consciousness, or convulsion, associated with abnormal electrical activity in the brain). Review of Resident 17's physician's form dated April 21, 2023, revealed an order for Dilantin (anti-epileptic drug) 30 mg (miligrams) by mouth once a day was given with Dilantin 100 mg to equal 130 mg for Epilepsy. Review of the facility's documentation, Incident Report revealed a medication error incident occurred on September 2, 2023, at 8:00 a.m. Further review of facility documentation including Investigation Review comment section revealed the incident was discovered on September 4, 2023. The resident required physical assistance with breakfast and slept the rest of the day without eating, reported that her/his body was jerking intermittently. The physician was notified, and a STAT (immediate) blood work was ordered. An additional review of the same report revealed that upon reviewing the medication, it was noted that the resident received an extra dose of 30mg of Dilantin on the morning of September 2, 2023. Review of Resident 17's blood work results dated September 5, 2023, revealed a Dilantin level of 23.0 (normal range was 10-20). Review of the physician's progress note dated September 7, 2023, at 9:41 a.m., revealed resident had no reasonable recall, resident received an extra dose of Dilantin over the weekend, had difficulty feeding themself, had tremors, and was less responsive. A/P (Assessment and Plan) revealed a resolved neuro episode, possibly due to an overdose of Dilantin. (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 2 Event ID: 395307 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 395307 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/05/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kendal at Longwood Box 100 Kennett Square, PA 19348 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)