Health inspection·February 15, 2024

F 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted **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 develop baseline care plans for two of 24 residents reviewed. (Resident 182 and 183) Findings Include: Review of Resident 182's clinical record revealed the resident was admitted to the facility on [DATE]. Review of Resident 182's Nursing admission screener, dated February 2, 2024 revealed the resident should have had a basic care plan for Activities of Daily living, Allergies, Communication, Discharge planning, falls, neurological, oral/nutrition, skin, sleep pattern, and smoking cessation. Review of Resident 182's care plan revealed the only care plan initiated in the 48 hours after admission was a nutrition care plan. All other care plans were initiated between February 5th and February 12, 2024. Review of Resident 183's clinical record revealed the resident was admitted to the facility on [DATE]. Review of Resident 183's Nursing admission screener, dated February 1, 2024 revealed the resident should have had a basic care plan for Activities of Daily living, Allergies, Communication, Discharge planning, falls, neurological, oral/nutrition, skin, sleep pattern, and smoking cessation. Review of Resident 183's care plan revealed the only care plan initiated in the 48 hours after admission was a nutrition care plan. All other care plans were initiated between February 8th and 11th 2024. Interview with the Director of Nursing on February 15, 2024 at 12:00 p.m. revealed Residents 182 and 183 did not have an initial care plan developed on admission. 28 Pa Code 201.18(b)(3) Management 28 Pa. Code 211.12 (d)(1)(3)(5) Nursing services Page 1 of 9 395319 395319 02/15/2024 Manatawny Center for Rehabilitation and Nursing 30 Old Schuylkill Road Pottstown, PA 19465

F 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm Based on clinical record review and staff interview it was determined the facility failed to provide care and services for pressure ulcer for one of six residents reviewed. (Resident 21) Residents Affected - Few Findings Include: Review of Resident 21's admission Nursing Assessment, dated January 16, 2024 revealed there was a stage 1 pressure ulcer (intact reddened skin), measuring 3 centimeter (cm), 1cm wide and 1cm deep on the coccyx (small triangular bone at the base of the spinal column). Review of Resident 21's physician orders on admission revealed there was no order for wound care to this wound. Review of Resident 21's wound consult note, dated January 24, 2024 revealed the resident had a stage 3 pressure ulcer (extend through the skin into deeper tissue and fat but do not reach muscle, tendon, or bone) measuring 2cm long, 1cm wide, and 0.2cm deep. The wound specialist recommended a treatment of Triad paste and to leave open to air daily. Review of Resident 21's physician orders revealed the triad paste as recommend by the wound specialist was not ordered for Resident 21 and they continued to have no treatment on the wound. Review of Resident 21's wound consultant note, dated January 31, 2024, revealed the resident had a stage 3 pressure ulcer measuring 0.5cm long, 0.5cm wide, and 0.1cm deep. The wound specialist recommended a treatment of Triad paste and to leave open to air daily. Review of Resident 21's physician orders revealed the triad paste as recommend by the wound specialist was not ordered for Resident 21 and they continued to have no treatment on the wound. Interview with the Director of Nursing and Licensed Nursing Employee E4 on February 15, 2023 at 12:00 p.m. revealed when Resident 21 was admitted to the facility the pressure ulcer identified was incorrectly assessed as a stage one due to the measurement of depth and the facility failed to provide wound care to the wound upon admission and when recommended by the wound consultant on January 24th and January 30, 2024. 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 201.18(b)(1)(3)(e)(1) Management 28 Pa. Code 211.12(c)(d)(1)(3)(5) Nursing services 395319 Page 2 of 9 395319 02/15/2024 Manatawny Center for Rehabilitation and Nursing 30 Old Schuylkill Road Pottstown, PA 19465

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, review of clinical records and facility documentation, and interviews with residents and staff, it was determined that the facility failed to provide proper continence care for one of one resident reviewed (Resident 70). Findings include: Review of Resident 70's Quarterly MDS (Minimum Data Set - a mandatory periodic resident assessment tool), dated January 19, 2024, revealed that the resident was admitted to the facility on [DATE], and had diagnoses including Encounter for attention to gastrostomy (tube feed- artificial external opening into the stomach for nutritional support or gastric decompression), Scoliosis (sideways curvature of the spine or back bone), Intellectual disability (a condition that limits intelligence and disrupts abilities necessary for living independently). Continued review revealed that the resident was dependent for toileting hygiene. Further review revealed that the resident was always incontinent of bowel and bladder. Review of Resident 70's care plan revealed the following intervention for potential for constipation: Bowel meds as ordered and Following facility bowel protocol for episode of constipation with a date initiated of April 20, 2022. Further review of Resident 70's clinical medical record revealed an order for Milk of Magnesia (used to treat occasional constipation) 400MG/5ML, Give 30 ml orally as needed for Constipation ON 3-11 SHIFT IF NO BOWEL MOVEMENT BY THE EVENING OF 3RD DAY. Review of Resident 70's bowel function (task used to track bowel movement) from January 17, 2024, through February 14, 2024, revealed Resident 70 did not have a bowel movement on the following days: January 18, 2024, January 19, 2024, January 20, 2024 January 22, 2024, January 23, 2024, January 24, 2024 February 1, 2024, February 2, 2024, February 3, 2024 February 5, 2024, February 6, 2024, February 7, 2024 Review of Resident 70's eMAR (electronic medication administration record) revealed the facility did not administer Milk of Magnesia on the evenings of January 20, 2024, January 24, 2024, February 3, 2024, or February 7, 2024. Interview conducted with the Director of Nursing (DON) on February 15, 2024, at 1:15 p.m. confirmed Resident 70 did not receive Milk of Magnesia on the dates listed above. 28 Pa Code 201.14(a) Responsibility of licensee 28 Pa Code 211.12(d)(5) Nursing services 395319 Page 3 of 9 395319 02/15/2024 Manatawny Center for Rehabilitation and Nursing 30 Old Schuylkill Road Pottstown, PA 19465

F 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm Based on review of facility policy, clinical record review, and staff interview, it was determined that the facility failed to adequately monitor and address weight loss in a timely manner for two of four residents reviewed for nutrition (Residents 105 and 112). Residents Affected - Few Findings include: Review of facility policy, Weight Assessment and Intervention, undated, revealed: Any weight change of 5% or more since the last weight assessment will be retaken the next day for confirmation. If the weight is verified, nursing will immediately notify the Dietitian in writing. Verbal notification must be confirmed in writing. Review of Resident 105's clinical record revealed on October 11, 2023, the resident was recorded as weighing 334.6 pounds (lbs.) On November 1, 2023, the resident was recorded as weighing 305 lbs., a 29.6 lb., or 8.85% weight loss in three weeks. Further review of Resident 105's weights revealed the next available weight was recorded on November 8, 2023, at 293.3 lbs. Review of Resident 105's progress notes revealed a Weight Note on November 17, 2023, where the dietitian, Employee E5, requested a reweight be obtained. Further review of Resident 105's weights revealed the next weight obtained was on November 21, 2023, with the resident recorded as weighing 278.6 lbs. Further review of Resident 105's progress notes revealed the physician was notified of Resident 105's weight loss on December 6, 2023, and requested the resident's fluid restrictions be discontinued and the resident started on comfort measures. The delay in obtaining a reweight to verify Resident 105's weight loss and the delay in the dietitian and physician being made aware of Resident 105's significant weight loss was discussed with the dietitian, Employee E5, on February 15, 2024, at approximately 11:15 a.m. Review of Resident 112's clinical record revealed that on December 20, 2023, the resident weighed 135.2 lbs. On December 27, 2023, the resident weighed 127.3 pounds which is a 5.84 % loss in one week. Further review of Resident 112's weights revealed the next recorded weight was January 2, 2024, where the resident was recorded as weighing 124.9 lbs. Review of Resident 112's progress notes revealed the Dietitian, Employee E5, did not address the resident's weight loss until January 9, 2024, where they documented that the resident was currently on antibiotic therapy for a urinary tract infection. Further review of Resident 112's progress notes revealed the next Weight Note was on January 26, 2024, where the Dietitian, Employee E5, stated that Resident 112 had a 6.5% weight loss since December 20, 2023. The dietitian recommended nursing notify the physician and that Resident 112 be started on a supplement. The delay in obtaining a reweight for Resident 112 and the delay in addressing Resident 112's significant weight loss was discussed with the dietitian, Employee E5, on February 15, 2024, at approximately 11:15 a.m. 395319 Page 4 of 9 395319 02/15/2024 Manatawny Center for Rehabilitation and Nursing 30 Old Schuylkill Road Pottstown, PA 19465

F 0692 28 Pa. Code 211.5(f) Clinical Records Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code 211.12(d)(1)(5) Nursing Services 28 Pa Code: 211.10(c) Resident care policies Residents Affected - Few 395319 Page 5 of 9 395319 02/15/2024 Manatawny Center for Rehabilitation and Nursing 30 Old Schuylkill Road Pottstown, PA 19465

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review and staff interview it was determined that the facility failed to ensure that the pharmacy provided medications timely for one of two residents reviewed (Resident 80) and failed to provide record of disposition of a controlled drug for one of three closed records reviewed (Resident 130). Findings include: Review of Resident 80's clinical medical record revealed the following diagnoses: Encephalopathy Unspecified (a disease that affects brain structure or function. It causes altered mental state and confusion.), Methicillin-resistant staphylococcus aureus (MRSA- Infections caused by specific bacteria that are resistant to commonly used antibiotics), Sepsis (occurs when the body's immune response to an infection causes widespread inflammation, damaging its own tissues and organs.), UTI (urinary tract infection). Review of Resident 80's comprehensive assessment Minimum Data Set (MDS - periodic assessment of resident care needs) dated [DATE], in section O (special treatments, procedures, and programs) revealed Resident 80 was receiving IV medications (intravenous injection is an injection of medication or another substance into a vein and directly into the blood stream). Further review revealed Resident 80 was also receiving antibiotics (medicines that fight bacterial infections in people). Additional review of Resident 80's clinical record revealed an order for Vancomycin (antibiotic used to treat bacteria) 500 mg (milligrams) IV Q8 (every 8 hours) for 7 days with a start date of [DATE], and an end date of [DATE]. Review of Resident 80's clinical medical record revealed a progress note dated [DATE], stating as per md (medical doctor) extended iv vancomycin through [DATE], due to missed doses regarding to pharmacy. Further review of Resident 80's progress notes revealed a note dated [DATE], stating Vancomycin HCl Intravenous Solution Use 500 mg intravenously every 8 hours for MRSA urine until January, 5, 2024, 11:59 p.m. SASH protocol with med (medications) administration unavailable. Review of Resident 80's eMAR (electronic medication administration record) revealed Resident 80 missed two doses of Vancomycin. The first missed dose was on [DATE], and the second dose was on [DATE]. Review of closed record revealed Resident 130 was admitted to Manatawny Center for Rehabilitation and Nursing on [DATE], and expired on [DATE]. Review of Resident 130's clinical medical record revealed an order for Morphine Sulfate (medication used to treat moderate to severe pain) solution 20 ML (milliliters) with a start date of [DATE]. Further review of Resident 130's clinical medical record failed to find documentation of disposition (disposal) of Resident 130's morphine Sulfate. Interview conducted with the Director of Nursing (DON) on February 15, 2024, at 11: 50 a.m. confirmed the above information. 395319 Page 6 of 9 395319 02/15/2024 Manatawny Center for Rehabilitation and Nursing 30 Old Schuylkill Road Pottstown, PA 19465

F 0755 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code: 211.9 (a)(1) Pharmacy services Residents Affected - Few 395319 Page 7 of 9 395319 02/15/2024 Manatawny Center for Rehabilitation and Nursing 30 Old Schuylkill Road Pottstown, PA 19465

F 0770 Provide timely, quality laboratory services/tests to meet the needs of residents. Level of Harm - Minimal harm or potential for actual harm Based on clinical record review and staff interview it was determined the facility failed to obtain laboratory services as ordered for one of 24 residents reviewed. (Resident 21) Residents Affected - Few Findings Include: Review of Resident 21's physician orders revealed an order dated January 25, 2024 for a PT/INR (blood test to determined how fast blood clots) every Thursday for monitoring Coumadin (blood thinner). Review of the clinical record revealed there was no PT/INR drawn on Thursday February 8, 2024. Interview with the Director of Nursing on February 14, 2023 at 11:30 a.m. confirmed resident 21 did not have a PT/INR drawn on Thursday February 8th, 2024 as ordered. 28 Pa. Code 211.12(c)(d) (1)(3)(5) Nursing services 395319 Page 8 of 9 395319 02/15/2024 Manatawny Center for Rehabilitation and Nursing 30 Old Schuylkill Road Pottstown, PA 19465

F 0773 Level of Harm - Minimal harm or potential for actual harm Provide or obtain laboratory tests/services when ordered and promptly tell the ordering practitioner of the results. Based on clinical record review and staff interview it was determined the facility failed to report results of laboratory studies to the physician for one of 24 residents reviewed. (Resident 21) Residents Affected - Few Findings Include: Review of Resident 21's progress notes revealed a nursing entry dated January 23, 2024 at 9:43 p.m. stating INR 5.5 (lab resulting indicating how long it takes for blood to clot) new order obtained to hold warfarin (blood thinner) dose and recheck on January 25, 2024. Review of Resident 21's labs revealed a PT/INR was drawn on January 25th 2024 and the results were reported to the facility on the same day. Review of Resident 21's clinical record revealed the results of the PT/INR drawn on January 25, 2024 were not reported to the physician until January 29, 2024. Interview with the Director of Nursing on February 14, 2023 at 11:30 p.m. confirmed the lab result from January 25, 2024 were not reported to the physician until January 29, 2024. 28 Pa. Code 211.12(c)(d) (1)(3)(5) Nursing services 395319 Page 9 of 9