Health inspection·August 10, 2023

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm Based on clinical records review and staff interview, it was determined that the facility failed to follow a physician's order for medication and blood work and failed to timely inform the physician of a missed medication for two of 21 resents reviewed (Resident 249, and 252). Residents Affected - Few Findings include: Review of Resident 249's diagnosis list includes Cerebrovascular Disease (CVA-Stroke), and Intracranial hemorrhage. Review of Resident 249's nursing progress notes dated August 4, 2023, at 10:50 p.m., revealed resident was admitted to the facility for wound care, nutrition management, intravenous therapy, and post-operative care of left craniotomy (A surgical opening into the skull) with wound infection. Review of the Physician Order dated August 4, 2023, revealed an order for Cefazolin (antibiotic) Sodium Injection Solution Reconstituted 2 grams. Use 2 grams intravenously every eight hours for infected wounds infuse 2 grams at 200ml/hr. over 30 minutes into a venous catheter. The order medication was scheduled for August 5, 2023, at 12 midnight, 8:00 a.m., and 4:00 p.m. Review of the August 2023 Medication Administration Record revealed Resident 249's Cefazolin was not administered on August 5, 2023, at midnight and 8:00 a.m. REview of Resident 249's clinical record review failed to reveal that the physician was notified of the missed medication. An interview with the Director of Nursing was conducted on August 10, 2023, at 10:00 a.m. The DON reported that on August 4, 2023, a midnight dose of Cefazolin was not administered because the facility was waiting for clearance from the hospital physician to use Resident 249's PICC line (Peripherally inserted central catheter). The DON reported that the physician did not respond until around 1:00 a.m. The DON reported that the 8:00 a.m., medication was not administered despite medication being available. The DON reported that as per the facility's investigation, and staff interview, the nurse did not check if the medication was available and reported that there was no available IV pump to use to administer the ordered medication. The DON confirmed that the physician was not notified of the missed medication until August 9, 2023, when the surveyor brought up the concern to the facility. Review of the nursing progress notes dated August 9, 2023, at 2:15 p.m., revealed Nurse Practitioner (NP) was notified of the resident's missed 12 a.m., and 8 a.m., doses of Cefazolin on August 5, 2023. A new order to add two additional doses of IV Cefazolin was made, to notify the infectious disease (ID) physician of the missed dosage and schedule a follow-up with the ID doctor. Page 1 of 6 395332 395332 08/10/2023 Wayne Center 30 West Avenue Wayne, PA 19087

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few The facility failed to ensure Resident 249's ordered IV medication was followed and the physician was notified of the missed medication. Review of Resident 252's diagnosis list revealed Chronic heart failure, Diabetes (group of metabolic disorders characterized by a high blood sugar level over a prolonged period), and Sepsis (body's extreme reaction to an infection, without prompt treatment can lead to organ failure, tissue damage, and death). Rview of Resident 252's July 28, 2023, Physician's order revealed an order for blood work (Complete Blood Count -CBC, and Basic Metabolic Panel-BMP) for July 31, 2023. Review of Resident 252's clinical records failed to reveal that Resident 252's blood work was done on July 31, 2023. Review of the nursing progress notes dated August 9, 2023, at 8:55 a.m., revealed NP was notified on August 8, 202, that lab was unable to obtain the resident's blood and will reschedule on August 9, 2023. Interview with the Director of Nursing conducted on August 10, 2023, at 11:00 a.m. confirmed Resident 252's blood work order for July 31, 2023, was not done. The DON reported that the order was received but was not transcribed and was therefore not drawn on July 31, 2023. The error was later found and scheduled the missed blood work on August 8, 2023. The facility failed to ensure Resident 252's blood work order was followed. 28 Pa. Code 211.11(d) Resident care plan 28 Pa. Code 211.12 (c)(d)(1)(5) Nursing services 395332 Page 2 of 6 395332 08/10/2023 Wayne Center 30 West Avenue Wayne, PA 19087

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on facility policy and procedure review, clinical record review, and staff interview it was determined the facility failed to develop interventions to prevent falls for one of 3 residents reviewed. (Resident 199) Findings Include: Revie of facility policy and procedure titled Falls Management, last revised on September 22, 2022 revealed Patients will be assessed for risk of falling as part of the nursing assessment process. Interventions to reduce risk and minimize injury will be implemented as appropriate. Review of Resident 199's demographic sheet revealed they were admitted to the facility on [DATE] with diagnosis including but not limited to muscle weakness, unspecified lack of coordination, unsteadiness on feet, and age-related cognitive decline. Review of Resident 199's admission nursing assessment, dated June 2, 2023 revealed the resident was not at risk for falls. Review of Resident 199's care plan revealed there was no care plan for the risk of falls developed with interventions to prevent falls developed on admission. Review of Resident 199's Progress notes revealed a nursing entry dated July 4, 2023 at 6:46 a.m. stating, Charge nurse reported that resident was found on floor in his bathroom, and that his Foley [a flexible tube that is passed into the bladder to drain urine] was dislodged (came out) resident stated, I fell while trying to use the bathroom. Interview with the Nursing Home Administrator on August 10, 2023 at 9:45 a.m. confirmed the resident was not correctly identified as a fall risk on admission and no care plan with interventions to prevent falls was developed prior to the fall on July 4, 2023. 28 Pa. Code 211.11(d) Resident care plan 28 Pa. Code 211.12 (c)(d)(1)(5) Nursing services 395332 Page 3 of 6 395332 08/10/2023 Wayne Center 30 West Avenue Wayne, PA 19087

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, a review of medication manufacturer's guidelines, and staff interviews, it was determined that the facility failed to ensure that medications were properly labeled and stored in two of three medication carts observed (First Floor A wing, and Second Floor 2CD Hall medication cart). Findings include: Review of manufacturer's storage guidelines for Insulin Gargline (long-acting insulin) revealed that the medication may be stored at room temperature and must be discarded within 28 days after opening. Review of the manufacturer's storage guidelines for Novolog Insulin (fast-acting insulin), revealed that the medication must be stored at room temperature and must be discarded within 28 days after opening. Review of manufacturers' storage guidelines for Lantus Insulin Pen (long-acting insulin) revealed that the medication may be stored at room temperature and must be discarded within 28 days after opening. [DATE] 09:32 AM Observation was conducted on the First Floor A wing medication cart on [DATE], at 9:32 a.m., in the presence of licensed nurse Employee E4. Observation revealed the following: One Insulin Gargline pen, opened and undated; One Novolog pen, opened and undated, and A glucagon kit with an expiration date of February 2023. Interview with Employee E4 confirmed that the above insulins should have been dated once opened and expired medication should have been discarded. Observation was conducted on the Second Floor 2 CD Hall medication cart on [DATE], at 10:02 a.m., in the presence of licensed nurse Employee E5. Observation revealed the following: One Novolog vial with an open date of [DATE], and One Lantus pen with an open date of [DATE]. The above findings were relayed to the Director of Nursing on [DATE], at 10:00 a.m. The facility failed to ensure medications were properly labeled and stored on the First Floor A wing, and Second Floor 2CD Hall medication cart 28 Pa. Code 201.18(b)(1)(3)(e)(1) Management 28 Pa. Code 211.12 (c)(d)(1)(5) Nursing services 395332 Page 4 of 6 395332 08/10/2023 Wayne Center 30 West Avenue Wayne, PA 19087

F 0919 Make sure that a working call system is available in each resident's bathroom and bathing area. Level of Harm - Minimal harm or potential for actual harm Based on observations and interviews with residents and staff, it was determined that the facility failed to ensure that a call bell was available for two of 21 residents reviewed (Resident 3 and Resident 44). Residents Affected - Few Findings include: Observation conducted on August 7, 2023, at 11:56 a.m. revealed that there was no call bell or communication system available that would allow for a resident, family member or staff member to call for assistance for Resident 3. Interview conducted with Resident 3 on August 7, 2023, at 11:56 a.m., Resident 3 stated that they took her call bell away about a year ago. Resident 3 also stated that she must ask her roommate to use her call bell to call for assistance for Resident 3. Further observation on August 9, 2023, at 1:21 p.m., revealed that there still was no call bell or communication system available for a resident, family member or staff member to call for assistance for Resident 3. Interview with Resident 15, roommate, on August 9, 2023, at 1:21 p.m., confirmed that Resident 3 would request Resident 15 use her call bell to alert facility staff for assistance with ADL needs. Observation on August 7, 2023, at 9:25 a.m. revealed that there was no call bell or communication system available that would allow for a resident, family member or staff member to call for assistance for Resident 44. Interview with Resident 44 on August 7, 2023, at 9:25 a.m., Resident 44 stated that he did not know where his call bell was. Resident 44 could not remember the last time he saw the call bell. Resident 44 stated he usually just yells out the door for assistance. Further observation on August 9, 2023, at 1:26 p.m., revealed that there still was no call bell or communication system available for a resident, family member or staff member to call for assistance for Resident 44. Interview on August 10, 2023, at 10:03 a.m., Employee 3 confirmed that the call bell in Resident 3's room was located on the floor, behind the privacy curtain, on her roommate's side of the curtain. The call bell was not within Resident 3's reach or sight. Interview on August 10, 2023, at 10:03 a.m., Employee 3 confirmed that there was no call bell available for Resident 44 and confirmed that there should be. Review of facility policy NSG101 Call Lights, on August 10, 2023, at 11:07 a.m., revealed that all Genesis HealthCare patients will have a call light or alternative communication device within their reach at all times when unattended. The facility failed to ensure that two residents had a call bell available within their reach when unattended. 395332 Page 5 of 6 395332 08/10/2023 Wayne Center 30 West Avenue Wayne, PA 19087

F 0919 28 Pa Code 201.29(j) Resident Rights Level of Harm - Minimal harm or potential for actual harm 28 Pa Code 207.2(a) Administrator's Responsibility Residents Affected - Few 395332 Page 6 of 6