F 0697
Provide safe, appropriate pain management for a resident who requires such services.
Level of Harm - Minimal harm
or potential for actual harm
Based on clinical record review and staff interview, it was determined that the facility failed to ensure pain
management included the attempt to provide non-pharmacological interventions to alleviate pain prior to or
in conjunction with the administration of pain medication prescribed on an as needed basis for one of 13
sampled residents. (Resident 21)
Residents Affected - Few
Findings include:
Clinical record review revealed that Resident 21 had diagnoses that included a right humerus fracture, right
ankle contusion, muscle wasting and atrophy (shrinking of muscles). On July 12, 2023, a physician ordered
that staff administer a pain medication (oxycodone) every six hours as needed for pain. Review of the
medication administration record (MAR) revealed that the resident received the as needed narcotic pain
medication 30 times in July 2023, and 14 times in August 2023. There was a lack of documentation to
support that non-pharmacological interventions were offered to address the assessed pain prior to or in
conjunction with the administration of the as needed narcotic pain medication.
In an interview on August 17, 2023, at 8:30 a.m., the Director of Nursing confirmed that there was no
documented evidence staff offered non-pharmacological interventions prior to administration of the as
needed pain medication.
28 Pa. Code 211.12(d)(1)(5) Nursing services.
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:
395343
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
395343
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
08/17/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Myerstown Nursing and Rehab LLC
7 West Park Avenue
Myerstown, PA 17067
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 0758
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated,
prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic
medications are only used when the medication is necessary and PRN use is limited.
**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 offer
non-pharmacological interventions prior to the administration of as needed anti-anxiety medications for two
of 13 sampled residents. (Residents 8, 199)
Findings include:
Clinical record review revealed that Resident 8 had diagnoses that included Alzheimer's disease and
difficulty in walking. Review of the Minimum Data Set (MDS) assessment dated [DATE], revealed the
resident had cognitive impairment. On July 26, 2023, and August 12, 2023, the physician ordered an
anti-anxiety medication, alprazolam, be given every eight hours as needed for 14 days. Review of the
medication administration record (MAR) for July 2023, revealed that staff had administered the as needed
alprazolam five times. Review of the MAR for August 2023, revealed that staff had administered the as
needed alprazolam 10 times. There was no documented evidence that staff attempted non-pharmacological
interventions prior to the administration of the as needed anti-anxiety medication.
Clinical record review revealed that Resident 199 had diagnoses that included chronic ulcer of the right
lower leg, anxiety, and hearing loss. The MDS assessment dated [DATE], indicated that the resident had
memory impairment and exhibited verbal and other behavioral symptoms one to three days in the
assessment period. On August 4, 2023, the physician ordered an anti-anxiety medication, lorazepam, to be
given every 12 hours as needed for 14 days. Review of the MAR for August 2023, revealed that staff had
administered the as needed lorazepam 10 times. There was no documented evidence that staff attempted
non-pharmacological interventions prior to the administration of the as needed anti-anxiety medication.
In an interview on August 17, 2023, at 8:35 a.m., the Administrator confirmed that there was no
documented evidence that staff attempted non-pharmacological interventions prior to the administration of
the as needed anti-anxiety medication.
28 Pa. code 211.12(d)(1)(5) Nursing services.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395343
If continuation sheet
Page 2 of 2
