Health inspection·July 25, 2024

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 record review and staff interview, it was determined that the facility failed to implement physician's orders for one of 15 sampled residents. (Resident 52) Residents Affected - Few Findings include: Clinical record review revealed that Resident 52 had diagnoses that included bacteremia (bacteria in the blood), congestive heart failure, and respiratory failure. A physician's order dated June 30, 2024, directed staff to weigh the resident daily and to notify the doctor for a weight gain of two or more pounds (lbs.) in one day. On July 20, 2024, the resident weighed 88.2 lbs. On July 21, 2024, the resident weighed 90.2 lbs., which reflected a weight gain of two lbs. in one day. There was no evidence that staff notified the doctor of the weight change per the order. A review of physician's orders dated July 1 through 9, 2024, and the Medication Administration Record for July 2024, revealed the following: Staff were to change administration tubing with the first dose of ampicillin (an antibiotic) daily. There was no evidence that the tubing was changed as ordered on two occasions. Staff were to administer ceftriaxone sodium (an antibiotic) two grams (g) intravenously (IV) every 12 hours daily. There was no evidence that the medication was administered as ordered on one occasion. Staff were to administer florastor oral capsule 250 milligrams (mg) two times per day. There was no evidence that the medication was administered as ordered on one occasion. Staff were to administer heparin sodium (a blood thinner) five milliliters (ml) via IV. There was no evidence that it was administered on ten occasions. Staff were to administer normal saline 10 ml via IV. There was no evidence to support that it was administered on 19 occasions. Staff were to replace a green antimicrobial cap to each port. There was no evidence that the cap was replaced on 10 occasions. Staff were to administer ampicillin sodium (an antibiotic) 2000 mg via IV three times per day. There was no evidence that the medication was administered as ordered on seven occasions. (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 3 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 07/25/2024 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)