Health inspection·August 3, 2023

F 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances. Based on a review of the grievance policy, review of facility documentation, and interviews of residents and facility staff, it was determined that the facility failed to resolve a grievance related to the resident's personal property in a timely manner for three of 22 residents reviewed. (Residents R12, R86, and R76). Findings include: Review of the facility's policy labeled Resident's Personal Belongings, effective July 2023, indicated that the clothing should be labeled by resident's representative or facility representative and then listed on the inventory sheet. A thorough investigation will be conducted if items are reported missing or damage, and the facility will not be responsible unless the damage or loss was identified as cause by the action of the facility's employee(s) or facility systems. Under Missing personal property states Any repot of missing personal property will result in the initiation of grievance form which will be given to Social Services, administrator, or grievance official. The facility's concern procedure will then be initiated. An interview was held on July 31, 2023, at 11:37 a.m. with Resident R12 who reported that he had clothing missing lot of clothing, 20 pairs of underwear, 2 pair of shorts with buttons. An interview was conducted on August 1, 2023, 1:38 p.m. with Social Worker, Employee E7, who reviewed a grievance initiated on April 18, 2023, for the personal clothing missing. Based on the investigation facility determined to reimburse Resident R12 for the missing item of a total of $306.00. Grievance was marked as resolved on May 4, 2023. Further investigation revealed that resident did not receive the reimbursement check as of August 1, 2023. Interview with the Nursing Home Administrator (NHA) on August 2, 2023, at 1:05 p.m. confirmed that there was no documented evidence to show Resident R12 received reinbursement for persobnal clothing. A check was overnighted on August 1, 2023, and Resident R12 received his check on August 3, 2023. NHA reported that all of her staff were reeducated on August 1, 2023 about resident missing items and process in reimbursement. An interview with Resident R86 on July 31, 2023, at 11:15 a.m. revealed that Resident R86 had no clothing to wear, and all of her clothing was to the laundry last week. Observation of the clothing in Resident R86's closet confirmed that Resident R86 had no clothing and was wearing a hospital gown. An interview with Resident R76 on July 31, 2023, at 12:01 p.m. revealed that R76 had no clothing to wear and was wearing a hospital gown. Observation of clothing in R76's closet confirmed that R76 Page 1 of 9 395346 395346 08/03/2023 Onyx Wellness Center 205 East Johnson Highway Norristown, PA 19401

F 0585 had no clothing. Level of Harm - Minimal harm or potential for actual harm An interview with the housekeeping director, Employee E25, on July 31, 2023, at 12:05 p.m. revealed a person who was doing personal laundry quit last week and now there was one staff doing laundry. Residents Affected - Few An interview with NHA on July 31, 2023, at 12:38 p.m. revealed that one washing machine was down last Thursday, July 27, 2023 and it was fixed Friday July 28, 2023 and resident's clothing needing to be washed was backed up. Validation of documentation of the washing machine was requested multiple times and it was not provided to validate the damage. Tour of facility's laundry room on August 1, 2023 at 1:43 p.m., with laundry director, employee E24, revealed the unlabeled blanket for Resident R5 prepared to be delivered back to Resident R5. During the resident council meeting, which was held on August 2, 2023, at 10:30 a.m. with 23 alert and oriented residents R74, R35, R72, R27, R52, R30, R93, R3, R85, R64, R4, R38, R77, R16, R3,R83, R45, R73, R86, R87, R41, R18 revealed six of the residents were still were missing clothing from laundry . 28 Pa. Code: 201.14 (a) Administrator's responsibility 28 Pa. Code: 201.18 (b) (3) Management 28 Pa. Code: 201.29(j) Resident rights 395346 Page 2 of 9 395346 08/03/2023 Onyx Wellness Center 205 East Johnson Highway Norristown, PA 19401

F 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. Level of Harm - Minimal harm or potential for actual harm Based on review of policies, review of personnel files, and staff interviews, it was determined that the facility failed to complete an employment reference verification upon hire for five of five newly hired employees reviewed (Employee E17, E18, E19, E20, E21). Residents Affected - Few Findings include: The facility's policy regarding abuse and screening potential employees, revised March 2023, revealed that under screening procedures potential employees will be screened, per federal &/or state regulation, during the hiring process for history of abuse, neglect, or mistreatment of residents. Screening will consist of inquiring. Into the State licensing authorities, inquiries into State nurse aide registry, reference checks from previous and/or current employers, criminal background checks will be completed to identify any potential employee unfit to work in LTC, resulting of the screening will be recorded to include the date, name and title of person contacted for reference, and name of person obtaining the reference. This document is filled with other employee records. The personnel file for license nurse, Employee E17 revealed that she was hired on June 28, 2023; license nurse, Employee E18, hired on June 20, 2023; nurse aid, Employee E19, hired on May 23, 2023; Dietary aide, Employee E20, hired on April 25, 2023, and Maintenance Director, Employee E21, hired on April 11, 2023. As of August 3, 2023, there was no documented evidence that the newly hired employees references were verified prior to hire. Interview with the Nursing Home Administrator on August 3, 2023, at 9:46 a.m. confirmed that there was no documented evidence of a reference, prior to employment, being completed as required upon hire for Employees E17, E18, E19, E20, E21. 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 201.18(e)(1) Management 395346 Page 3 of 9 395346 08/03/2023 Onyx Wellness Center 205 East Johnson Highway Norristown, PA 19401

F 0623 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. Based on review of facility documentation and interviews with staff, it was determined that the facility failed to notify the Office of the State Long-Term Care Ombudsman of facility-initiated emergency transfers and discharges as required for three of three months reviewed. (May, June and July 2023) Findings include: Documentation of notification to the Office of the State Long-Term Care Ombudsman of facility-initiated emergency transfers and discharges for the past three months (May, June and July 2023) was requested on August 3, 2023, at 11:05 a.m. from Employee E1, Nursing Home Administrator (NHA). Interview with NHA on August 3, 2023, at 12:15 p.m. confirmed that the facility did not send the notification to the Office of the State Long-Term Care Ombudsman of facility-initiated emergency transfers and discharges for the past three months. She indicated that this function was to be performed by a new employee in the business office, but that the person was not instructed to send these notices. Continued interview revealed that the NHA was not aware that the new employee was not sending the required notices to the Office of the State Long-Term Care Ombudsman. 28 Pa Code 201.14(a) Responsibility of licensee 28 Pa Code 201.18(b)(2) Management 395346 Page 4 of 9 395346 08/03/2023 Onyx Wellness Center 205 East Johnson Highway Norristown, PA 19401

F 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a review of clinical records and review of the Resident Assessment Instrument and staff interview, it was determined that the facility failed to ensure that the Minimum Data Set Assessments (MDS - a federally mandated standardized assessment conducted at specific intervals to plan resident care) accurately reflected the status of two out of 22 sampled resdients (Residents R97 & R98). Residents Affected - Few Findings included: A review of Resident R97's Discharge MDS assessment dated [DATE], Section A2100 Discharge Status revealed that Resident R97 was coded 01 Community (private home/apartment, boarding home, assisted living, group home) or discharged home. Review of Resident R97's clinical record revealed a June 7, 2023, progress note written at 11:30 p.m. documenting that the resident was taken by ambulance to the hospital to be evaluated and indicating that the discharge MDS was not accurate. Interview with the Registered Nurse Assessment Coordinator (RNAC) on August 3, 2023, at 11:05 a.m. revealed that she was unsure when she coded the MDS as she was informed that Resident R97 was taken to jail. Interview with the Director of Nursing on August 3, 2023, at 11:07 a.m., confirmed that Resident R97's discharge MDS should have been coded 03 Acute Hospital as he left the facility in an ambulance and was taken to the hospital for evaluation before being arrested and taken to jail, making the MDS inaccurate. A review of Resident R98's Discharge MDS assessment dated [DATE], Section A2100 Discharge Status revealed that Resident R98 was coded 03 Acute Hospital. Review of Resident 98's clinical record revealed a June 9, 2023, progress note written at 4:00 p.m. documenting that the resident was discharged home awake and alert with all belongings and medications leaving the unit with his responsible party and indicating that the discharge MDS was not accurate. Interview with the Registered Nurse Assessment Coordinator (RNAC) on August 3, 2023, at 11:00 a.m. revealed that she was confused when she coded the MDS as Resident R98 was recently hospitalized , but that it should have been coded 01, Community as he was discharged home with his family. 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 211.5(f) Clinical Records 395346 Page 5 of 9 395346 08/03/2023 Onyx Wellness Center 205 East Johnson Highway Norristown, PA 19401

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 observations, clinical record review, staff interview, review of facility policy and interview with residents, it was determined that the facility to ensure that a breathing medication was provided as ordered byt the physician for one of 22 residents reviewed (Resident R88) Residents Affected - Few Findings include: Review of facility's policy for 'Medication Administration' revised on September 2018, states: If a dose of regularly scheduled medication is withheld, refused, or given at other than the scheduled time, the space provided on the front of the medication administration record (MAR) for that dosage administration is initiated and circled. An explanatory note is entered on the reverse side of the record provided for PRN (as needed) documentation. If two consecutive doses of a vital medication are withheld or refused, the physician is notified. Additional review of policy revealed The individual who administers the medication dose, records the administration on the resident's MAR immediately following the medication being given. In no case should the individual who administered the medications report off-duty without first recording the administration of any medications. Review of Resident R88's clinical records revealed diagnosis of chronic obstructive pulmonary disease (COPD - difficulty breathing), anemia (when your blood produces a lower-than-normal amount of healthy red blood cells), heart failure. Review of Resident R88's physicians orders revealed an active order placed on July 26, 2023 for Incruse Ellipta Inhalation Aerosol Powder Breath activated 62.5 mcg/act to use 1 puff inhale orally one time a day for asthma/COPD. Interview with Resident R88 on August 1, 2023 at 1:58 p.m., revealed that he has not been receiving a stronger congestion medication. Resident R88 stated that he has been prescribed an inhaler which he has not been receiving consistently, and only received it twice. Review of Resident R88's electronic MAR revealed that Incruse inhaler administration has been administered and signed out by licensed nurse, each day since an order was placed on July 26, 2023. However, observation of Resident R88's Incruse inhaler dose counter revealed number 28 on August 2, 2023. According to Incruse Ellipta inhaler manufacturer's product information regarding dose counter, before the inhaler has been used, it shows exactly 30 doses. It counts down by 1 each time you open the cover. Finding confirmed with Licensed nurse, Employee E17. 28 Pa Code 211.2(c) Nursing services 28 Pa Code 211.2(d)(1) Nursing services 28 Pa Code 211.2(d)(5) Nursing services 395346 Page 6 of 9 395346 08/03/2023 Onyx Wellness Center 205 East Johnson Highway Norristown, PA 19401

F 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. Based on observations, clinical record review and interviews with staff, it was determined that the facility did not ensure that a resident received appropriate treatment services for contracture management as recommended for one out of 22 residents reviewed (Resident R49) Findings include: Review of Resident R49's clinical records revealed diagnosis of stiffness of left shoulder, stiffness of left elbow, contracture (a condition of shortening and hardening of muscles, tendons, or other tissue, often leading to deformity and rigidity of joints) of left knee, contracture of left hip, contracture of left hand, and contracture of left thigh. Review of 'Therapy Recommendations for Restorative/Functional Maintenance Program, completed by occupational therapist, Employee E25, on April 12, 2023, revealed the following: Resting hand splint on left UE (upper extremity) - 9AM to noon, daily, or as tolerated by patient. Skin check before application of resting hand splint - and upon removal of hand splint. Review of Resident R49's orders revealed an active order placed on January 26, 2021, by unit manager, Employee E26, to apply left hand splint at bedtime daily, inspect skin under splint and document. Additional order placed on January 26, 2023 revealed Remove L (left) hand splint daily in AM. Inspect skin under splint. Document. Review of Resident R49's care plan revealed focus on Range Of Motion: the resident has a risk or actual limitations in Range of Motion as evidence by; contracture to left UE, with an intervention to Splint to UE daily on at 9am, removed at 12 noon or as tolerated by resident. During medication administration observation on August 1, 2023, at 9:42 a.m., Resident R49 was observed without the hand splint. Resident R49 stated that she has two hand splints which were in her bedside drawer and that she was unsure when to use the hand splint on the contractured hand. Additional observation of the electronic medication administration record revealed that licensed nurse, Employee E17, signed out treatment for left hand splint removal on August 1, 2023. Upon interview, Employee E17 stated that nurse aide probably removed left hand splint during morning care. Employee E17 confirmed that Resident R49 is to have left hand splint applied overnight and removed in the morning. Additional interview with Licensed nurse, Employee E23, on August 2, 2023 at 10:28 a.m. revealed that she follows physicians orders over occupational therapist recommendations as mentioned in Resident R49's care plan. Additional interview with facility's resident assessment coordinator on August 2, 2023 at 11:00 a.m., revealed that recommendation from occupational therapist to apply splint from 9 a.m. to noon was not incorporated into Resident R49's orders; resulting in miscommunication between nursing staff regarding timing and duration of left hand splint application. 28 Pa. Code 211.12(d)(3) Nursing services 28 Pa. Code 211.12(d)(5) Nursing services 395346 Page 7 of 9 395346 08/03/2023 Onyx Wellness Center 205 East Johnson Highway Norristown, PA 19401

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observations and interviews with staff, it was determined that the facility did not ensure that food was stored, prepared, distributed and served in accordance with professional standards for food service safety. Findings include: A tour of the Food Service Department conducted on July 31, 2023, at 10:45 a.m. with the Food Service Director (FSD), Employee E4, revealed the following concerns: Observation in the dry food and paper storage area revealed a broken ceiling tile. Observations in the dish room area revealed a big box under the dish table, which was a Hatco booster heater that was no longer in use which was dusty and dirty, and the top cover was rusted through creating a sharp-edged opening to the inside electrical components and the surrounding pipes and table legs were dusty and soiled. Observations in the kitchen revealed dirty and broken ceiling tiles above the coffee urn and which was missing the top cover, and the shelf under the coffee urn was dusty and the paint was peeling from the surface revealing rust colored substance. Observations in the kitchen revealed an HVAC vent with white peeling paint hanging from the surface. Observation in the hot production area revealed a dirty wall behind the stove with dark splashed on food debris sticking to the wall and baseboard. Observation of the milk refrigerator revealed that the milk crates were in at least one inch of standing water. Interview with the FSD on July 31, 2023, at 10:55 a.m. confirmed the above findings. 28 Pa. Code 201.14(a) Responsibility of licensee 395346 Page 8 of 9 395346 08/03/2023 Onyx Wellness Center 205 East Johnson Highway Norristown, PA 19401

F 0814 Dispose of garbage and refuse properly. Level of Harm - Minimal harm or potential for actual harm Based on observations and an interview with staff it was determined that the facility did not ensure that garbage and refuse was disposed of properly. Residents Affected - Few Finding include: A tour of the Food Service Department conducted on July 31, 2023, at 10:45 a.m. with the Food Service Director (FSD), Employee E4, revealed the following concerns: Observation in the back of the facility revealed that the dumpster area had seven old mattresses leaning against the dumpster, which was missing a lid on one side of the top leaving the trash inside exposed and the slider door was not closed all the way. Further observation revealed a lot of debris around the dumpsters including used latex gloves, paper and plastic waste. An interview with the FSD on July 31, 2023, at 10:55 a.m. confirmed the above findings. 28 Pa. Code 201.18(b)(3) Management 28 Pa. Code 207.2(a) Administrator's responsibility 395346 Page 9 of 9