Health inspection·August 1, 2024

F 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm Based on clinical record review and interviews with staff, it was determined that the facility failed to accurately complete a resident assessment for one of 21 residents reviewed (Resident R102). Residents Affected - Few Findings include: A review of Resident R102's quarterly Minimum Data Set (MDS- assessment of resident needs) dated May 15, 2024, revealed that the resident was discharge to hospital. Review of Resident R102's physician discharge summary revealed that the resident was discharged home with family. An interview with the Registered Nurse Assessment Coordinator, Employee E8, conducted on August 1, 2024, at 11:26 a.m. confirmed that Resident 102's MDS was coded inaccurately. 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 211.5(f) Medical records Page 1 of 7 395346 395346 08/01/2024 Onyx Wellness Center 205 East Johnson Highway Norristown, PA 19401

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a review of clinical records and interviews with staff, it was determined that the facility failed to develop and implement comprehensive person-centered plans of care in a timely manner, for three of 21 resident records reviewed (Residents R56, R97 and R71). Findings include: Review of Resident R56's clinical record revealed that she was admitted to the facility on [DATE], with the diagnoses of Parkinson's Disease (progressive disorder that affects the nervous system and the parts of the body controlled by the nerves causing hand tremors and difficulty moving). Review of Resident R56's Annual MDS (Minimum Data Set- assessment of resident's needs) dated June 6, 2024, section title Functional Limitation in Range of Motion revealed that Resident R56 had impairment on both sides for upper extremities. Observation Resident R56 conducted on July 29, 2024, at 11:30 a.m. revealed that Resident R56's bilateral hands and wrists were observed flexed and contracted and she was not wearing her hand splints which were noted on her bedside nightstand. Review of Resident R56's physician's orders dated July 12, 2024, revealed an order for BUE (bilateral upper extremity) resting hand splints to be placed on patient after breakfast and removed before lunch daily. Further review of Resident R56's clinical records did not reveal a care plan for the use of bilateral hand splints. Interview with the Director of Nursing (DON) on August 1, 2024, at 10:20 a.m. confirmed that the resident was not wearing the hand splints, and that the order was for between breakfast and lunch. The DON confirmed that there was no care plan for the use of bilateral hand splints for Resident R56. Review of Resident R97's clinical record revealed that he was admitted on [DATE], with the diagnoses of Fournier's gangrene (a rare, life-threatening bacterial infection of your scrotum, penis or perineum). Observation Resident R97 conducted on July 29, 2024, at 11:00 a.m. revealed that Resident R97's had a catheter draining clear yellow urine. When asked about the catheter the resident stated that it had not been changed since his admission and that he was to be discharged soon and would be meeting with his outside surgeon and hoped to have it removed soon. Review of Resident R97's physician's orders dated June 24, 2024, revealed an order for urinary catheter including daily care, drain catheter bag every shift and PRN (as needed). Further review of Resident R97's clinical records did not reveal a care plan for the use and care of a urinary catheter. Interview with the Director of Nursing (DON) on July 31, 2024, at 12:30 p.m. confirmed that there was no care plan for the use and care of a urinary catheter for Resident R97. Review of clinical records for resident R71 revealed that she was admitted to the facility on [DATE], and had diagnoses including, but not limited to, dementia (a condition of progressive cognitive 395346 Page 2 of 7 395346 08/01/2024 Onyx Wellness Center 205 East Johnson Highway Norristown, PA 19401

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few decline), psychosis (a condition where a person's thoughts and perceptions are disrupted and they may have difficulty recognizing what is real and what is not), and generalized muscle weakness. Additionally, an MDS (Minimum Data Set- a periodic assessment of resident needs) from July 7, 2024, reported in section O (Special Treatments and Programs) that the resident was receiving hospice care while at the facility. Continued review revealed a physician order from July 25, 2024, which stated Hospice services for DX (diagnosis) End Stage Senile Dementia. Review of the care plan for resident R71 revealed that no care plan had been developed for the resident's hospice care as of August 1, 2024. Interview with the DON and the Nursing Home Administrator (NHA) at 2:00 p.m. on August 1, 2024, revealed that it is the expectation of the facility to develop a care plan for all residents entering into hospice care. 28 Pa. Code 211.12(d)(3) Nursing services 28 Pa. Code 211.12(d)(5) Nursing services 395346 Page 3 of 7 395346 08/01/2024 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, clinical record reviews and interviews with staff, it was determined that the facility failed to provide restorative nursing programs for one of 21 residents reviewed (Residents R56). Findings include: Review of Resident R56's clinical record revealed that she was admitted on [DATE], the diagnoses of Parkinson ' s Disease (progressive disorder that affects the nervous system and the parts of the body controlled by the nerves causing hand tremors and difficulty moving). Review of Resident R56's Annual MDS (Minimum Data Set- assessment of resident's needs) dated June 6, 2024, section title Functional Limitation in Range of Motion, revealed that Resident R56 had impairment on both sides for upper extremities. Observation of Resident R56 conducted on July 29, 2024, at 11:30 a.m. revealed that Resident R56's bilateral hands and wrists were observed flexed and contracted and she was not wearing her hand splints which were noted on her bedside nightstand. Review of Resident R56's physician ' s orders dated July 12, 2024, revealed an order for BUE (bilateral upper extremity) resting hand splints to be placed on patient after breakfast and removed before lunch daily. Observation of Resident R56 on July 30, 2024, at 11 a.m. revealed that the resident was sitting in her wheelchair at the foot of her bed and was not wearing her hand splints, which were on her nightstand. Observation of Resident R56 on July 31, 2024, at 10:48 a.m. revealed that the resident was sitting in her wheelchair and not wearing her hand splints, which were sitting on the nightstand. Interview with Nurse aide, Employee E8, revealed that Resident R56 was not on her usual assignment, and that she was unaware that the resident was to be wearing her hand splints between breakfast and lunch. Observation of Resident R56 on August 1, 2024, at 10:00 a.m. revealed that the resident was sitting in her wheelchair and not wearing her hand splints. Interview with the Director of Nursing (DON) on August 1, 2024, at 10:20 a.m. confirmed that the resident was not wearing the hand splints, and that the order was for between breakfast and lunch, and that the facility was in the process of training the CNA staff for performing these restorative nursing orders. The DON interviewed Employee E9, CNA who ' s regular shift is 3 p.m. to 11 p.m. and who stated that she was unaware of placing the hand splints on Resident R56 after breakfast even though it was on Resident R56 ' s care card. 28 Pa. Code 211.12(d)(3) Nursing services 28 Pa. Code 211.12(d)(5) Nursing services 395346 Page 4 of 7 395346 08/01/2024 Onyx Wellness Center 205 East Johnson Highway Norristown, PA 19401

F 0801 Level of Harm - Minimal harm or potential for actual harm Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician. Based on staff interviews and a review of employee credentials, it was determined that the facility failed to employ a qualified director of food and nutrition services (Employees E4). Residents Affected - Few Findings include: An interview on July 29, 2024, at 9:15 a.m. with Employee E4, Food Service Director (FSD), revealed that his responsibilities included oversight of ordering, receiving, storing, preparation and service of food. Further interview with the FSD confirmed that he was not currently a certified dietary manager (CDM); or a certified food manager (CFM); or had a national certification for food service management and safety from a national certifying body; or had an associate's or higher degree in food service management or hospitality from an accredited institution; and that he had not received frequently scheduled consultations from a qualified dietitian. A review of Employee E4's credentials revealed that Employee E5 did not meet the statutory qualifications of a director of food and nutrition services. During an interview on August 1, 2024, at 12:50 p.m. with the Administrator, the FSD's personnel file was reviewed, and his qualifications were discussed which revealed he had not yet completed his program and had not taken the exam for Certified Dietary Manager or Certified Food Manager. The Administrator confirmed that the FSD had not completed these requirements. The Nursing Home Administrator was unable to provide evidence that the FSD was Certified, and therefore unqualified to direct the dietary department. 28 Pa Code 201.18(e)(1)(6) Management 28 Pa. Code 211.6(c)(d) Dietary services 395346 Page 5 of 7 395346 08/01/2024 Onyx Wellness Center 205 East Johnson Highway Norristown, PA 19401

F 0804 Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. Level of Harm - Minimal harm or potential for actual harm Based on review of facility documentation, observations, and resident and staff interviews, it was determined that the facility failed to provide food and drink that was palatable and served at the proper temperature for 18 of 18 residents interviewed (Residents R79, R89, R65, R39, R30, R97, R64, R35, R74, R21 R62, R53, R78, R88, R28, R27, R22 and R66.) Residents Affected - Some Findings include: A review of the undated Test Tray Evaluation form revealed that the standard temperature range for milk and cold beverage were 41° F. A test tray was conducted at the lunch meal on July 30, 2024, at 12:15 p.m. with the Food Service Director (FSD), which revealed that the carton of whole milk was served at 57 degrees. Upon tasting the milk tasted warm, and the baked ziti was not baked, but rather just mixed with the meat sauce and the noodles were overcooked and very soft and the meat sauce had an off sweet flavor, the mixed vegetables were very overcooked with the squash so soft the it could not be picked up with a fork, it just fell apart. The FSD confirmed that the milk should be at or below 41 degrees, and that 57 degrees was not acceptable. Resident interviews during the initial tour of the second floor North Hall on July 29, 2024, beginning at 10:05 a.m. revealed the following: Interview at 10:15 a.m. with Resident R79 revealed that he felt that the food sucks, he said that they don't send juice, but rather milk, he thinks they run out of juice all the time. Interview at 10:20 a.m. with Resident R89 revealed that she is not getting what is on the ticket, especially she is not getting the breakfast meats like ham yesterday of sausage the other day, which they are on the ticket, but she does not get it. The other day the ticket said coffee, but she did not get it. The resident indicated that she is very frustrated and feels like they don't listen to her or care. Interview at 10:27 a.m. with Resident R65 revealed that he is a diabetic and he feels that he is getting too much starch in foods like white rice, macaroni, pancake, waffles, etc. and he is concerned for his health. Interview at 10:32 a.m. with Resident R39 revealed that he is getting regular milk, and he should be getting lactose free milk every meal, and he prefers blueberry yogurt, but never gets that. Interview at 10:35 a.m. with Resident R30 revealed that she felt that the food has too much gravy on everything, and she wants whole milk with breakfast and supper, and that she does not like fish or rice and is receiving these items. Interview at 10:38 a.m. with Resident R97 revealed that he is not getting what is on the ticket, was supposed to get pancakes the other day, it is on the ticket, but he does not get it on his plate. Interview at 10:44 a.m. with Resident R64 revealed that he felt that the food sucks, he said that it is so bad that he will go days without eating, and he is tired of always spending his money, he should not have to buy his own food. 395346 Page 6 of 7 395346 08/01/2024 Onyx Wellness Center 205 East Johnson Highway Norristown, PA 19401

F 0804 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Interview at 10:50 a.m. with Resident R35 revealed that she felt that the food is usually too spicy for her, that she doesn't want pork and shouldn't have dairy products, tomatoes, nuts, or eggs and yet she says she gets these items regularly. A group meeting held at 10:11 a.m., on July 31, 2024, with alert and oriented residents (R74, R21 R62, R53, R78, R88, R28, R27, R22 and R66.) revealed that these residents were unsatisfied with the taste and temperature of the food and beverages that were being served for breakfast, lunch, and dinner daily. Food is usually dry meat, a lot of gravy, overcooked vegetables, and overcooked food. 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 201.18(b)(3) Management 28 Pa. Code 211.1 Dietetic Services, Principle 395346 Page 7 of 7