Health inspection·October 9, 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, observation, and resident and staff interview, it was determined that the facility failed to provide the highest practicable care regarding physician ordered medications for five of five residents (Residents 1, 2, 3, 4, and 5) and provide incontinence care for one of five residents reviewed (Resident 1). Residents Affected - Few Findings include: Clinical record review for Resident 1 revealed physician orders for staff to administer the following medications: Metoprolol Tartrate 25 mg (milligrams) by mouth (PO) twice daily (BID) for hypertension (high blood pressure) Gabapentin 100 mg PO three times daily (TID) for venous insufficiency Hydralazine 25 mg PO TID for hypertension Lasix 60 mg PO in the morning for edema Escitalopram Oxalate 10 mg PO daily (QD) for major depression Aspirin EC Delayed Release 325 mg PO QD for cerebral infarction (stroke) Allopurinol 300 mg PO QD for gout Pramipexole Dihydrochloride 0.25 mg PO QD for restless legs Vitamin D3 25 mcg 5 tablets in the morning for vitamin deficiency Alphagan P Ophthalmic Solution 0.15% 1 drop bilateral (b/l) eyes BID for glaucoma Fluticasone Propionate 50 mcg/act 1 spray both nostrils (nose) BID Review of Resident 1's September 2024 MAR (medication administration record, a form to document medication administration) revealed that there was no documentation that staff administered their medications on September 8, 2024, for the 6:00 AM and 8:00 AM administration times. Clinical record review for Resident 2 revealed physician orders for staff to administer the Page 1 of 4 395350 395350 10/09/2024 Locust Grove Retirement Village 69 Cottage Road Mifflin, PA 17058

F 0684 following medications: Level of Harm - Minimal harm or potential for actual harm Clearlax powder 17 grams/scoop 17 grams PO in the morning for constipation Cranberry tablet 450 mg PO in the morning related to urinary incontinence Residents Affected - Few Divalproax Sodium delayed release 500 mg 3 tablets in the morning for mood disorder Loratidine 10 mg PO QD for allergic rhinitis Omeprazole 20 mg PO QD for indigestion Metformin HCL 1000 mg BID for Diabetes with meals Acetaminophen 325 mg 4 tablets PO TID for compression vertebra fracture Repaglinide 1 mg PO before meals for Diabetes Artificial Tears 1% 1 drop in right eye four times daily (QID) for severe dry eyes Barrier cream to groin TID and as needed (PRN) with brief changes for irritation to groin Review of Resident 2's September 2024 MAR revealed that there was no documentation that staff administered their medications on September 8, 2024, for the 6:00 AM. 7:30 AM, and 8:00 AM administration times. Clinical record review for Resident 3 revealed physician orders for staff to administer the following medications: Finasteride 5 mg Po QD related to benign prostate hyperplasia (BPH, prostate enlargement) Omeprazole 20 mg PO QD related to reflux Prozac 10 mg PO QD for major depression Tamsulosin HCL 0.4 mg PO QD for BPH Zonisamide 100 mg 4 capsules PO QD for epilepsy (seizures) Keppra 100 mg/ml 15 mg PO BID for epilepsy Miralax 17 grams PO BID for constipation Phenobarbital 97.2 mg 0.5 tablet PO BID for epilepsy Senna S 8.6-50 mg 2 tablets PO BID for constipation Ursodiol 300 mg PO BID for retained cholelithiasis (gallstones in the abdomen after surgery) 395350 Page 2 of 4 395350 10/09/2024 Locust Grove Retirement Village 69 Cottage Road Mifflin, PA 17058

F 0684 Level of Harm - Minimal harm or potential for actual harm Review of Resident 3's September 2024 MAR revealed that there was no documentation that staff administered their medications on September 8, 2024, for the 10:00 AM administration time. Clinical record review for Resident 4 revealed physician orders for staff to administer the following medications: Residents Affected - Few Aspirin 81 mg PO QD for peripheral vascular disease (PVD) Calcium and Vitamin D3 600-100 mg-mcg PO in the morning as a supplement Clopidogrel 75 mg PO QD for PVD Multivitamin 1 tablet PO QD as a supplement Polyethylene powder 17 gram PO in the morning for constipation Potassium Chloride ER 10 mEq (milliequivalent) PO in the morning for low potassium Senna-S 8.6-50 mg PO QD for constipation House supplement 4 ounces TID between meals as a supplement Review of Resident 4's September 2024 MAR revealed that there was no documentation that staff administered their medications on September 8, 2024, for the 10:00 AM administration time. Clinical record review for Resident 5 revealed physician orders for staff to administer the following medications: Cholestyramine Light powder 4 grams PO BID with meals Levetiracetam 100 mg/ml (milliliter) 5 ml PO BID for encephalopathy (brain disfunction) Lorazepam 0.5 mg BID for anxiety Omeprazole 20 mg 2 capsule PO BID for reflux Prednisone 5 mg PO BID for encephalopathy Pyridostigmine Bromide 60 mg PO TID for myasthenia gravis (autoimmune muscle weakness) Sucralfate 1 gram PO QID for gastrointestinal bleed Review of Resident 5's September 2024 MAR revealed that there was no documentation that staff administered their medications on September 8, 2024, for the 6:00 AM, 8:00 AM, and 10:00 AM administration times. Clinical record review for Resident 1 revealed that staff completed an MDS (Minimum Data Set, an assessment tool completed at specific intervals to determine resident care needs) on August 3, 2024. Staff indicated that Resident 1 was cognitively intact, frequently incontinent of bladder, was able 395350 Page 3 of 4 395350 10/09/2024 Locust Grove Retirement Village 69 Cottage Road Mifflin, PA 17058

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few to transfer to and from the toilet with supervision/touch assistance but required substantial/maximum assistance with toileting abilities to maintain perineal (groin) hygiene and adjust clothes before and after voiding. Review of Resident 1's September and October 2024, task intervention documentation (an action intended to improve the resident's health and comfort) regarding toileting revealed that staff were to provide toileting every two hours. Staff documented that Resident 1 usually accepted toileting utilizing limited assistance of one staff person. Review of October 5, 2024, and October 6, 2024, toileting documentation revealed that staff documented the following: Toileting refusalsOctober 5, 2024, at 2:00 AM, 12:00 PM, 2:00 PM, and 6:00 PM October 6, 2024, at 2:00 AM, 6:00 AM, 08:00 AM, 10:00 AM, 12:00 PM, 2:00 PM, and 6:00 PM Staff documented that toileting Resident 1 was not applicable on October 5, 2024, at 6:00 AM and 8:00 AM. There was no documentation that indicated nurse aide staff notified their charge nurses regarding Resident 1's frequent toileting refusals. Interview with Resident 1 on October 9, 2024, at 10:50 AM revealed that they did not have any concerns with staff or the care that they provided, however, she indicated that when staff call off it takes longer for staff to respond to her call bell and care needs. Review of facility staff scheduling revealed that on October 5, 2024, only three nurse aides worked during day shift and only 2.88 nurse aides worked during the evening shift for a census of 64 residents. The facility provided an average of 2.73 hours of direct nursing care to residents on October 5, 2024. On October 6, 2024, only 3.63 nurse aides worked during the day shift, 2.5 nurse aide worked during the evening shift, and three nurse aides during the overnight shift for a census of 64 residents. The facility provided an average of 2.45 hours of direct nursing care to residents on October 6, 2024. The facility did not provide sufficient staff to provide direct nursing care and services to residents. The surveyor reviewed the above information during an interview on October 9, 2024, at 2:15 PM with the Nursing Home Administrator. 483.25 Quality of Care Previously cited 5/3/24 28 Pa. Code 211.10(c) Resident care policies 28 Pa. Code 211.12(c)(d)(1)(3)(5) Nursing Services 395350 Page 4 of 4