Health inspection·January 25, 2024

F 0623 Level of Harm - Potential for minimal harm Residents Affected - Many Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review, it was determined that the facility failed to notify the residents and the residents' representatives regardless of transfers from the facility and reasons for the moves in writing for six of nine sampled residents who were transferred to the hospital. (Residents 19, 28, 32, 79, 81, 123) Findings include: Clinical record review revealed that Resident 19 was transferred and admitted to the hospital on [DATE], after a change in condition. There was no documented evidence that the resident, the resident's responsible party, or the legal representative was provided written information regarding the resident's transfer to the hospital. Clinical record review revealed that Resident 28 was transferred and admitted to the hospital on [DATE], after a change in condition. There was no documented evidence that the resident, the resident's responsible party, or the legal representative was provided written information regarding the resident's transfer to the hospital. Clinical record review revealed that Resident 32 was transferred and admitted to the hospital on [DATE], and January 1, 2024, after a change in condition. There was no documented evidence that the resident, the resident's responsible party, or the legal representative was provided written information regarding the resident's transfer to the hospital. Clinical record review revealed that Resident 79 was transferred and admitted to the hospital on [DATE], and December 20, 2023, after a change in condition. There was no documented evidence that the resident, the resident's responsible party, or the legal representative was provided written information regarding the resident' transfer to the hospital. Clinical record review revealed that Resident 81 was transferred and admitted to the hospital on [DATE], after a change in condition. There was no documented evidence that the resident, the resident's responsible party, or the legal representative was provided written information regarding the resident's transfer to the hospital. Clinical record review revealed that Resident 123 was transferred and admitted to the hospital on [DATE], after a change in condition. There was no documented evidence that the resident, the resident's responsible party, or the legal representative was provided written information regarding the resident's transfer to the hospital. Page 1 of 6 395351 395351 01/25/2024 West Reading Skilled Nursing and Rehabilitation Ce 425 Buttonwood Street West Reading, PA 19611

F 0623 Level of Harm - Potential for minimal harm In an interview on January 24, 2024, at 12:54 p.m., the Administrator confirmed that written transfer information, including the reasons for the move, was not provided to the residents and the residents' representatives. Residents Affected - Many 395351 Page 2 of 6 395351 01/25/2024 West Reading Skilled Nursing and Rehabilitation Ce 425 Buttonwood Street West Reading, PA 19611

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 clinical record review and staff interview, it was determined that the facility failed to ensure that the Minimum Data Set (MDS) assessment was completed to accurately reflect the resident's current status for two of 27 sampled residents. (Residents 10, 32) Residents Affected - Few Findings include: Clinical record review revealed that Resident 10 had diagnoses that included vascular dementia and major depressive disorder recurrent with psychotic symptoms. On November 29, 2023, the resident received a last dose of an anti-psychotic medication (Risperidone). The MDS assessment dated [DATE], indicated that the resident was still on an anti-psychotic medication. The MDS inaccurately reflected that the resident was still on an anti-psychotic medication during the assessment look back period of seven days. Clinical record review revealed that Resident 32 had diagnoses that included diabetes mellitus and muscle wasting. On November 25, 2023, the physician directed nursing to administer enteral nutrition via a tube. The MDS assessment dated [DATE], indicated that the resident did not have any enteral nutrition and was not receiving any tube feeding formula through the tube during the seven day review period. The MDS inaccurately reflected that Resident 32 did not have a feeding tube and was not receiving any enteral nutrition through it during the seven day review period. In an interview on January 25, 2024, at 8:59 a.m., the Director of Nursing confirmed that both MDS assessments had not accurately reflected Resident 10 and 32's status during the seven day review period and had to be modified by the facility. 395351 Page 3 of 6 395351 01/25/2024 West Reading Skilled Nursing and Rehabilitation Ce 425 Buttonwood Street West Reading, PA 19611

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 ensure physician's orders were implemented for one of 27 sampled residents. (Resident 15) Residents Affected - Few Findings include: Clinical record review revealed that Resident 15 had diagnoses that included chronic kidney disease, hyperkalemia(high blood potassium), and anemia of chronic kidney disease. The resident had an arteriovenous (AV) fistula (an artificial tube used to connect an artery to a vein for hemodialysis) placed on the left arm in December 2021. On December 22, 2021, a physician's order directed staff to not obtain Resident 15's blood pressure or blood draws from the left arm related to the left arm AV fistula site. Review of Resident 15's blood pressure summary revealed that from December 22, 2023, through January 22, 2024, nursing had taken the resident's blood pressure in the left arm 25 of 96 times. In an interview conducted on January 25, 2024, at 10:00 a.m., the Director of Nursing confirmed that the staff should have taken Resident 15's blood pressure using the right arm. 28 Pa. Code 211.12(d)(1)(5) Nursing services. 395351 Page 4 of 6 395351 01/25/2024 West Reading Skilled Nursing and Rehabilitation Ce 425 Buttonwood Street West Reading, PA 19611

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 clinical record review, observation and staff interview, it was determined that the facility failed to provide services and treatment to prevent a further decrease in range of motion and contractures for one of four sampled residents with limited range of motion. (Resident 62) Findings include: Clinical record review revealed that Resident 62 had diagnoses that included a stroke with left sided paralysis, dementia, abnormal posture and contracture of the muscle. The Minimum Data Set assessment dated [DATE], indicated that the resident had some memory impairment, required extensive assistance from staff for dressing and had limitations in range of motion in both lower extremities. Review of an occupational therapy Discharge summary dated [DATE], revealed that there was a recommendation for staff to apply a left lower extremity bean bag splint at all times. Review of the care plan identified the resident had a self care deficit related to activities of daily living due to physical limitations due to a stroke. There was an intervention for staff to apply a left lower extremity bean bag splint at all times. On January 23, 2024, at 10:00 a.m., 11:58 a.m., and 1:00 p.m., the resident was dressed and in his chair without the bean bag splint in place on his lower left extremity. On January 24, 2024, at 10:14 a.m. and 12:00 p.m., the resident was again dressed and in his chair without the bean bag splint in place on his lower left extremity. In an interview on January 25, 2024, at 9:28 a.m., the Director of Rehabilitation Therapy stated that the bean bag splint was to be applied by staff at all times on his lower left leg in order to help prevent contractures and further decrease in range of motion. 28 Pa. Code 211.12(d)(1)(5) Nursing services. 395351 Page 5 of 6 395351 01/25/2024 West Reading Skilled Nursing and Rehabilitation Ce 425 Buttonwood Street West Reading, PA 19611

F 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on policy review, observation, and staff interview, it was determined that the facility failed to store food in a sanitary manner in the dietary department. Residents Affected - Many Findings include: Review of the facility's policy entitled, Refrigerated/ Frozen Storage, last reviewed November 3, 2023, revealed that all foods were to be labelled with a date received and prepared food items were to be dated. Observation during the kitchen tour on January 23, 2024, at 10:00 a.m., revealed that in the kitchen freezer, there were three bags of spinach removed from the original box and not dated. In the snack refrigerator, there was a tray of 14 dishes containing applesauce or fruit cocktail that were not dated. There was a dish of pureed fruit cocktail with a date of January 6, 2024. In the milk refrigerator, there were two containers of cottage cheese with a use-by date of January 19, 2024, and two containers of icing that were not dated. In the cook's refrigerator, there were two mislabeled chef salads. The coffee machine table had a bottom shelf that had multiple areas of peeling paint. The shelf had three pitchers that were stored upside down, with the top rim directly touching the peeling paint areas. The pitchers were used for residents per the Dietary Manager (DM). In an interview conducted on January 23, 2024, at 10:30 a.m., the DM confirmed all the previously mentioned food items should have been dated and were not and that the expired items should have been removed. 28 Pa. Code 201.14(a) Responsibility of licensee. 395351 Page 6 of 6