Health inspection·December 10, 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. Based on clinical record review and staff interview, it was determined that the facility failed to notify the resident and the resident's representative(s) of transfer(s) from the facility, including the reasons for the moves and Ombudsman information, in writing upon transfer for eight of eight sampled residents who were transferred to the hospital. (Residents 39, 85, 89, 94, 95, 143, 146, 157) Findings include: Clinical record review revealed that Resident 39 was transferred to the hospital on October 25 and November 7, 2024, after changes in condition. There was no documentation to support that the resident or the resident's responsible party or legal representative was provided written information regarding the transfers to the hospital. Clinical record review revealed that Resident 85 was transferred to the hospital on July 9, September 1 and 13, and October 2, 2024, after changes in condition. There was no documentation to support that the resident or the resident's responsible party or legal representative was provided written information regarding the transfers to the hospital. Clinical record review revealed that Resident 89 was transferred to the hospital on November 3, 2024, after a change in condition. There was no documentation to support that the resident or the resident's responsible party or legal representative was provided written information regarding the transfer to the hospital. Clinical record review revealed that Resident 94 was transferred to the hospital on August 23, 2024, after a change in condition. There was no documentation to support that the resident or the resident's responsible party or legal representative was provided written information regarding the transfer to the hospital. Clinical record review revealed that Resident 95 was transferred to the hospital on July 7, 2024, after a change in condition. There was no documentation to support that the resident or the resident's responsible party or legal representative was provided written information regarding the transfer to the hospital. Clinical record review revealed that Resident 143 was transferred to the hospital on November 2, 2024, after a change in condition. There was no documentation to support that the resident and/or the resident's responsible party or legal representative was provided written information regarding the transfer to the hospital. Page 1 of 13 395351 395351 12/10/2024 West Reading Skilled Nursing and Rehabilitation Ce 425 Buttonwood Street West Reading, PA 19611

F 0623 Level of Harm - Potential for minimal harm Residents Affected - Many Clinical record review revealed that Resident 146 was transferred to the hospital on December 4, 2024, after a change in condition. There was no documentation to support that the resident or the resident's responsible party or legal representative was provided written information regarding the transfer to the hospital. Clinical record review revealed that Resident 157 was transferred to the hospital on September 11, 2024, after a change in condition. There was no documentation to support that the resident and/or the resident's responsible party or legal representative was provided written information regarding the transfer to the hospital. In an interview on December 10, 2024, at 9:45 a.m., the Administrator confirmed that residents and/or resident representatives were not given written notice regarding transfers from the facility. CFR 483.15(c)(3) Notice before transfer Previously cited 1/25/24 395351 Page 2 of 13 395351 12/10/2024 West Reading Skilled Nursing and Rehabilitation Ce 425 Buttonwood Street West Reading, PA 19611

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 clinical record review and staff interview, it was determined that the facility failed to develop a comprehensive care plan that addressed individual resident needs as identified in the comprehensive assessment for four of 32 sampled residents. (Residents 16, 48, 132, 143) Findings include: Clinical record review revealed that Resident 16 had diagnoses that included pressure ulcer of the sacral region. The Minimum Data Set (MDS) assessment dated [DATE], noted that the resident had a pressure area. The MDS Care Area Assessment (CAA) summary dated September 12, 2024, noted that the resident's pressure area was to be addressed in the care plan. There was no evidence that interventions to address Resident 16's pressure area were included in the current care plan. Clinical record review revealed that Resident 48 had diagnoses that included obstructive uropathy (build up of excess urine in the kidneys). The MDS assessment dated [DATE], noted that the resident had an indwelling catheter. The MDS CAA summary dated September 19, 2024, noted that the resident's indwelling catheter was to be addressed in the care plan. There was no evidence that interventions to address Resident 48's indwelling catheter were included in the current care plan. Clinical record review revealed that Resident 132 was admitted to the facility on [DATE], and had diagnoses that included neoplasm of the bladder and pancreas, cervicalgia, and migraines. The MDS assessment dated [DATE], noted that the resident received daily scheduled pain medication. The MDS CAA summary dated November 4, 2024, noted that the resident's pain was to be addressed in the care plan. There was no evidence that interventions to address Resident 132's pain were included in the current care plan. Clinical record review revealed that Resident 143 was admitted to the facility on [DATE], and had diagnoses that included acute cerebrovascular insufficiency, cellulitis, and psoriasis. The MDS assessment dated [DATE], noted that the resident was frequently incontinent. The MDS CAA summary dated July 19, 2024, noted that the resident's urinary incontinence was to be addressed in the care plan. There was no evidence that interventions to address Resident 143's urinary incontinence were included in the current care plan. In an interview on December 10, 2024, at 11:44 a.m., the Director of Nursing confirmed the above care areas were not addressed in the care plans. CFR 483.21(b)(1) Comprehensive Care Plans Previously cited 1/25/2024 28 Pa. Code 211.12(d)(1)(5) Nursing services. 395351 Page 3 of 13 395351 12/10/2024 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 implement physician's orders for two of 32 sampled residents. (Residents 16, 56) Residents Affected - Few Findings include: Clinical record review revealed that Resident 16 had diagnoses that included hypotension (low blood pressure). A physician's order dated June 7, 2024, directed staff to administer a medication (midodrine) three times a day every Monday, Wednesday, and Friday for hypotension. Staff were not to administer the medication if the resident's systolic blood pressure (SBP, the first measurement of blood pressure when the heart beats and the pressure is at its highest) was greater than 130 millimeters of mercury (mmHg). Review of Resident 16's medication administration records (MARs) revealed that staff administered the medication seven times in November and four times in December 2024 when the resident's SBP was greater than 130 mmHg. Clinical record review revealed that Resident 56 had diagnoses that included cerebral infarction (sudden loss of blood flow to the brain), chronic kidney disease, and chronic osteomyelitis (bone infection). A physician's order dated October 29, 2024, directed staff to weigh the resident weekly on Tuesday for four weeks, then monthly. A review of the MAR revealed that there was no evidence that staff weighed Resident 56 as ordered on November 5, 19, and 26, 2024. In an interview on December 10, 2024, at 10:05 a.m., the Director of Nursing confirmed that the medication was administered outside of the established parameters for Resident 16 and that there was no documented evidence that Resident 56 was weighed as ordered. CFR 483.25 Quality of care Previously Cited 1/25/24 28 Pa. Code 211.12(d)(1)(5) Nursing services. 395351 Page 4 of 13 395351 12/10/2024 West Reading Skilled Nursing and Rehabilitation Ce 425 Buttonwood Street West Reading, PA 19611

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on facility policy review, clinical record review, review of facility documentation, and staff interview, it was determined that the facility failed to ensure that safety interventions were implemented to prevent falls and that the physician was notified per facility policy for one of 32 sampled residents. (Resident 146) Findings include: Review of the facility policy entitled, Accidents/Incidents, last reviewed November 15, 2024, revealed that staff was to investigate all accidents and implement appropriate interventions based on conclusions, and that the physician would be notified of any unwitnessed fall. Clinical record review revealed that Resident 146 was admitted to the facility on [DATE], with diagnoses that included hemiplegia and hemiparesis (paralysis), and altered mental status. Review of the Minimum Data Set assessment dated [DATE], revealed that the resident had cognitive impairment. Review of the care plan revealed Resident 146 was at risk for falls due to cognitive loss and lack of safety awareness. Review of facility documentation revealed that Resident 146 had unwitnessed falls on October 22, November 1, 8, 14, 20, and December 7, 2024, and no additional interventions were put into place. On November 3, 2024, Resident 146 had a fall with an intervention for a bowel and bladder assessment, and on November 15, 2024, with an intervention for safety checks every 15 minutes. There was no documented evidence that a bowel and bladder assessment was completed or that safety checks were put into place. There was no documented evidence that the physician was notified of the fall on November 20, 2024. In an interview on December 10, 2024, at 11:45 a.m., the Director of Nursing confirmed that there were no safety interventions initiated after the falls, and that there should have been. The Director of Nursing also confirmed that there was no bowel and bladder assessment completed, or safety checks implemented, and that the physician was not notified of the fall on November 20, 2024. 28 Pa. Code 211.12(d)(1)(5) Nursing services. 395351 Page 5 of 13 395351 12/10/2024 West Reading Skilled Nursing and Rehabilitation Ce 425 Buttonwood Street West Reading, PA 19611

F 0732 Post nurse staffing information every day. Level of Harm - Potential for minimal harm Based on observation and interview, it was determined that the facility failed to post accurate and current nurse staffing information. Residents Affected - Many Findings include: During a tour of the facility conducted on December 8, 2024, at 9:05 a.m., the staffing information that was posted in the lobby was dated for December 6, 2024. In an interview on December 10, 2024, at 10:00 a.m., the Administrator confirmed that incorrect staffing data was posted. 28 Pa Code 201.18(b)(3) Management. 395351 Page 6 of 13 395351 12/10/2024 West Reading Skilled Nursing and Rehabilitation Ce 425 Buttonwood Street West Reading, PA 19611

F 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. **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 pharmacy recommendations were acted upon in a timely manner for two of 32 sampled residents. (Residents 79, 149) Findings include: Clinical record review revealed that Resident 79 was admitted to the facility on [DATE], with diagnoses that included Parkinsonism, dementia, and depression. Review of the clinical record revealed that the pharmacist made recommendations regarding Resident 79's medications on June 19, July 26, August 19, September 17, October 28, and November 30, 2024. There was no documentation to indicate what the recommendations were for June, July, August, or September, or that they were addressed by the physician. Clinical record review revealed that Resident 149 was admitted to the facility on [DATE] with diagnoses that included syncope and collapse (fainting), hypertension (high blood pressure), and dementia. Review of the clinical record revealed that the pharmacist made recommendations regarding Resident 149's medications on September 25 and November 12, 2024. There was no documentation regarding what the recommendations were for September and November or that they were addressed by the physician. In an interview on December 10, 2024, at 11:40 a.m., the Director of Nursing confirmed that there was no documentation regarding specific pharmacy recommendations or that they were acted upon in a timely manner. 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services. 395351 Page 7 of 13 395351 12/10/2024 West Reading Skilled Nursing and Rehabilitation Ce 425 Buttonwood Street West Reading, PA 19611

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a review of facility policy, observation, and staff interview, it was determined that the facility failed to properly store medications in one of three nursing units. (Second Floor Nursing Unit) Findings include: Review of the facility policy entitled, Storage of Medication, last reviewed [DATE], revealed that staff were to note the date on the label for insulin vials and pens when first opened. Outdated, contaminated, discontinued, or deteriorated medications were to be immediately removed from stock and disposed of according to procedures for medication disposal. Observation of a medication cart used for resident rooms 218 through 229 on [DATE], revealed four insulin lispro pens that were opened and not labeled, one insulin glargine pen that was opened and not labeled, one Semglee insulin pen that was opened and not labeled, and one Basaglar insulin pen that was opened and not labeled. In an interview, the licensed practical nurse 1 (LPN 1) stated that the insulin pens should have been labeled with an open date. Observation of the medication storage room refrigerator on the second floor nursing unit on [DATE], revealed one vial of Tubersol that was opened and not labeled, in a storage box labeled discard by [DATE]. There were three bottles of doxycycline labeled do not use after [DATE]. There was a large container of glycerin suppositories labeled for a resident who had expired [DATE]. In an interview, on [DATE], at 9:45 a.m., the Director of Nursing stated that the staff was to label all medications with open and expiration dates and all expired or discontinued medication was to be removed from the medication cart and medication storage room refrigerator. 28 Pa. Code 211.12 (d)(1)(2)(5) Nursing services. 395351 Page 8 of 13 395351 12/10/2024 West Reading Skilled Nursing and Rehabilitation Ce 425 Buttonwood Street West Reading, PA 19611

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 interview, it was determined that the facility failed to employ a full-time qualified dietary services manager in the absence of a full-time qualified dietitian. Residents Affected - Some Findings include: During an interview on December 8, 2024, at 11:00 a.m., the dietary manager stated the facility did not employ a certified dietary manager. In an interview conducted on December 10, 2024, at 11:30 a.m., the Administrator confirmed that there was not a full-time dietitian employed onsite at the facility and that the facility did not employ a qualified certified dietary manager in the absence of a full-time dietitian. 28 Pa. Code 201.18(b)(3) Management. 395351 Page 9 of 13 395351 12/10/2024 West Reading Skilled Nursing and Rehabilitation Ce 425 Buttonwood Street West Reading, PA 19611

F 0803 Level of Harm - Minimal harm or potential for actual harm Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. Based on resident interview, review of facility documentation, observation, and staff interview, it was determined that the facility failed to follow the pre-approved menus. (Residents 16, 22, 208) Residents Affected - Some Findings include: During the Resident Council interview conducted on December 9, 2024, at 10:30 a.m., four of four residents stated that food items at meals were often substituted without notice. Review of the facility menus revealed the lunch meal on December 8, 2024, was to include roasted potatoes, dinner roll, and fruit pie. The lunch meal on December 9, 2024, was to include fruit ambrosia salad. Observation of Resident 16 and Resident 208's lunch meal ticket on December 8, 2024, at 1:10 p.m., revealed that the meal should have included roasted potatoes, a dinner roll, and fruit pie. The residents received mashed potatoes, fruit ambrosia salad, and no dinner roll. On December 9, 2024, at 12:55 p.m., Resident 16 and Resident 22's meal ticket revealed that the meal should have included fruit ambrosia salad and the residents received applesauce. In an interview on December 10, 2024, at 9:30 a.m., the Dietary Manager reported the previously mentioned items were not served as planned on the facility menu. 28 Pa. Code 211.6(a) Dietary services. 395351 Page 10 of 13 395351 12/10/2024 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 facility policy review, staff interview, and observation, it was determined that the facility failed to store food in a sanitary manner in the dietary department and on one of three nursing units. (Nursing unit 2) Residents Affected - Many Findings include: Review of the facility policy entitled, Food Handling, dated November 15, 2024, revealed that staff were to label food items with the date prepared or opened. At the beginning of each meal service, staff were to obtain tray line holding food temperatures and record them onto the Production Worksheet. Observations during the kitchen tour on December 8, 2024, at 9:23 a.m., revealed the following: In reach-in cooler #1, there were two chef salads, three opened bags of cheddar cheese, lettuce, shredded carrots, and an opened container of diced tomatoes that were not dated. There was dried food debris on the bottom of the cooler. In reach-in cooler #2, there was an opened bag of diced potatoes and parmesan cheese that were not dated. In reach-in cooler #3, there were three cups of dished crushed pineapple that were not dated. In reach-in cooler #6, there was an opened package of cinnamon rolls that was not dated. In reach-in cooler #9, there was a container of cottage cheese with a use by date of September 29, 2024, and a carton of whole milk dated October 23. In the reach-in snack cooler, there were three cups of diced peaches that were not dated. In dry storage, there was a large opened bag of dried breadcrumbs on top of a file cabinet. There were bread crumbs on the floor. On the floor below the condiment shelf, there were multiple dried onion peels and paper debris. In the food preparation area, there were three bulk containers of dried milk, thickener, and flour that had food debris covering the lids. In the flour bin, the scoop was in the flour. According to the Dietary Manager (DM), the dish machine required a chemical solution to sanitize the dishware. Observations of two chemical strips done at 10:20 a.m., and 10:24 a.m., during dish wash service for breakfast revealed a chemical solution of 10 parts per million (ppm) with the federal regulation being 50 ppm. There was no documented evidence that the tray line holding food temperatures were taken and recorded onto the Production Worksheet since November 12, 2024. In an interview on December 8, 2024, at 11:30 a.m., the DM confirmed that the previously mentioned items should have been dated and the expired items removed. In an interview on December 10, 2024, at 11:45 a.m., the Administrator confirmed that there was no documented evidence that the tray line holding temperatures were taken and recorded on the Production Worksheet per policy. Review of the facility policy entitled, Food Brought in for Residents, dated November 15, 2024, revealed that foods that require refrigeration were to be labelled with the resident's name and the 395351 Page 11 of 13 395351 12/10/2024 West Reading Skilled Nursing and Rehabilitation Ce 425 Buttonwood Street West Reading, PA 19611

F 0812 date. Level of Harm - Minimal harm or potential for actual harm Observation of the Nursing unit 2 resident pantry on December 8, 2024, at 11:30 a.m., revealed that there was a beef patty in the freezer that was not dated or labelled. In the refrigerator there was an opened jar of pickles and mustard, a container of pasta with red sauce and soup, a sandwich, a bottle of soda, a bag that had an opened bottle of dressing and two containers of salad, chocolate pudding, and three dishes of pineapple that were not labelled or dated. Residents Affected - Many CFR 483.60(i) Food Safety Requirement Previously cited 1/25/24, 6/28/24 28 Pa. Code 201.14(a) Responsibility of licensee. 28 Pa. Code 201.18(b)(3)(e)(2.1) Management. 395351 Page 12 of 13 395351 12/10/2024 West Reading Skilled Nursing and Rehabilitation Ce 425 Buttonwood Street West Reading, PA 19611

F 0814 Dispose of garbage and refuse properly. Level of Harm - Potential for minimal harm Based on observation, it was determined that the facility failed to dispose of trash and refuse properly. Findings include: Residents Affected - Many Observation of the dumpster area on December 8, 2024, at 9:45 a.m., revealed multiple pieces of crushed plastic and cardboard debris, crushed Styrofoam containers, and used gloves around the outside of both dumpsters. One dumpster had two lids on top of it, one of the lids was wide open and the other lid had two full bags of garbage on top of it. 28 Pa Code 201.18(b)(3) Management. 395351 Page 13 of 13