Health inspection·August 31, 2023

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. Based on clinical record review and staff and resident interview, it was determined that the facility failed to implement interventions to maintain a resident's continence status for one of four residents reviewed (Resident 1). Findings include: The MDS (Minimum Data Set, an assessment tool completed at specific intervals to determine resident care needs) Resident Assessment Indicators (RAI) 3.0 Manual, Section H indicated that each resident who is incontinent or at risk of developing incontinence should be identified, assessed, and provided with individualized treatment (medications, non-medicinal treatments and/or devices) and services to achieve or maintain as normal elimination function as possible. Clinical record review for Resident 1 revealed that the facility admitted him on August 11, 2023. Upon admission, the facility identified that Resident 1 was capable, with a BIMS (Brief Interview for Mental Status, assessment that scores a resident's response to memory questions; 13-15 indicates cognitively intact) of 15, was continent of bowel, and aware of the need to defecate. Resident 1 was ordered to be non-weight bearing on his right lower extremity due to a recent hip fracture with surgical repair, therefore requiring staff assistance for toileting. Review of Resident 1's task interventions (an action intended to improve the resident's health and comfort) revealed that he frequently needed limited to extensive assistance from one staff member with his toileting needs. Further review from August 11, 2023, through August 30, 2023, revealed that Resident 1 was incontinent of bowel 13 times, with evening and night shift incontinence occurring for 11 of the 13 times. Resident 1 had loose stool from August 12, 2023, to August 18, 2023. Review of Resident 1's nursing and physician documentation dated August 16, 2023, revealed that Resident 1 was complaining of diarrhea almost every time he eats with nine episodes over the past several days. The physician ordered Imodium for the diarrhea, with noted positive results and Resident 1's diarrhea ceased on August 18, 2023; however, Resident 1's incontinence continued. Interview with Resident 1 on August 30, 2023, at 12:49 PM confirmed that he was continent of bowel prior to admission and that he becomes incontinent of bowel when staff fail to respond to his call bell, especially on the evening and night shifts. He revealed that he notified staff after supper on August 29, 2023, of the need to defecate. Staff indicated that they could not provide assistance at that time. Resident 1 indicated that he waited over an hour for staff to return. By that time, he had become incontinent of bowel and was forced to sit in it while in his wheelchair, until staff returned to provide care. Resident 1 indicated that he could not access his call bell because of being in Page 1 of 3 395352 395352 08/31/2023 Broad Acres Health and Rehabilitation 1883 Shumway Hill Road Wellsboro, PA 16901

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few his wheelchair at the time of staff notification and while awaiting staff return. He did reveal that when he does ring his call bell it sometimes takes staff over an hour to respond and provide incontinence care. Review of nursing documentation dated August 29, 2023, at 10:56 PM (the time of the entry) revealed that Resident 1 was out of bed in his wheelchair and went down to the dining room for supper. Resident 1 informed staff that he was not going again because he always needs the bathroom after he eats, and they told him they would get him back after he ate, and they did not. Review of facility call bell logs for Resident 1's room revealed the following call bell response times: August 12, 2023, 7:03 PM until 8:06 PM, 1 hour, 3 minutes until staff responded August 12, 2023, 10:02 PM until 10:44 PM, 41 minutes until staff responded August 13, 2023, 7:13 PM until 8:19 PM, 1 hour 6 minutes until staff responded August 17, 2023, 1:56 PM until 2:28 PM, 31 minutes until staff responded August 17, 2023, 2:36 PM until 3:14 PM, 36 minutes until staff responded August 19, 2023, 7:07 PM until 7:45 PM, 37 minutes until staff responded August 23, 2023, 6:17 PM until 7:02 PM, 45 minutes until staff responded August 25, 2023, 6:51 PM until 7:26 PM, 34 minutes until staff responded Review of Resident 1's continence documentation revealed that staff documented bowel incontinence on the following dates, potentially due to lengthy call bell response times noted above: August 13, 2023, evening shift August 17, 2023, evening shift August 25, 2023, evening shift Review of the facility's nursing time and staff ratios revealed that the facility failed to meet the following: On August 13, 2023, the facility did not meet the licensed practical nurse (LPN) state required ratio of one LPN to 25 residents on day shift and one LPN to 30 residents on evening shift. On August 13, 2023, the facility did not meet the state required nursing time of 2.87 direct nursing care on August 13, 2023. Review of nursing staff care hours provided by the facility revealed the following nurse aides (NA) scheduled for the resident census: 395352 Page 2 of 3 395352 08/31/2023 Broad Acres Health and Rehabilitation 1883 Shumway Hill Road Wellsboro, PA 16901

F 0690 August 13, 2023, 6 NAs for a census of 81, requires 7 NAs. Level of Harm - Minimal harm or potential for actual harm August 18, 2023, 6 NAs for a census of 86, requires 8 NAs. August 19, 2023, 7 NAs for a census of 85, requires 8 NAs. Residents Affected - Few August 23, 2023, 7 NAs for a census of 87, requires 8 NAs. August 24, 2023, 7 NAs for a census of 87, requires 8 NAs. August 25, 2023, 7 NAs for a census of 85, requires 8 NAs. This surveyor reviewed the above information with the Nursing Home Administrator on August 30, 2023, at 1:30 PM. 28 Pa. Code 201.18(b)(1) Management 28 Pa. Code 211.10(c)(d) Resident care policies 28 Pa. Code 211.12(d)(1)(5) Nursing services 395352 Page 3 of 3