Health inspection·January 25, 2024

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review, observations, and interviews with residents and staff, it was determined that the facility failed to ensure resident dignity for one out of seven residents reviewed (Resident R1). Findings include: Review of the clinical record revealed that Resident R1 was admitted to the facility on [DATE], with diagnoses of Obstructive Sleep Apnea (OSA) (OSA occurs when the upper airway becomes blocked, leading to brief pauses in breathing during sleep), and Asthma (Asthma is a chronic lung disease caused by inflammation and muscle tightening around the airways, which makes it harder to breathe). Observation of Resident R4 on January 26, 2024, at 10:40 a.m., revealed the Resident R1 had untrimmed facial hair, and long fingernails with dark substance under the fingernails. During interviewed with Resident R1 on January 25, 2024 the resident stated that no staff offered him to trim the facial hair and nails. 28 Pa. Code: 211.11(d)(1)(5) Nursing services Page 1 of 2 395354 395354 01/25/2024 Silver Stream Nursing and Rehabilitation Center 905 Penllyn Pike Spring House, PA 19477

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, clinical record review, review of facility policy and staff interview, it was determined that the facility failed to provide appropriate respiratory care and services for one of seven residents reviewed (Resident R1). Residents Affected - Few Findings include: Review of the clinical record revealed that Resident R1 was admitted to the facility on [DATE], with diagnoses of Sleep Apnea (OSA) (OSA occurs when the upper airway becomes blocked, leading to brief pauses in breathing during sleep), and Asthma (Asthma is a chronic lung disease caused by inflammation and muscle tightening around the airways, which makes it harder to breathe). A review of Resident R1's clinical records revealed a physician order, dated March 21, 2023, to administer Oxygen 4 liters/minute, via nasal canula (nasal cannula is a thin tube, often affixed behind the ears and used to deliver oxygen directly to the nostrils from a source connected with tubing), every shift; and a physician order, dated, December 1, 2023, to change oxygen tubing weekly, every night shift, every Friday, sign, and date tubing on Friday nights per facility protocol. On January 26, 2024, at 10:40 a.m., it was observed that Resident R1 was administered with oxygen at three point five liters per minute, via nasal canula; and that the staff did not change the oxygen tube, as the date on the oxygen tube marked was September 2023. At the time of observation, the finding was confirmed with Employee E5, a Licensed Nurse. 28 Pa Code 211.12(d)(5) Nursing services 395354 Page 2 of 2