Health inspection·August 10, 2023

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. Based on review of facility policy and clinical records, observations, and staff interviews, it was determined that the facility failed to maintain resident dignity for one of two residents (Resident R189) with urinary catheters (tubing inserted into the bladder to drain urine into a bag) and two of 13 residents (R70 and R185) observed during medication administration. Findings include: Review of the facility policy entitled, Urinary Catheterization dated January 2023, revealed The continuous drainage bag is to be concealed with an outer bag to enhance resident privacy and dignity both when resident is in bed and out of bed. Review of Resident R189's clinical record revealed an admission date of 4/12/23, with diagnoses that included Adult Failure to Thrive (Adult loss of appetite, decreased food intake, weight loss and resident is less active than normal), Major Depressive Disorder (a mood disorder causing a feeling of sadness and loss of interest in normal activities), and Neuromuscular Dysfunction of the Bladder (a condition that affects the bladder's ability to store and empty urine properly). Observation on 8/08/2023, at 11:30 a.m. and 8/09/2023, at 9:20 a.m. revealed Resident R189's urinary catheter bag hanging from the resident's bed uncovered exposing the bag with urine to be viewed easily by all who walked by the room and/or by all who entered the room. During an interview on 8/09/2023, at 9:20 a.m. Licensed Practical Nurse (LPN) Employee E1 confirmed that Resident R189's urinary catheter bag was hanging from the bed with urine visible and that the catheter bag should have been covered to protect Resident R189's privacy/dignity. Review of the facility policy entitled, Administering medications via enteral feeding tube dated January 2023, revealed Procedure: 1. Identify resident, assure privacy. Medications should not be administered in pubic areas. During a medication pass observation on 8/08/2023, at 4:47 p.m. i was observed that LPN Employee E4 failed to pull the curtain or close the door to resident room when taking a blood glucose reading, and administering an insulin injection to Resident R70. LPN Employee E4 entered the room of Resident R70, and explained what he/she was there for, proceeded to obtain Resident R70's blood glucose reading. After obtaining the blood glucose reading, LPN Employee E4 left the room and returned to the medication cart to obtain the order of insulin for Resident R70. LPN Employee E4 returned to the resident room, entered the room with two other residents in the room, explained to Resident R70 that he/she would be administering insulin. LPN Employee E4 then proceeded to expose Resident R4's abdomen Page 1 of 6 395361 395361 08/10/2023 Pleasant Ridge Manor East/West 8300 West Ridge Road Girard, PA 16417

F 0550 and administer an insulin injection with a needle. Level of Harm - Minimal harm or potential for actual harm During an interview with LPN Employee E4 on 8/08/2023, after administering the injection at 4:47 p.m. it was confirmed that resident dignity was not maintained by pulling the privacy in the room while two residents were in the room, and not closing the door to the resident room while passers by were in the hall way when exposing Resident R70 to administer an insulin injection. Residents Affected - Few During a medication pass observation on 8/08/2023, at 10:00 a.m. LPN Employee E5 failed to pull the privacy curtain or close the door to protect Resident R185's dignity and privacy when administering medications via Resident R185's peg tube (percutaneous endoscopic gastrostomy-a tube passed into a person's stomach through the abdominal wall to provide means of medication administration and nutritional intake). LPN Employee E5 entered the room of Resident R185 and administered the medications exposing Resident R185's abdomen without the privacy curtain pulled and/or door closed allowing all persons in the hallway to easily view the administration of medications. During an interview with LPN Employee E5 on 8/08/2023, after administering Resident R185's medications, it was confirmed that due to not closing Resident R185's door and/or pulling the privacy curtain, Resident R185's dignity and privacy was not protected during the administration of the peg tube medications. 28 Pa. Code 211.12 (d)(1)(5) Nursing Services 395361 Page 2 of 6 395361 08/10/2023 Pleasant Ridge Manor East/West 8300 West Ridge Road Girard, PA 16417

F 0610 Respond appropriately to all alleged violations. Level of Harm - Minimal harm or potential for actual harm Based on review of clinical records and facility documentation and staff interview, it was determined that the facility failed to immediately notify the alleged victim's responsible party of potential physical abuse for one of 14 resident records reviewed (Resident R42). Residents Affected - Few Findings include: Review of Resident R42's clinical record revealed an admission date of June 28, 2018, with diagnoses that included right and left above knee amputations, diabetes, high blood pressure and circulation problems. Review of a facility submitted event report dated July 13, 2023, reported an allegation in which a staff member was accused of an act of physical abuse against Resident R42. There was no evidence that Resident R42's responsible part facility was notified of the above abuse allegation or subsequent investigation. During interview on August 9, 2023, at 2:20 p.m. the Director of Nursing confirmed that there was no indication that Resident R42's responsible party was notified of the allegation. 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 211.12(d)(1)(5) Nursing services 395361 Page 3 of 6 395361 08/10/2023 Pleasant Ridge Manor East/West 8300 West Ridge Road Girard, PA 16417

F 0675 Honor each resident's preferences, choices, values and beliefs. Level of Harm - Minimal harm or potential for actual harm Based on observations, resident and staff interviews, and clinical record review, it was determined that the facility failed to ensure residents receive the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, for one of five resident care areas observed (Unit G). Residents Affected - Few Findings include: Observations on three separate days including 8/07/2023, at approximately 1:00 p.m. and 3:00 p.m., 8/08/2023, at approximately 3:15 p.m., and 8/09/2023, at approximately 3:30 p.m. revealed numerous residents (15 or greater number of residents) positioned by staff in their wheelchairs and independent chairs sitting in a centralized circle gathering area on Unit G. During each observation, residents were agitated, screaming out Shut up, swearing vulgarities, and raising their hands and fists at each other. Staff were observed placing more residents in the centralized circle gathering area, even when other residents were already agitated and talking loudly/screaming/cussing and swearing. During an interview at approximately 1:00 p.m. on 8/07/2023, Resident R7 verbalized, I am so unhappy. I hate it here. You will see why; everyone yells and screams, and it is just awful. Resident R7 indicated he/she was able to go off the nursing unit, however, indicated the screaming could be heard throughout the nursing unit while he/she was in his/her room and sometimes even down the hallways away from the Unit G resident care area. Review of the RAI manual instructions for Section C0500 Brief Interview for Mental Status (BIMS) revealed that a score of 13-15 identified a resident as cognitively intact and a score of 8-12 identified a resident as moderately impaired, and a score of 0-7 as severely impaired. Resident R7's clinical record revealed a BIMS score of 15/15. During an interview with Unit G Licensed Practical Nurse (LPN) Employee E5 on 8/09/2023, at approximately 3:30 p.m., he/she indicated he/she had a 4:00 p.m. medication pass to do, there were no activity aides, and this was how the residents were arranged daily (positioned closely together in a circle gathering area), regardless of residents who are alert and oriented, and without behaviors, and residents with cognitive impairment and behaviors. During an interview with the Director of Nursing and the Nursing Home Administrator on 8/10/2023, at 10:15 a.m. no policy or protocol was provided regarding quality of life for residents with cognitive impairment and behaviors and/or residents without behaviors who are alert, oriented. 28 Pa. Code 211.10(a)(c)(d) Resident care policies 28 Pa. Code 211.12 (d)(1)(2)(3)(5) Nursing services 395361 Page 4 of 6 395361 08/10/2023 Pleasant Ridge Manor East/West 8300 West Ridge Road Girard, PA 16417

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 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. Based on observations, review of facility policy and manufacturer's instructions, and staff interviews, it was determined that the facility failed to properly store a multi-use vial of medication with an opened date for one of three medication storage rooms reviewed and failed to safely secure/store medications for three of four medication storage rooms (Unit A, G, and J) reviewed. Findings include: Review of the facility policy entitled, Policy and Procedure for Medications, Storage of, dated of January 2023, identified that Medications will be securely stored according to state and federal regulations. No discontinued, outdated, or deteriorated drugs or biologicals may be retained for use. All such drugs must be returned to the Pharmacy. Review of the manufacturer's instructions for storage of Lantus insulin vials revealed, The Lantus vials you are using should be thrown away after 28 days, even if it still has insulin left in it. Observation of medication storage room on Unit A, on 8/08/2023, at 2:39 p.m. revealed that a multi-use vial of Lantus insulin was in the refrigerator opened with no opened date and/or use-by date printed on the vial. During an interview with Licensed Practical Nurse (LPN) Employee E3 on 8/08/2023, at the time of the observation, it was confirmed that the multi-use vial of Lantus insulin was opened and in the refrigerator for use and there was no opened date and/or use-by date on the vial for staff to know if the medication was still safe for use or to discard. Review of the policy entitled, Storage of Medications, dated January 2023, revealed All medications for our residents are stored at the nurses' station in a locked cabinet, a locked medication room, or one or more locked mobile medication carts. Observations on 8/07/2023, 8/08/2023, and 8/09/2023, of the medication storage rooms on Units A, G, and J, revealed that various medications were stored in tackle boxes located at the nurses' stations. The nurses' stations were not a locked area and did not always have nursing personnel present in the area. The tackle boxes were not stored in the secured medication room. The tackle boxes were not secured at the nurses' stations and could be easily removed from the area by unauthorized persons. During an interview on 8/09/2023, at 10:57 a.m. the Director of Nursing confirmed that medications in the tackle boxes were not safely secured in a locked medication storage room on Units A, G, and J. 28 Pa. Code 211.12(d)(1)(2)(5) Nursing services 28 Pa. Code 211.10(c) Resident care policies 395361 Page 5 of 6 395361 08/10/2023 Pleasant Ridge Manor East/West 8300 West Ridge Road Girard, PA 16417

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on review of facility policy, observations, and staff interviews, it was determined that the facility failed to follow acceptable infection control practices related to prevention of potential of cross-contamination for one of 13 residents observed for medication administration (Resident R70). Residents Affected - Few Findings include: A review of facility policy entitled, Obtaining a fingerstick glucose level dated January 2023, indicated 6. [NAME] [put on] clean gloves Observation of medication administration on 8/8/2023, at 4:39 p.m. revealed that Licensed Practical Nurse (LPN) Employee E4 did not don gloves prior to the checking of blood glucose reading and administration of insulin for Resident R70. During an interview on 8/8/2023, at 4:45 p.m. LPN Employee E4 confirmed that he/she failed to don gloves prior to the checking of blood glucose level, and administration of insulin for Resident R70. LPN Employee E4 confirmed that he/she should have worn gloves when checking blood glucose readings and administering an insulin injection to Resident R70. 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 211.10(d) Resident care policies 28 Pa Code 211.12 (d)(1)(2)(5) Nursing services 395361 Page 6 of 6