Health inspection·December 28, 2023

F 0610 Respond appropriately to all alleged violations. Level of Harm - Minimal harm or potential for actual harm Based on a review of facility policy, clinical records, and facility documentation review, and staff interview, it was determined that the facility failed to comprehensively investigate an injury of unknown origin for one of the 13 residents reviewed (Resident 42). Residents Affected - Few Findings include: Review of the facility's policy titled Reporting Incidents/Accidents, last revised September 2018, revealed that if the etiology of the injury is not known, Injury of Unknown Origin Investigation will be initiated to investigate injury and rule out abuse, as well as to attempt to determine contributing factors/root cause. Staff caring for residents for 24 hours before injury will be interviewed to determine if there is any knowledge related to the skin injury. Review of Resident 42's diagnosis list revealed Dementia (group of symptoms affecting memory, thinking, and social abilities severely enough to interfere with daily life), and Bipolar Disorder (episodes of mood swings ranging from depressive lows to manic highs). Review of Resident 42's Minimum Data Set (MDS- standardized assessment tool that measures health status in long-term care residents) dated October 17, 2023, revealed resident had a BIMS-(Brief Interview for Mental Status-tool used to screen and identify the cognitive condition of residents) of 10 indicating resident had a moderate cognitive impairment. Review of Resident 42's nursing progress notes dated November 15, 2023, at 9:29 a.m., revealed resident was noted with bright red blood bleeding/dripping from the vagina. The Nurse Practitioner (NP) notified and assessed the resident. The resident denied trauma and inappropriate touching by herself and any other person. Denied pain or discomfort. Review of Resident 42's Nurse Practitioner notes dated November 15, 2023, at 10:02 a.m., revealed staff reported vaginal bleeding with clots, inspection revealed a cut on the resident's labia (Folds of skin around the vaginal opening) about ¼ cm and another skin flap cut on the same area with the same size. Some tenderness at the site when cleaning the resident, patient denies anyone touching her. Review of Resident 42's clinical record failed to reveal the possible/cause of the injury. Review of facility documentation failed to reveal completed statements from staff who cared for the resident. Interview with the Director of Nursing on December 28, 2023, at 11:00 a.m., confirmed witness Page 1 of 2 395388 395388 12/28/2023 Crosslands 1660 East Street Road Kennett Square, PA 19348

F 0610 statements from staff that cared for the residents were not completed. Level of Harm - Minimal harm or potential for actual harm The facility failed to ensure Resident 42's skin tear to the labia with unknown origin was comprehensively investigated. Residents Affected - Few Pa. 28 Code 211.5(f) Clinical Records Pa. 28 Code 211.10(c) Resident Care Policies Pa. 28 Code 211.12(d)(1)(5) Nursing Services 395388 Page 2 of 2