Health inspection·September 15, 2023

F 0582 Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a review of facility provided documentation and staff interview, it was determined the facility failed to timely issue the Skilled Nursing Facility Advanced Beneficiary Notice form (SNF ABN CMS-10055) for one of three residents (Resident R31). Residents Affected - Few Findings include: Review of the Skilled Nursing Facility Advanced Beneficiary Notice (SNF ABN CMS-10055) form provides information to residents/resident representatives that skilled nursing services may not be paid by Medicare and so that the resident/resident representative can decide if they wish to continue receiving skilled nursing services and assume financial responsibility. Review of Resident R31's clinical record documented the resident was admitted to the facility on [DATE], and remained in the facility. Review of the facility provided Beneficiary Notice list, which includes residents who were discharged from Medicare Part A with benefit days remaining, and remained in the facility indicated Resident R31's last covered day was 4/21/23. Review of Resident R31's record did not include a SNF ABN CMS-10055 form and was not notified of the last day of Medicare Part A coverage. During an interview on 9/14/23, at 1:15 a.m. the Nursing Home Adminstrator confirmed the facility failed to timely issue the Skilled Nursing Facility Advanced Beneficiary Notice form (SNF ABN CMS-10055). 28 Pa. Code 201.18(e)(1) Management. Page 1 of 4 395391 395391 09/15/2023 Asbury Health Center 700 Bower Hill Road Pittsburgh, PA 15243

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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of clinical records and staff interview, it was determined that the facility failed to make certain that residents were provided appropriate treatment and services for one of four residents (Resident R91). Residents Affected - Few Findings include: Review of Brief Interview for Mental Status (BIMS, a screening test that aides in detecting cognitive impairment). The BIMS total score suggests the following distributions: 13-15: cognitively intact 8-12: moderately impaired 0-7: severe impairment Review of Resident R91's clinical record revealed the resident was admitted to the facility on [DATE]. Review of Resident R91's Minimum Data Set (MDS - periodic assessment of care needs) dated 1/26/23, included diagnoses of dementia (a group of symptoms that affects memory, thinking and interferes with daily life), muscle wasting and atrophy (loss of muscle leading to its shrinking and weakening), and cognitive communication deficit (difficulties with how someone thinks and uses language). Section C: Cognitive Patterns, Question C0500 BIMS Summary Score revealed a score of 3, indicating the resident had a severe cognitive impairment. Review of Resident R91's progress note dated 7/31/23, 11:09 p.m. stated Pt c/o (complained of) sore throat for several days and occasional dry cough. Pt states the pain goes across front of anterior neck but sometimes felt when swallowing. VS 141/69 temp 98.1, 93% on RA, 70 HR, Resp 20. No c/o pain with palpation of neck. Some fullness noted to left side of neck. (Medical provider) notified via email. Review of Resident R91's follow up note dated 8/1/23, 11:44 a.m. stated Spoke with (Medical provider) in regard to patients symptoms. New orders for Tylenol 500 mg every 6hrs for 3 days. Mouth wash gargle with Listerine every 4 hrs PRN (as needed). CBC (complete blood count) and BMP (basic metabolic panel) tomorrow 8/2. Orders placed; patient aware. Vital signs stable, covid negative. Review of Resident R91's change in condition note dated 8/5/23, at 11:36 a.m. stated Resident c/o body ache, malaise. V/S 136/64-92-98.4-20- 82% on RA. 3L O2 (oxygen) start to bring sat (saturation) to 92%. Resident has occasionally dry cough. No abnormal lung sound noted at this time. Rapid covid test negative. Spoken to (Medical provider) on the phone, Dr. wants staff to monitor her, and states he may come today to see her. Supervisor notified. Review of Resident R91's Incident-Trauma-Falls note dated 8/5/23, at 4:36 p.m. Stated CNA (nurse aide) found resident sitting with legs crossed on the floor at her room resident is confusion denies pain or discomfort, no injury note, with two assists back to her bed, V/S 136/71 98.2 98 20 90% 4L, called (Medical provider) sent resident to (hospital) for evaluation. 395391 Page 2 of 4 395391 09/15/2023 Asbury Health Center 700 Bower Hill Road Pittsburgh, PA 15243

F 0684 Level of Harm - Minimal harm or potential for actual harm Review of Resident R91's progress notes from 7/31/23, through 8/5/23, failed to reveal that a medical provider assessed Resident R91 for respiratory symptoms. Review of Resident R91's progress note dated 8/5/23, 10:35 p.m. stated that Call received from hospital. Resident is admitted to hospital with DX (diagnosis) of pneumonia. Residents Affected - Few Review of Resident R91's progress note dated 8/10/23, at 5:45 p.m. indicated that Resident R91 was readmitted to the facility, five days later. During an interview on 9/14/23, the Director of Nursing confirmed Resident R91 was sent to the hospital due to the fall, not for respiratory issues, and further confirmed that the facility failed to make certain that residents were provided appropriate treatment and services for one of four residents. 28 Pa. Code 201.14(a) Responsibility of Licensee. 28 Pa. Code 201.29(a) Resident rights. 28 Pa. Code 211.10(c)(d) Resident care policies 28 Pa Code 211.12(d)(1)(5) Nursing services. 395391 Page 3 of 4 395391 09/15/2023 Asbury Health Center 700 Bower Hill Road Pittsburgh, PA 15243

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 review of observations and staff interviews, it was determined that the facility failed to properly dispose of expired and/or opened medical supplies in one of two medication rooms (Willow nursing unit). Findings include: Review of the facility policy Medication Storage dated [DATE], indicated all medications are stored and maintained under strict conditions according to accepted standard of practice. During an observation of the [NAME] medication room on [DATE], at 9:54 a.m. the following was observed: -Two sterile suture removal kits open to air, no longer sterile. -One sterile catheter insertion tray open to air, no longer sterile. -One dressing change kit, with an expiration date of [DATE]. -Eight PICC line securement devices, with an expiration date of [DATE]. During an interview on [DATE], at 10:13 a.m. Licensed Practical Nurse Employee E3 confirmed the above items were expired or opened and no longer sterile. During an interview on [DATE], at 2:40 p.m. the Nursing Home Administrator confirmed the facility failed to properly dispose of expired and/or opened medical supplies in one of two medication rooms. 28 Pa. Code: 211.10(c) Resident care policies. 28 Pa. Code: 211.12(d)(1)(2)(5) Nursing services. 395391 Page 4 of 4