Health inspection·October 8, 2024

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on clinical record review, facility document review, and staff interview, it was determined that the facility failed to ensure a system of recording the disposition of all controlled drugs in sufficient detail to enable accurate reconciliation and to ensure an account of all controlled drugs is maintained and periodically reconciled for prompt identification of loss or potential diversion of controlled substance for one of three residents reviewed (Resident 1). Findings include: Review of facility policy, titled 5.3 Storage and Expiration Dating of Medications and Biologicals, last revised August 1, 2024 stated, 18. Controlled Substance Storage: 18.1(2)Controlled medications must be counted with another designated staff member when there is an exchange of keys. Review of Resident 1's clinical record revealed diagnoses that included dementia (progressive, irreversible degenerative disease of the brain that results in decreased contact with reality and decreased ability to perform activities of daily living) and anxiety disorder (excessive and uncontrollable feelings of worry and/or fear). Review of Resident 1's physician orders revealed an order for lorazepam (schedule IV controlled substance) 0.5 milligrams (mg - metric unit of measure) by mouth every six hours for anxiety. Review of Resident 1's Controlled Medication Utilization Record, revealed that on June 10, 2024, the facility received 120 tablets of lorazepam 0.5 mg for administration. Review of the form revealed it provided space for licensed nursing staff to document each administration of Ativan including the date and time the medication was prepared/administered, the amount of tablets prepared/administered, the number of pills that remained, and an area for the licensed staff to sign. Further review of the aforementioned Controlled Medication Utilization Record, revealed that the amount of pills that remained from administrations on June 19, 2024, at 12:00 PM, to June 23, 2024, at 6:00 AM was altered. The original number of pills remaining was written as 85 and then was written over top of to look like a 65, which represented a loss of 20 controlled medication pills. Review of the written over numbers, it appeared that numbers 85 through 58 that black ink was used, at times, over original blue ink. Further, some numbers were not legible as a result of writing over original numbers. (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 3 Event ID: 395395 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 395395 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/08/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE River's Bend Health & Rehab Center 800 King Russ Road Harrisburg, PA 17109 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)