Health inspection·December 21, 2023

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, it was determined that the facility failed to provide a safe, sanitary, and comfortable environment on four of five nursing units. (Station 1, Station 2, Station 3, and Station 5) Findings include: Observation on December 20, 2023, at 11:58 a.m., revealed a ceiling tile outside of room [ROOM NUMBER] and inside of room [ROOM NUMBER] that was stained and bowing. Observation on December 19, 2023, at 10:39 a.m., revealed peeling paint in rooms [ROOM NUMBERS]. There was a brown stained ceiling tile in room [ROOM NUMBER]. In room [ROOM NUMBER], a ceiling tile was stained and bowing. Observation on December 19, 2023, at 10:28 a.m., revealed clear splatter on the wall under the television, a bent outlet cover, and missing wall panels that left metal bars exposed in room [ROOM NUMBER]. The ceiling vent in the hallway outside room [ROOM NUMBER] had an accumulation of dust. There were brown stained ceiling tiles in the hallway outside the shower room, in room [ROOM NUMBER], and room [ROOM NUMBER]. There was a cracked ceiling tile in room [ROOM NUMBER]. 28 Pa. Code 201.18(b)(3)(e)(1) Management. Page 1 of 5 395409 395409 12/21/2023 Liberty Pointe Rehabilitation and Healthcare Ctr 252 Belmont Avenue Doylestown, PA 18901

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review and staff interview, it was determined that the facility failed to develop a care plan and interventions to meet each residents' needs as identified in the comprehensive assessment for two of 28 sampled residents. (Residents 101, 136) Findings include: Clinical record review revealed that Resident 101 had diagnoses that included mood disorder, major depressive disorder, and anxiety. Review of the Minimum Data Set (MDS) assessment dated [DATE], revealed that Care Area Assessments (CAA) triggered cognitive loss/dementia and communication as problem areas to be care planned. Resident 101's current care plan did not include interventions to address cognitive loss/dementia and communication. In an interview on December 21, 2023, at 9:29 a.m., the Director of Nursing confirmed that there had been no care plan developed to address Resident 101's cognitive loss/dementia and communication. Clinical record review revealed that Resident 136 was admitted to the facility on [DATE], with diagnoses that included hypotension (low blood pressure), anxiety, and acute kidney failure. Review of the MDS assessment dated [DATE], revealed that the resident had an indwelling catheter. The CAA for this MDS triggered urinary incontinence and indwelling catheter as a problem area to be care planned. Observation on December 19, 2023, at 10:45 a.m., revealed Resident 136 laying in bed with an indwelling catheter intact. Resident 136's current care plan did not include interventions to address urinary incontinence and indwelling catheter. In an interview on December 21, 2023, at 12:12 p.m., the Director of Nursing confirmed that there had been no care plan developed to address Resident 136's indwelling catheter. CFR 483.10(c)(3)(i) Comprehensive Care Plans Previously cited 1/27/23 28 Pa. Code 211.12(d)(5) Nursing services. 395409 Page 2 of 5 395409 12/21/2023 Liberty Pointe Rehabilitation and Healthcare Ctr 252 Belmont Avenue Doylestown, PA 18901

F 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review and staff interview, it was determined that the facility failed to ensure that a resident receiving an as needed psychotropic medication was provided with behavioral interventions prior to administration and that physician's orders included duration parameters and rationale for continued use for one of seven sampled residents on psychotropic medications. (Resident 136) Findings include: Clinical record review revealed that Resident 136 was admitted to the facility on [DATE], with diagnoses that included hypotension (low blood pressure) and anxiety and had a physician's order, dated November 21, 2023, for staff to administer a psychotropic medication (Xanax) every 12 hours as needed for anxiety. The current order for the Xanax failed to include a time frame for the continued use of the medication. There was no physician documentation that it was appropriate for the order to be extended beyond 14 days. Review of the medication administration records for November and December 2023, revealed that the medication was adminstered 11 times with no documentation to support that behavioral interventions were attempted. In an interview on December 21, 2023, at 11:33 a.m., the Director of Nursing confirmed that there was no time frame for the continued use of Resident 136's Xanax and no documented evidence that behavioral interventions were attempted prior to administration. 28 Pa. code 211.12(d)(1)(5) Nursing Services. 395409 Page 3 of 5 395409 12/21/2023 Liberty Pointe Rehabilitation and Healthcare Ctr 252 Belmont Avenue Doylestown, PA 18901

F 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation and interview, it was determined that the facility failed to maintain sanitary conditions in the kitchen. Residents Affected - Many Findings include: Observation during the kitchen tour on December 19, 2023, at 10:22 a.m., revealed the following: There was a container of mushrooms in the walk-in refrigerator that was dated December 5, 2023. The Regional Director of Dining Services stated that the food should have been discarded seven days after it was opened. In the dry storage room, there was a number ten can of mushrooms and the bottom of the can was bulging. There were number ten cans of fruit cocktail, cherry pie filling, and pitted prunes, that were dented. The cans were not stored in a separate area designated for dented cans. There was a bag of thickener powder in a plastic container, that did not have a lid on the container, and the bag was opened and not sealed. There was an accumulation of debris on the windowsill under the air conditioner. There were multiple cases of food items that were on the floor. The Regional Director of Dining stated that the food items were delivered on December 18, 2023, and remained on the floor since that time. There was an open package of pasta that was not dated. A piece of pipe that extended from the grease trap under the three-compartment sink was broken. The pipe was not covered, and the contents of the pipe were exposed to air. There was liquid and particles of debris on the bottom of two reach-in freezers. There were containers of dry cereal and a scoop used to dish the cereal was stored on top of the container. There was a large accumulation of ice on the shelves and floor of the walk-in freezer. The base cover of the fan was off and was on the shelf. The fan was leaking fluid onto food items and there was moisture and an accumulation of ice on boxes of potato tots, gluten free bagels, shrimp, and turkey breast. There was an open bag of pie shells on the shelf under the fan. There was an accumulation of liquid on the bag. There was an accumulation of a black substance in the grease trap and a dried substance on the front of the oven door under the stove top. 28 Pa. Code 201.18(b)(3)(e)(2.1) Management. 395409 Page 4 of 5 395409 12/21/2023 Liberty Pointe Rehabilitation and Healthcare Ctr 252 Belmont Avenue Doylestown, PA 18901

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and staff interview, it was determined that the facility failed to provide maintenance services to ensure safe water temperatures on two of five nursing units. (Stations 2 and 5) Findings include: Observations of water temperature readings taken by Employee 1 (maintenance staff), using a facility thermometer, from 9:30 a.m., to 11:54 a.m., on December 20, 2023, revealed the following: The resident room [ROOM NUMBER] sink was 121.5 degrees Fahrenheit (°F). The resident room [ROOM NUMBER] sink was 127.0 °F. The resident room [ROOM NUMBER] sink was 126.1 °F. The sink in the shower room on Station 5 was 127.7 °F. In an interview on December 20, 2023, at 12:20 p.m., the Administrator stated that hot water should be below 110 °F and the temperatures were above that in rooms identified and the Station 5 shower room. 28 Pa. Code 201.18(b)(3)(e)(1) Management. 28 Pa. Code 205.63 (b)(c) Plumbing and piping systems required for existing and new construction. 395409 Page 5 of 5