Health inspection·April 19, 2024

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 Based on clinical record review, facility documentation review, and resident and staff interviews, it was determined that the facility failed to provide care and services to ensure the residents' highest level of functioning and well-being for five of 10 residents reviewed (Resident 5, 7, 8, 9, and 10). Residents Affected - Few Findings include: Review of Resident 5's clinical record revealed diagnoses that included hypertension (high blood pressure) and peripheral vascular disease (a slow and progressive circulation disorder caused by narrowing, blockage, or spasm). Review of Resident 5's current physician orders reveal an order for the following: No blood pressure in left arm every shift for previous graft from left arm, with a start date of March 24, 2024. Review of Resident 5's clinical record Blood Pressure Summary documentation for the past 30 days (March 23, 2024, through April 18, 2024) revealed Resident 5 had their blood pressure taken in their left arm on the following dates and times: March 27, 2024 at 3:25 PM; April 2, 2024, at 9;17 PM, April 5, 2024, at 10:02 AM, April 9, 2024, at 10:23 PM, April 11, 2024, at 1:12 PM, and April 15, 2024, at 1:28 AM. During an interview with Resident 5 on April 18, 2024, at approximately 11:15 AM, revealed that a nurse had woken the Resident up in the middle of the night (date unknown) trying to put a cuff on their left arm to check blood pressure, and Resident 5 woke up and told them to stop, and the nurse finally stopped. Resident 5 said they had a graft put in their left arm and could not have anything on that arm as it could be life threatening. Review of the facility's grievance log for the past three months revealed a grievance filed on behalf of Resident 5 on March 29, 2024, with the following concern: Nurse woke patient for blood pressure and tried to use left arm. He has a no stick/no blood pressure alert bracelet and a sign on wall explaining no stick no blood pressure. Further review of the grievance revealed a summary of findings, which included: Have identified agency staff involved, reached out to agency staff to request re-education be performed. Review of electronic correspondence received from the Nursing Home Administrator (NHA) on April 18, 2024, at 5:12 PM, revealed that she acknowledged there was an issue with Resident 5's blood pressure, and had added additional measures to ensure their blood pressure is taken in the correct arm as ordered by the physician. Page 1 of 3 395428 395428 04/19/2024 Northern Dauphin Nursing and Rehabilitation Center 990 Medical Road Millersburg, PA 17061

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of Resident 7's clinical record revealed diagnoses that included hyperlipidemia (a condition in which there are high levels of fat particles [lipids] in the blood) and osteoarthritis (type of arthritis that occurs when flexible tissue at the ends of bones wears down). Review of Resident 7's current comprehensive person-centered care plan revealed the following focus area: The Resident has an activities of daily living (ADL) self-care performance deficit related to rhabdomyolysis, muscle weakness, and cognitive impairment, with the intervention to include: Transfer: The Resident requires two-person assist with full mechanical lift, with an initiation date of January 2, 2024, and a revision date of March 10, 2024. Review of Resident 7's clinical record revealed an ADL transfer task relating to transfer support provided, specifically how the Resident moves between surfaces to or from: bed, wheelchair, and standing position for the past 30 days (March 20, 2024, through April 17, 2024), revealed Resident 7 was documented as being transferred with a one-person physical assist on the following dates and times: March 26, 2024, at 4:14 PM; April 6, 2024, at 2:23 PM; and April 7, 2024, at 9:40 PM. Review of Resident 8's clinical record revealed diagnoses that included osteoarthritis (type of arthritis that occurs when flexible tissue at the ends of bones wears down) and hypertension. Review of Resident 8's current comprehensive person-centered care plan revealed the following focus area: The Resident has an ADL self-care performance deficit related to lack of coordination, muscle weakness, cognitive impairment, and abnormal gait and mobility, with the intervention to include: Transfer with total mechanical lift and assist of two-person, with an initiation date of October 17, 2022, and a revision date of January 20, 2024. Review of Resident 8's clinical record revealed an ADL transfer task relating to transfer support provided, specifically how the Resident moves between surfaces to or from: bed, wheelchair, and standing position for the past 30 days (March 20, 2024, through April 17, 2024), revealed Resident 8 was documented as being transferred with a one-person physical assist on the following dates and times: March 22, 2024 at 2:42 PM; March 26, 2024, at 8:59 PM; March 31, 2024, at 2:59 PM; and April 6, 2024, at 12:20 PM. Review of Resident 9's clinical record revealed diagnoses that included heart failure (a condition that develops when your heart doesn't pump enough blood for your body's need) and hypertension. Review of Resident 9's current comprehensive person-centered care plan revealed the following focus area: The Resident has an ADL self-care performance deficit related to dyspnea on exertion and abnormality of gait and mobility, with the intervention to include: Transfers with total mechanical lift and assist of two-person, with an initiation date of November 21, 2022, and a revision date of March 26, 2024. Review of Resident 9's clinical record revealed an ADL transfer task relating to transfer support provided, specifically how the Resident moves between surfaces to or from: bed, wheelchair, and standing position for the past 30 days (March 20, 2024, through April 17, 2024), revealed Resident 9 was documented as being transferred with a one-person physical assist on the following dates and times: April 1, 2024, at 11:43 AM; April 6, 2024, at 1:59 PM; April 11, 2024, at 7:43 PM; and April 13, 2024, at 3:36 AM and 8:14 PM. Review of Resident 10's clinical record revealed diagnoses that included type 2 diabetes (a 395428 Page 2 of 3 395428 04/19/2024 Northern Dauphin Nursing and Rehabilitation Center 990 Medical Road Millersburg, PA 17061

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few long-term condition in which the body has trouble controlling blood sugar and using it for energy) and hypertension. Review of Resident Review of Resident 10's current comprehensive person-centered care plan revealed the following focus area: The Resident has an ADL self-care performance deficit related to gout, chronic obstructive pulmonary disease, and weakness, with the intervention to include: Transfer: The Resident requires full mechanical lift and two-person assist, with an initiation date of March 25, 2024, and a revision date of April 8, 2024. Review of Resident 10's clinical record revealed an ADL transfer task relating to transfer support provided, specifically how the Resident moves between surfaces to or from: bed, wheelchair, and standing position for the past 30 days (March 20, 2024, through April 17, 2024), revealed Resident 10 was documented as being transferred with a one-person physical assist on the following dates and times: March 25, 2024, at 9:04 PM; March 26, 2024, at 1:49 PM, 4:02 PM, and 11:34 PM; March 27, 2024, at 10:44 AM and 3:40 PM; March 28, 2024, at 2:45 PM and 11:46 PM; March 29, 2024, at 2:37 PM; March 30, 2024, at 11:23 PM; March 31, 2024, at 10:40 AM; and April 5, 2024, at 9:46 AM and 7:39 PM. During an interview with the Nursing Home Administrator on April 18, 2024, at 2:00 PM, revealed they believe the staff were miss-clicking the documentation and marking the Residents above being a one-person physical assist in error. 28 Pa. Code 211.12(d)(1) Nursing services 28 Pa. Code 211.12(d)(3) Nursing services 28 Pa. Code 211.12(d)(5) Nursing services 395428 Page 3 of 3