Health inspection·December 10, 2024

F 0689 Level of Harm - Minimal harm or potential for actual harm Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Based on clinical record review, select document review and staff interview, it was determined that the facility failed to prevent accident hazards for one of five residents reviewed (Resident 2). Residents Affected - Few Findings include: Review of Resident 2's clinical record revealed diagnoses that included heart failure (a serious condition that occurs when the heart is unable to pump enough blood and oxygen to the body's organs) and chronic kidney disease (a long-term condition where the kidneys gradually lose their ability to filter blood properly). Review of a fall incident report that occurred on November 1, 2024, at 11:30 PM, revealed that a nurse aid (NA) found Resident 2 while answering the roommate's call bell, lying prone position in the bathroom. The fall resulted in a hematoma to Resident 2's face, and Resident 2 was transported to the hospital. Further review of the fall incident report, revealed a witness statement by the nurse aid (NA 1) that found Resident 2, with the following description of occurrence, Just seen her at 11:00 PM in her rest room having loose bowel movements. Resident was found face down in bathroom. Review of Resident 2's care plan revealed a focus area for falls, initiated on February 9, 2023, with an intervention for 15-minute checks, initiated on May 1, 2024, and provide staff education that the Resident must transfer and ambulate with assist of one to prevent falls, initiated on May 17, 2024. Review of Resident 2's care plan revealed a focus area for activities of daily living (ADLs), with an initiation date of February 8, 2023, and an intervention that Resident 2 requires staff participation to use toilet, initiated on February 8, 2023, and transfer with rolling walker and assist of 2, initiated on February 16, 2023. Review of Resident 2's clinical record ADL toilet use: support provided task for the past 30 days (November 10, 2024 - December 9, 2024) revealed that Resident 2 either required 1-person physical assist or 2-persons physical assist to use the toilet. Review of Resident 2's clinical record ADL toilet use: self-performance task for the past 30 days (November 10, 2024 - December 9, 2024), revealed that Resident 2 either required limited staff assistance, extensive staff assistance, or total staff dependence to use to toilet. Page 1 of 5 395428 395428 12/10/2024 Northern Dauphin Nursing and Rehabilitation Center 990 Medical Road Millersburg, PA 17061

F 0689 Level of Harm - Minimal harm or potential for actual harm During an interview with the Nursing Home Administrator on December 9, 2024, at approximately 1:55 PM, revealed that if Resident 2 was seen in the bathroom by staff, she would have expected them to stay with her until she is done and assist her back to bed. 28 Pa. Code 201.18(b)(1)(2)Management Residents Affected - Few 28 Pa. Code 211.12(d)(3)(5)Nursing services 395428 Page 2 of 5 395428 12/10/2024 Northern Dauphin Nursing and Rehabilitation Center 990 Medical Road Millersburg, PA 17061

F 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. Based on clinical record review and resident and staff interviews, it was determined that the facility failed to have sufficient nursing staff to provide personal care and related services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident for seven of fifteen residents reviewed (Resident 5, 6, 7, 8, 9, 10, and 11). Findings include: Interview conducted with NA 3 on December 9, 2024, at approximately 1:17 PM, revealed they do not feel the facility has enough staff to provide care and showers to the residents that are assigned to them the majority of the time, especially on second shift. Interview conducted with Nurse Aid 2 (NA 2) on December 10, 2024, at approximately 1:55 PM, revealed they do not feel the facility has enough staff to care for the residents who are assigned to them most of the time. Review of Resident 5's clinical record revealed diagnoses that included dementia (a group of symptoms affecting memory, thinking, and social abilities) and depression (mood disorder that causes a persistent feeling of sadness and loss of interest and can interfere with your daily life). Review of Resident 5's clinical record revealed their shower days are on Tuesdays and Fridays. Review of Resident 5's activities of daily living (ADL) - bathing/shower task revealed their shower task was marked not applicable (N/A) on Friday, December 6, 2024. Review of Resident 6's clinical record revealed diagnoses to include chronic kidney disease (CKD - a long-term condition where the kidneys gradually lose their ability to filter blood properly) and anxiety (intense, excessive, and persistent worry and fear about everyday situations). Review of Resident 6's clinical record revealed their shower days are on Tuesdays and Fridays. Review of Resident 6's ADL - bathing/shower task revealed their shower task was marked N/A on Friday, November 15, 2024, and the Resident did not receive a shower on Friday, December 6, 2024. Review of Resident 7's clinical record revealed diagnoses to include CKD and depression. Review of Resident 7's clinical record revealed their shower days are on Wednesdays and Saturdays. Review of Resident 7's ADL - bathing/shower task revealed the Resident did not receive a shower on Saturday, December 7, 2024. Review of Resident 8's clinical record revealed diagnoses to include hypertension and schizoaffective disorder (a mental health condition characterized by mania, racing thoughts, and increased risky behavior). Interview conducted with Resident 8 on December 9, 2024, at 1:09 PM, revealed that the Resident had staffing concerns with their not being enough staff to provide adequate care to them or other 395428 Page 3 of 5 395428 12/10/2024 Northern Dauphin Nursing and Rehabilitation Center 990 Medical Road Millersburg, PA 17061

F 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few residents. Resident 8 revealed staff will tell them there is not enough people to provide the Resident showers if they are short of help. Review of Resident 8's clinical record revealed their shower days are on Wednesdays and Saturdays. Review of Resident 8's ADL - bathing/shower task revealed the Resident did not receive a shower on Saturday, December 7, 2024. Review of Resident 9's clinical record revealed diagnoses to include epilepsy (a disorder in which nerve cell activity in the brain is disturbed, causing seizures) and type 2 diabetes (a chronic condition that happens when you have persistently high blood sugar levels). Review of Resident 9's clinical record revealed their shower days are on Wednesdays and Saturdays. Review of Resident 9's ADL - bathing/shower task revealed the Resident did not receive a shower on Saturday, December 7, 2024. Review of Resident 10's clinical record revealed diagnoses to include hypertension and dementia. Review of Resident 10's clinical record revealed their shower days are on Wednesdays and Saturdays. Review of Resident 10's ADL - bathing/shower task revealed the Resident did not receive a shower on Saturday, December 7, 2024. Review of Resident 11's clinical record revealed diagnoses to include acute kidney failure (a condition in which the kidneys suddenly can't filter waste from the blood) and hypertension. Review of Resident 11's clinical record revealed their shower days are on Tuesdays and Fridays. Review of Resident 11's ADL -bathing/shower task revealed their shower task was marked N/A on December 6, 2024. During an interview with the Nursing Home Administrator (NHA) on December 9, 2024, at 1:55 PM, revealed she does not know why staff would be marking N/A under the resident shower task, and she would expect them to be marking refused if the resident refused a shower. Further interview with the NHA on December 10, 2024, at 12:36 PM, revealed the staff that were identified as marking N/A or not marking at all under resident shower task will be educated. 28 Pa. Code 211.12 (a)(c)(d)(4)(5) Nursing Services 28 Pa. Code 201.18 (e)(1)(2)(3)(6) Management 395428 Page 4 of 5 395428 12/10/2024 Northern Dauphin Nursing and Rehabilitation Center 990 Medical Road Millersburg, PA 17061

F 0770 Provide timely, quality laboratory services/tests to meet the needs of residents. Level of Harm - Minimal harm or potential for actual harm Based on clinical record reviews and staff interview, it was determined that the facility failed to obtain laboratory services for one of 15 residents reviewed (Resident 3). Residents Affected - Few Findings include: Review of Resident 3's clinical record revealed diagnoses that included heart failure (a serious condition that occurs when the heart is unable to pump enough blood and oxygen to the body's organs) and major depressive disorder (a serious mental health condition that affects how a person feels, thinks, and acts). Review of Resident 3's clinical record revealed a fall incident progress note on November 1, 2024, at 7:54 PM, that read, in part, nursing did request a urine to be obtained due to history of urinary tract infections (UTIs). Further review of Resident 3's clinical record revealed an interdisciplinary progress note on November 4, 2024, at 11:38 AM, that read, in part, members of the interdisciplinary team reviewed Resident 3's fall that occurred on November 1, 2024. Medical director made aware with new order received to obtain urine analysis and culture sensitivity test (UA C&S) to rule out infection as cause of increased behavior and fall. Review of Resident 3's clinical record revealed a physician/nurse practitioner progress note on November 21, 2024, at 7:12 AM, with the following note text, patient seen on November 19, 2024. Please obtain UA C&S due to dysuria. Review of Resident 3's November 2024 Treatment Administration Record revealed an order for UA C&S, may straight cath if needed one time only for change in behaviors for one day, with a start date of November 21, 2024. Review of Resident 3's UA C&S lab results documentation reveals Resident 3's urine culture was collected on November 22, 2024, with a result showing Resident 3 is positive for having a UTI. During an interview with the Nursing Home Administrator on December 9, 2024, at 1:55 PM, revealed she would have expected Resident 3's UA C&S to have been obtained prior to November 22, 2024. 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services 395428 Page 5 of 5