Health inspection·November 2, 2023

F 0580 Level of Harm - Minimal harm or potential for actual harm Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. Based on clinical record review and staff interview, it was determined that the facility failed to notify the resident representative of a change in condition for one of 35 sampled residents. (Resident 29) Residents Affected - Few Findings include: Clinical record review revealed that Resident 29 had diagnoses that included schizoaffective disorder and dementia. Review of a nurse's noted dated October 23, 2023, revealed that Resident 29 tested positive for COVID-19 and a message was left for the resident representative to call the facility. Review of the clinical record revealed no further documentation that an attempt to notify the resident representative was made. There was no documented evidence that the resident's representative was notified of the change in condition. In an interview on November 2, 2023, at 12:15 p.m., the Director of Nursing confirmed that the resident's representative was not notified of the change in condition. 28 Pa. Code 211.12(d)(1)(5) Nursing services. Page 1 of 12 395429 395429 11/02/2023 Bethlehem South Skilled Nursing and Rehabilitation 2021 Westgate Drive Bethlehem, PA 18017

F 0584 Level of Harm - Potential for minimal harm Residents Affected - Many 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 and resident interview, it was determined that the facility failed to ensure that a safe, clean, and comfortable environment was maintained on four of four nursing units. (Medbridge, Unit 2, Unit 3, Unit 4) Findings include: Observation of the Medbridge Unit on October 30, 2023, at various times, revealed a hole in the wall by the door and stained ceiling tiles in the resident dining room. There was peeling wallpaper in the bathroom of room [ROOM NUMBER], peeling wallpaper and a black substance on the floor of the bathroom in room [ROOM NUMBER], and a black substance on the floor and a broken soap dispenser in the bathroom of room [ROOM NUMBER]. Observations of Unit 2 on October 30 and 31, 2023, at various times, revealed dead bugs on the floor by the window in room [ROOM NUMBER], stained ceiling tiles by the windows in rooms [ROOM NUMBERS], cracked tiles in the hallway across from the elevator, a cracked red outlet cover outside room [ROOM NUMBER], and a towel covering the wall vent in room [ROOM NUMBER]. In an interview on October 30, 2023, at 12:58 p.m., Resident 2 stated there were sticky spots on the floor next to the bed that had not been cleaned. At this time, and again on October 31, 2023, a substance observed on the floor next to the A bed in room [ROOM NUMBER]. Observations on Unit 3 on October 30, 2023, at various times, revealed the over bed table was dirty in room [ROOM NUMBER] B. In addition, the door to the central bathing area did not open or close properly and made a loud noise. Observations on Unit 4 on October 30 and 31, 2023, at various times, revealed the dining room walls were marred, several areas had chipped paint, four ceiling tiles had brown stains, and the clock had been at the same time for two days. At the end of the hallway by room [ROOM NUMBER], there were marred walls, several areas of chipped paint, a hole in the wall above the baseboard molding, and a brown stained ceiling tile. The right side shower stall in the shower room had a brown dried substance spattered on the floor and hair covering the drain. room [ROOM NUMBER] had peeling wallpaper behind bed D and half of the window curtain was missing. room [ROOM NUMBER] had peeling wallpaper on the wall closest to the resident bathroom. room [ROOM NUMBER] was missing a pull shade for the right window and the left window pull shade had several dark brown dried stains. room [ROOM NUMBER] bed B had dirty linen on the floor for two days. 395429 Page 2 of 12 395429 11/02/2023 Bethlehem South Skilled Nursing and Rehabilitation 2021 Westgate Drive Bethlehem, PA 18017

F 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. Level of Harm - Minimal harm or potential for actual harm Based on review of facility policy and personnel file review, it was determined that the facility failed to obtain reference checks at the start of employment for two of five newly hired employees. (Employees 1 and 4) In addition, the facility failed to provide abuse training upon hire as per facililty policy for one of five employees. (Employee 2) Residents Affected - Few Findings include: Review of the facility policy entitled Abuse Prohibition, last reviewed November 21, 2022, revealed that the facility prohibited abuse, mistreatment, neglect, misappropriation of resident/patient property and exploitation for all patients. The facility was to implement an abuse prohibition program by screening potential hires and training employees, both new employees and on-going training for all employees. Review of the personnel file for newly hired employee 1, who was hired on August 1, 2023, revealed that there was no documented evidence that reference checks were obtained through the screening process. Review of the personnel file for newly hired employee 4, who was hired on October 9, 2023, revealed that there was no documented evidence that reference checks were obtained through the screening process. Review of the personnel file for newly hired employee 1, who was hired August 1, 2023, revealed that there was no documented evidence that the employee had abuse training upon hire. In an interview on November 2, 2023, at 12:15 p.m., the Administrator stated that reference checks were to be obtained through the screening process prior to hire. The Administrator further stated that there was no documented evidence that reference checks were obtained for employees 1 and 4 and that there was no documented evidence that employee 1 had received abuse training as per facility process. 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa Code 201.19 Personnel policies and procedures. 395429 Page 3 of 12 395429 11/02/2023 Bethlehem South Skilled Nursing and Rehabilitation 2021 Westgate Drive Bethlehem, PA 18017

F 0623 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on facility policy review, clinical record review, and staff interview, it was determined that the facility failed to notify the resident's representative(s) of transfer and the reasons for the move in writing for seven of 11 sampled residents who were transferred to the hospital. (Residents 37, 77, 90, 91, 137, 154, 159 ) Findings include: Review of the facility policy entitled, Discharge and Transfer, last reviewed November 11, 2022, revealed that the facility must notify the resident and resident representative in writing prior to the transfer or discharge in a language and manner they understand. Clinical record review revealed that Resident 37 was transferred and admitted to the hospital on [DATE], after a change in condition. There was no evidence that the resident and the resident's representative was provided with written information regarding the resident's transfer to the hospital. Clinical record review revealed that Resident 77 was transferred and admitted to the hospital on [DATE], after a change in condition. There was no evidence that the resident and the resident's representative was provided with written information regarding the resident's transfer to the hospital. Clinical record review revealed that Resident 90 was transferred and admitted to the hospital on [DATE], after a change in condition. There was no evidence that the resident and the resident's representative was provided with written information regarding the resident's transfer to the hospital. Clinical record review revealed that Resident 91 was transferred and admitted to the hospital on [DATE] and May 17, 2023, after changes in condition. There was no evidence that the resident and the resident's represenative was provided with written information regarding the resident's transfers to the hospital. Clinical record review revealed that Resident 137 was transferred and admitted to the hospital on [DATE], after a change in condition. There was no evidence that the resident and the resident's representative was provided with written information regarding the resident's transfer to the hospital. Clinical record review revealed that Resident 154 was transferred and admitted to the hospital on [DATE], after a change in condition. There was no evidence that the resident and the resident's representative was provided with written information regarding the resident's transfer to the hospital. Clinical record review revealed that Resident 159 was transferred and admitted to the hospital on [DATE], after a change in condition. There was no evidence that the resident and the resident's representative was provided with written information regarding the resident's transfer to the hospital. In an interview on November 1, 2023, at 9:15 a.m., the Administrator confirmed that written transfer information, including the reasons for the move, was not provided to the residents and the residents' representatives. 395429 Page 4 of 12 395429 11/02/2023 Bethlehem South Skilled Nursing and Rehabilitation 2021 Westgate Drive Bethlehem, PA 18017

F 0625 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave. **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 provide a written notice of the facility's bed-hold policy to the resident or resident representative at the time of transfer for seven of 11 sampled residents who were transferred to the hospital. (Residents 37, 77, 90, 91, 137, 154, 159) Findings include: Clinical record review revealed that Resident 37 was transferred and admitted to the hospital on [DATE], after a change in condition. There was no documented evidence that the resident or resident's representatives were provided written information about the facility's bed-hold policy at the time of transfer. Clinical record review revealed that Resident 77 was transferred and admitted to the hospital on [DATE], after a change in condition. There was no documented evidence that the resident or resident's representatives were provided written information about the facility's bed-hold policy at the time of transfer. Clinical record review revealed that Resident 90 was transferred and admitted to the hospital on [DATE], after a change in condition. There was no documented evidence that the resident or resident's representatives were provided written information about the facility's bed-hold policy at the time of transfer. Clinical record review revealed that Resident 91 was transferred and admitted to the hospital on [DATE] and May 17, 2023, after changes in condition. There was no documented evidence that the resident or resident's representatives were provided written information about the facility's bed-hold policy at the time of transfer. Clinical record review revealed that Resident 137 was transferred and admitted to the hospital on [DATE], after a change in condition. There was no documented evidence that the resident or resident's representatives were provided written information about the facility's bed-hold policy at the time of transfer. Clinical record review revealed that Resident 154 was transferred and admitted to the hospital on [DATE], after a change in condition. There was no documented evidence that the resident or resident's representatives were provided written information about the facility's bed-hold policy at the time of transfer. Clinical record review revealed that Resident 159 was transferred and admitted to the hospital on [DATE], after a change in condition. There was no documented evidence that the resident or resident's representatives were provided written information about the facility's bed-hold policy at the time of transfer. In an interview on November 1, 2023, at 9:15 a.m., the Administrator confirmed that no written notice of the bed-hold policy was given to the residents or residents' representatives upon transfer out of the facility. 395429 Page 5 of 12 395429 11/02/2023 Bethlehem South Skilled Nursing and Rehabilitation 2021 Westgate Drive Bethlehem, PA 18017

F 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm **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 the Minimum Data Set (MDS) assessment was complete to accurately reflect the resident's status for four of 35 sampled residents. (Residents 57, 62, 68,104) Residents Affected - Few Findings include: Clinical record review revealed that Sections C (Brief Interview for Mental Status), D (Mood assessment/interview) and E (Behaviors) of Resident 57's MDS assessment dated [DATE], was incomplete. Clinical record review revealed that Sections C (Brief Interview for Mental Status) and D (Mood assessment/interview) of Resident 62's MDS assessment dated [DATE], was incomplete. Clinical record review revealed that Section N (Medications) of Resident 68's MDS assessments dated August 18, 2023, and October 25, 2023, inaccurately indicated that the resident was on an anti-anxiety medication. There was no documented evidence or physician's orders to reflect that the resident was on an anti-anxiety medication during those assessment periods. Clinical record review revealed that Sections C (Brief Interview for Mental Status), D (Mood assessment/interview) and E (Behaviors) of Resident 104's MDS assessment dated [DATE], was incomplete. In an interview on November 2, 2023, at 11:00 a.m., the Administrator confirmed that the MDS sections were not completed during the assessment period to reflect the resident's current status. 395429 Page 6 of 12 395429 11/02/2023 Bethlehem South Skilled Nursing and Rehabilitation 2021 Westgate Drive Bethlehem, PA 18017

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 a clinical record review, observation, and staff interview, it was determined that the facility failed to provide care in accordance with physician's orders for a percutaneous cholecystostomy (Catheter attached to the gall bladder, also called a chole) for one of 35 sampled residents. (Resident 50) Residents Affected - Few Findings include: Clinical record review revealed Resident 50 was admitted to the facility on [DATE], with diagnoses that included acute cholecystitis (an inflammed gall bladder) with sepsis, acute respiratory failure with hypoxia (low oxygen levels in the tissues), and an infection of streptococcus anginosus. A physician order dated August 10, 2023, directed staff to record the amount of drainage from right chole tube every shift. Review of the treatment administration record for October 2023, revealed no evidence that the amount of drainage was recorded on the evening shifts for October 20, 21, 22, 26, 29, 27, 28, 29, 31 and November 1, 2023, as well as the night shifts on October 26, 27, 28, 2023. Observation on October 31, 2023, at 12:33 p.m., revealed Resident 50's cholecystostomy bag was partially filled. At the time of the observation, the alert and oriented resident stated that the appliance was not emptied and that it does not get emptied unless she complains. In an interview on November 2, 2023, at 12:00 p.m., the Director of Nursing confirmed that there were shifts where there was no documentation that the volume of drainage from the cholecystostomy bag had been recorded. 28 Pa. Code 211.12(d)(1)(5) Nursing services. 395429 Page 7 of 12 395429 11/02/2023 Bethlehem South Skilled Nursing and Rehabilitation 2021 Westgate Drive Bethlehem, PA 18017

F 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review, observations, and resident and staff interview, it was determined that the facility failed to provide services and treatment to prevent further limitations in range of motion for four of eight sampled residents with limitations in range of motion. (Residents 57, 91, 132, and 154) Findings include: Clinical record review revealed that Resident 57 had diagnoses that included dementia, osteoarthritis, and chronic pain syndrome. The Minimum Data Set (MDS) assessment dated [DATE], indicated that the resident required extensive assistance from staff with Activities of Daily Living (ADL's). A review of the care plan revealed that the resident was at risk for loss of range of motion related to physical limitations. There was an intervention for staff to provide active range of motion to bilateral upper extremities with a.m.,and p.m.,care. Review of an occupational therapy Discharge summary dated [DATE], revealed that there was a recommendation for staff to provide a restorative nursing program that included providing active range of motion to bilateral upper extremities with a.m.,and p.m.,care. There was no documented evidence that staff had provided the restorative nursing program as recommended by occupational therapy. Clinical record review revealed that Resident 91 had diagnoses that included a stroke with left side hemiplegia (paralysis), and a contracture of the left hand. The MDS assessment dated [DATE], indicated that the resident was alert and oriented, required extensive assistance from staff for ADL's including dressing and had limitations in range of motion on both sides of the upper and lower extremities. A review of the care plan revealed that the resident had an ADL self care deficit related to physical limitations. There was an intervention for the resident to wear a left upper extremity splint six to eight hours a day. Review of an occupational therapy Discharge summary dated [DATE], revealed that the resident was able to tolerate a left resting hand splint for seven hours. There was a recommendation for staff to apply the left resting hand splint daily and to provide a restorative nursing program that included passive range of motion of bilateral upper extremities to reduce the risk for further contractures. In an interview on October 30, 2023, at 1:22 p.m., Resident 91 was observed laying in his bed without the splint in place. At this time, he stated that he did not have a splint for his arm or his hand. There was no documented evidence that staff had been applying the splint nor was there documentation to reflect that staff had provided the restorative nursing program to include the passive range of motion. In an interview on November 2, 2023, at 11:00 a.m., the Administrator stated that Resident 91 had the splint in his room but that there was no documented evidence that staff had been applying the splint as recommended by occupational therapy. Clinical record review revealed that Resident 132 had diagnoses that included a stroke with right side hemiplegia, dementia and a right hand contracture. The MDS assessment dated [DATE], indicated that the resident had memory impairment, required extensive assistance with ADL's and had limited range of motion on one side of both upper and lower extremities. A review of the care plan revealed that the resident was at risk for loss of range of motion due to physical limitations. There was an intervention for staff to provide passive range of motion to bilateral upper extremities with a.m.,and 395429 Page 8 of 12 395429 11/02/2023 Bethlehem South Skilled Nursing and Rehabilitation 2021 Westgate Drive Bethlehem, PA 18017

F 0688 Level of Harm - Minimal harm or potential for actual harm p.m.,care and active range of motion to bilateral lower extremities with ADL's. Review of an occupational therapy Discharge summary dated [DATE], revealed that staff was to provide a restorative nursing program that included passive range of motion of the right upper extremity to reduce the risk for further contracture. There was no documented evidence that staff had provided the restorative nursing program as recommended by occupational therapy. Residents Affected - Some Clinical record review revealed that Resident 154 had diagnoses that included dementia, monoplegia, (paralysis of a single limb), of the upper limb affecting the right dominant side and osteoarthritis. The MDS assessment dated [DATE], revealed that the resident had memory impairment, required total dependence for most ADL's and had limited range of motion on one side of the upper extremities. A review of the care plan revealed that the resident was at risk for loss of range of motion related to physical limitations. There was an intervention for staff to provide active range of motion to bilateral upper extremities with a.m.,and p.m.,care. Review of an occupational therapy Discharge summary dated [DATE], revealed that there was a recommendation for staff to provide a restorative nursing program that included active range of motion to bilateral upper extremities during a.m.,and p.m., care. There was no documented evidence that staff had provided the restorative nursing program as recommended by occupational therapy. In an interview on November 2, 2023, at 11:00 a.m., the Administrator stated that there was no documented evidence that the restorative nursing programs had been completed by staff as recommended by occupational therapy. 28 Pa. Code 211.12 (d)(1)(5) Nursing services. 395429 Page 9 of 12 395429 11/02/2023 Bethlehem South Skilled Nursing and Rehabilitation 2021 Westgate Drive Bethlehem, PA 18017

F 0697 Provide safe, appropriate pain management for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm Based on clinical record review and staff interview, it was determined that the facility failed to provide non-pharmacological interventions to alleviate pain prior to the administration of pain mediation prescribed on an as needed basis for three of 35 sampled residents. (Residents 37, 108, 137) Residents Affected - Some Findings include: Clinical record review revealed that Resident 37 had diagnoses that included peripheral vascular disease and spondylosis (arthritis of the spine). The resident had a physician's order for as needed pain medication, tramadol 50 milligrams (mg) to be administered every six hours as needed for pain. Review of the October 2023, Medication Administration Record (MAR) revealed that the resident received the tramadol 20 times without evidence to support that non-pharmacological interventions were offered to address the assessed pain prior to the administration of the as needed pain medication. Clinical record review revealed that Resident 108 had diagnoses that included chronic obstructive pulmonary disease and diabetes. The resident had a physician's order for as needed pain medication, tramadol 25 mg, to be administered every eight hours as needed for pain after non-pharmacological interventions were tried and failed. Review of the October 2023, MAR revealed that the resident received the tramadol 11 times without evidence to support that non-pharmacological interventions were offered to address the assessed pain prior to the administration of the as needed pain medication. Clinical record review revealed that Resident 137 had diagnoses that included diabetes and peripheral vascular disease. The resident had a physician's order for as needed pain medication, oxycodone 7.5 mg, to be administered every four hours as needed for pain. Review of the October 2023, MAR revealed that the resident received the tramadol 34 times without evidence to support that non-pharmacological interventions were offered to address the assessed pain prior to the administration of the as needed pain medication. In an interview on November 2, 2023, at 10:40 a.m., the Director of Nursing confirmed that there was no documented evidence staff offered non-pharmacological interventions prior to the administration of the as needed pain medication. 28 Pa. Code 211.12(d)(1)(5) Nursing services. 395429 Page 10 of 12 395429 11/02/2023 Bethlehem South Skilled Nursing and Rehabilitation 2021 Westgate Drive Bethlehem, PA 18017

F 0814 Dispose of garbage and refuse properly. Level of Harm - Potential for minimal harm Based on observation, it was determined that the facility failed to properly contain refuse. Findings include: Residents Affected - Many Observation on October 30, 2023, at 10:38 a.m., revealed the compactor for garbage was located at the rear of the building. At this time, there was garbage and debris that included plastic bags and soiled gloves on the ground around the compactor area. 395429 Page 11 of 12 395429 11/02/2023 Bethlehem South Skilled Nursing and Rehabilitation 2021 Westgate Drive Bethlehem, PA 18017

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on facility policy review, clinical record review, and observation, it was determined that the facility failed to ensure aeseptic (free from germs that can cause infection or disease) wound treatments were completed in accordance with facility policy for one of 35 sampled residents. (Resident 132) Residents Affected - Few Findings include: Review of the facility policy entitled, Procedure: Wound Dressings: Aseptic, last reviewed November 21, 2022, revealed that during the treatment of wounds, after removing the old dressing, staff was to remove gloves, perform hand hygiene, and apply new gloves. Clinical record review revealed that Resident 132 was admitted to the facility on [DATE], with diagnoses that included dementia and depression. On October 10, 2023, the physician ordered that Resident 132's right buttocks wound be cleansed with soap and water, irrigated with saline, packed with Aquacel AG or silver alginate (a silver impregnated dressing), and covered with a dressing. On October 30, 2023 at 1:50 p.m., Licensed Practical Nurse (LPN) 1 was observed providing the prescribed treatment to Resident 132's right buttocks. LPN 1 removed her old gloves after removing the old dressing and applied new gloves without performing hand hygiene per facility policy during the observation. 28 Pa. Code 211.10(c) Resident care policies. 28 Pa. Code 211.12(d)(1)(5) Nursing services. 395429 Page 12 of 12