Health inspection·December 11, 2023

F 0572 Give residents a notice of rights, rules, services and charges. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interviews, it was determined that the facility failed to ensure that residents were provided a written notice of his or her rights and services provided, as well as all rules and regulations governing resident conduct and responsibilities during their stay in the facility prior to or upon admission for 13 of 13 residents (R4, R5, R6, R2, R7, R8, R9, R3, R10, R11, R12, and R13). Residents Affected - Some Findings include: Review of the facility provided admission Packet included: application for admission, personal information, legal representation, choice of funeral home, income information, provision of services, charges and billing, Medicare/Medicaid programs, personal finances, transfers, bed holds, resident responsibilities, personal properly, notice of privacy practices, authorization of treatment, grievance procedures, and the facility arbitration agreement. Review of residents admitted to the facility between 10/16/23, through 12/6/23, revealed the following: During an interview on 12/8/23, at 9:47 a.m. the Nursing Home Administrator confirmed that the facility failed to orient residents to the facility upon admit. R4, admitted on [DATE], with no signed admission agreement, facility orientation, or authorization to treat. R5, admitted on [DATE], with no signed admission agreement facility orientation, or authorization to treat. R6, admitted on [DATE], with no signed admission agreement facility orientation, or authorization to treat. R2, admitted on [DATE], with no signed admission agreement facility orientation, or authorization to treat. R7, admitted on [DATE], with no signed admission agreement facility orientation, or authorization to treat. R8, admitted on [DATE], with no signed admission agreement facility orientation, or authorization to treat. Page 1 of 12 395434 395434 12/11/2023 Wecare at MT Lebanon Rehabilitation and Nrsg Ctr 350 Old Gilkeson Road Pittsburgh, PA 15228

F 0572 R9, admitted on [DATE], with no signed admission agreement facility orientation, or authorization to treat. Level of Harm - Minimal harm or potential for actual harm R3, admitted on [DATE], with no signed admission agreement facility orientation, or authorization to treat. R10, admitted on [DATE], with no signed admission agreement facility orientation, or authorization to treat. Residents Affected - Some R11, admitted on [DATE], with no signed admission agreement facility orientation, or authorization to treat. R12, admitted on [DATE], with no signed admission agreement facility orientation, or authorization to treat. R 13 admitted on [DATE], with no signed admission agreement facility orientation, or authorization to treat. During an interview on 12/11/23, at 2:00 p.m. the Nursing Home Administrator confirmed that the facility failed to ensure that residents were provided a written notice of his or her rights and services provided, as well as all rules and regulations governing resident conduct and responsibilities during their stay in the facility prior to or upon admission for 13 of 13 residents 395434 Page 2 of 12 395434 12/11/2023 Wecare at MT Lebanon Rehabilitation and Nrsg Ctr 350 Old Gilkeson Road Pittsburgh, PA 15228

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy, clinical records and staff interview, it was determined that the facility failed to document notification of emergency contacts of emergent hospital transports for two of five residents (Resident R1 and R2). Findings include: Review of the facility policy, Notification of Change of Condition: Responsible Party/Guardian last reviewed 3/21/23, indicated the responsible party or guardian is to be notified of changes in condition or occurrences to ensure that the resident's responsible party or guardian is notified of changes and /or occurrences and action and pertinent information are documented. Review of the clinical record revealed that Resident R1 was admitted to the facility on [DATE]. Review of the Minimum Data Set (MDS - periodic assessment of care needs) dated 9/21/23, included diagnoses dementia (a group of symptoms that affects memory, thinking and interferes with daily life) and diabetes (a metabolic disorder in which the body has high sugar levels for prolonged periods of time). Review of Section C: Cognitive Patterns indicated that Resident R1 is rarely/never understood, not allowing her cognitive level to be assessed. Review of Resident R1's demographic information indicated her son to be both her emergency contact and responsible party. Review of a progress note dated 10/15/23, at 3:26 p.m. indicated Resident found on the floor in the back hallway stuck underneath an unused bed. Streaks of blood noted on floor and on resident's arm. Resident assessed for injury. 911 notified. Review of subsequent progress notes failed to reveal documentation of a notification to her son/emergency contact. Review of a facility provided incident report dated 10/15/23, stated, Resident found on the floor in the back hallway underneath an unused bed. Streaks of blood noted on resident's arm. Review of the section of the report titled Agencies/People Notified was blank. Review of family submitted information dated 11/14/23, indicated the son of Resident R1 stated he was not informed that his mother was transported to the hospital. Review of Resident R1's physician's orders indicated an order for Namenda (medication used to treat dementia), 5 mg (milligrams) at bedtime dated 5/11/23, and an order for Zoloft (medication used to treat depression) 25 mg once daily for seven days, then increased to 50 mg once daily. Review of progress notes and physician/provider notes failed to reveal a notification and/or authorization from her son for the initiation of new medicaations. Review of family submitted information dated 11/14/23, indicated the son of Resident R1 stated he was not informed when his mother was ordered new medications. Review of the clinical record revealed that Resident R2 was admitted to the facility on [DATE]. 395434 Page 3 of 12 395434 12/11/2023 Wecare at MT Lebanon Rehabilitation and Nrsg Ctr 350 Old Gilkeson Road Pittsburgh, PA 15228

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Review of the MDS dated [DATE], included diagnoses coronary artery disease (damage or disease in the heart's major blood vessels) and history of a stroke. Review of Section C: Cognitive Patterns indicated that Resident R2 had severe cognitive impairment. Review of Resident R2's demographic information indicated Resident R2 had a Healthcare Power of Attorney. Review of a progress note dated 11/6/23, at 1:10 p.m. indicated that Resident R2 was being sent to the hospital for evaluation of a possible cardiovascular accident (stroke). Review of subsequent progress notes failed to reveal documentation of a notification to Resident R2's Healthcare Power of Attorney. During an interview on 12/5/23, at 4:10 p.m. the Nursing Home Administrator confirmed that residents were provided appropriate treatment and care to possibly prevent hospitalization for one of four residents. 28 Pa. Code 201.14(a) Responsibility of Licensee. 28 Pa. Code 201.18(b)(1)(3) Management. 28 Pa. Code 201.29(a)(c)(d)(j) Resident Rights 28 Pa. Code 211.10(c)(d) Resident Care Policies. 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services. 395434 Page 4 of 12 395434 12/11/2023 Wecare at MT Lebanon Rehabilitation and Nrsg Ctr 350 Old Gilkeson Road Pittsburgh, PA 15228

F 0636 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months. Based on review of the Resident Assessment Instrument User's Manual and clinical records, and staff interview, it was determined that the facility failed to make certain that comprehensive Minimum Data Set assessments were completed in the required time frame for 14 of 20 newly admitted residents. Findings include: The Long-Term Care Facility Resident Assessment Instrument (RAI) User's Manual, which provides instructions and guidelines for completing required Minimum Data Set (MDS) assessments (mandated assessments of a resident's abilities and care needs), dated October 2019, indicated that an admission MDS assessment was to be completed no later than 14 days following admission. Review of the facility policy MDS/RAI/Care Planning dated 3/21/23, indicated residents will have a comprehensive assessment completed by day 14 of a stay. During an interview on 12/11/23 at 2:00 p.m., the Nursing Home Administrator confirmed that the facility failed to make certain that MDS assessments were completed in the required time frame for 14 for 20 residents. 395434 Page 5 of 12 395434 12/11/2023 Wecare at MT Lebanon Rehabilitation and Nrsg Ctr 350 Old Gilkeson Road Pittsburgh, PA 15228

F 0636 28 Pa. Code: 211.5(f) Clinical records. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 395434 Page 6 of 12 395434 12/11/2023 Wecare at MT Lebanon Rehabilitation and Nrsg Ctr 350 Old Gilkeson Road Pittsburgh, PA 15228

F 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm Based on review of the Resident Assessment Instrument User's Manual and clinical records, and staff interview, it was determined that the facility failed to make certain that comprehensive Minimum Data Set assessments were completed accurately for eleven of 20 newly admitted residents (R14, R16, R18, R20, R21, R22, R23, R25, R26, R28, and R29). Residents Affected - Some Findings include: The Long-Term Care Facility Resident Assessment Instrument (RAI) User's Manual, which gives instructions for completing Minimum Data Set Assessments (MDS - periodic assessment of care needs) dated October 2018, and updated October 2019, indicated that Section C: Cognitive Patterns, Question C0100 Should Brief Interview for Mental Status Be Conducted? (BIMS) should be coded as 0 if the resident is rarely/never understood, or it should be coded 1, and the BIMS assessment should be completed if the resident is at least sometimes understood. Section D: Mood, Question D0100 Should Resident Mood Interview Be Conducted? should be coded as 0 if the resident is rarely/never understood, and or it should be coded 1, and the assessment should be completed if the resident is at least sometimes understood. Review of admission MDSs completed on residents admitted between 2/1/23, through 3/31/23 revealed: -Resident R14 had an admission MDS completed on 3/22/23. Review of Sections C: Cognitive Patterns and Section D: Mood were both documented as Not Assessed. and Section D: Mood were both documented as Not Assessed. and Section D: Mood were both documented as Not Assessed. Sections C: Cognitive Patterns and Section D: Mood were both documented as Not Assessed. -Resident R21 had an admission MDS completed on 3/7/23. Review of Sections C: Cognitive Patterns and Section D: Mood were both documented as Not Assessed. Sections C: Cognitive Patterns and Section D: Mood were both documented as Not Assessed. -Resident R23 had an admission MDS completed on 3/10/23. Review of Sections C: Cognitive Patterns and Section D: Mood were both documented as Not Assessed. Patterns and Section D: Mood were both documented as Not Assessed. -Resident R26 had an admission MDS completed on 3/8/23. Review of Sections C: Cognitive Patterns and Section D: Mood were both documented as Not Assessed. 395434 Page 7 of 12 395434 12/11/2023 Wecare at MT Lebanon Rehabilitation and Nrsg Ctr 350 Old Gilkeson Road Pittsburgh, PA 15228

F 0641 Patterns and Section D: Mood were both documented as Not Assessed. Level of Harm - Minimal harm or potential for actual harm and Vision, Question B0700 indicated that Resident R48 is sometimes understood. Review of Section C: Cognitive Patterns, Question C0100 indicated that Resident R29 is rarely understood, and the BIMS assessment was not completed. Review of Section D: Mood, Question C0100 indicated that Resident R29 is rarely understood, and the Resident Mood Interview assessment was not completed. Residents Affected - Some During an interview on 12/11/22, at 2:00 p.m. the Nursing Home Adminstrator confirmed that the facility failed to make certain that MDS assessments were completed in the required time frame for eleven of 20 residents. 28 Pa. Code: 211.5(f) Clinical records. 395434 Page 8 of 12 395434 12/11/2023 Wecare at MT Lebanon Rehabilitation and Nrsg Ctr 350 Old Gilkeson Road Pittsburgh, PA 15228

F 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review and staff interview, it was determined the facility failed to provide nutritional services by enteral feeding as ordered by the physician for one of two residents reviewed (Residents R3). Findings include: The facility policy entitled Feeding Tubes (delivery of food or medication via tube surgically inserted into stomach) dated 3/21/23, indicated that enteral feedings may be prescribed for residents who are physically unable to take food by mouth in amounts that will support adequate nutrition. Review of admission record indicated Resident R3 admitted to the facility on [DATE]. Review of Resident R3's Minimum Data Set (MDS- periodic assessment of care needs) dated 11/18/23, indicated diagnoses of dysphagia (difficulty swallowing) following a stroke and diabetes (a metabolic disorder in which the body has high sugar levels for prolonged periods of time). Review of a physician order dated 11/16/23, discontinued on 11/18/23, at 2:30 p.m., indicated that Resident R3 was to receive IsoSource via enteral tube at a rate of 60 cubic centimeters (cc) per hour, for each shift. Review of Resident R3's progress notes dated 11/18/23, indicated Upon changing the patient's enteral feed, I noticed that the feed itself was the incorrect feed. The patient is ordered Isosource @ 60 mL (milliliters) per hour. The patient had running Peptide 1.5 @ 50 mL per hour. The bag was immediately switched out and the settings were corrected on the pump. The supervisor was made aware. Review of facility documentation dated 11/18/23, indicated the incorrect enteral feeding product was administered to Resident R3. During an interview on 12/5/23, at 4:00 p.m. the Nursing Home Administrator confirmed the facility failed to provide nutritional services by enteral feeding as ordered by the physician for one of two residents reviewed. 28 Pa. Code: 201.18(b)(1) Management. 28 Pa. Code: 211.12(d)(1) Nursing services. 28 Pa. Code: 211.10(c) Resident care policies. 395434 Page 9 of 12 395434 12/11/2023 Wecare at MT Lebanon Rehabilitation and Nrsg Ctr 350 Old Gilkeson Road Pittsburgh, PA 15228

F 0847 Inform resident or representatives choice to enter into binding arbitration agreement and right to refuse. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a review of facility admission documents and staff interview, it was determined that the facility failed to ensure resident rights to make informed decisions and choices about important aspects of residents' health, safety and welfare by making certain residents understand the conditions of a binding arbitration agreement and failed to ensure the agreement is explained to the resident and his or her representative in a form and manner that he or she understands, three of seven residents (Resident R14, R30, and R31). Residents Affected - Some Findings include: Review of the facility's admission packet contained the document Voluntary Arbitration Agreement, indicated In arbitration, a neutral third party chosen by the Parties issues a final, binding decision. When Parties agree to arbitrate, they waive their right to a trial by jury and the possibility of an appeal. Review of Resident R14's admission record indicated the resident was admitted to the facility on [DATE]. Review of the Social Services Initial Assessment completed on 3/8/23, at 3:56 p.m. indicated that Resident R14 had his son named as Durable Power of Attorney. Review of the Nursing admission Assessment completed on 3/8/23, at 9:51 p.m. indicated that Resident R14 was alert to person, but not to place or time. Review of Resident R16's admission paperwork indicated all sections, including the Voluntary Arbitration Agreement, were signed by Resident R16. During an interview on 12/8/23, at 12:30 p.m. with Resident R14's Son/Power of Attorney, he stated that Resident R14 was not enough in possession of his mental faculties to sign legal documents. Review of Resident R30's admission record indicated the resident was admitted to the facility on [DATE]. Review of Resident R30's admitting diagnosis list included dementia (a group of symptoms that affects memory, thinking and interferes with daily life), as of 2/17/21. Review of Resident R30's admission referral information, sent by Resident R30's prior facility, included a diagnosis of dementia, as of 9/1/17. Review of Resident R30's admission paperwork indicated all sections, including the Voluntary Arbitration Agreement, were signed by Resident R30. Review of Resident R31's admission record indicated the resident was originally admitted to the facility on [DATE], and readmitted on [DATE]. Review of a progress note dated 12/20/21, at 7:02 p.m. indicated Resident is alert and oriented x 395434 Page 10 of 12 395434 12/11/2023 Wecare at MT Lebanon Rehabilitation and Nrsg Ctr 350 Old Gilkeson Road Pittsburgh, PA 15228

F 0847 Level of Harm - Minimal harm or potential for actual harm one, to person. Reoriented to place and time, unable to state who was president, stated the month is October. Review of Resident R31's admission paperwork dated 12/21/21, indicated all sections, including the Voluntary Arbitration Agreement, were signed by Resident R31. Residents Affected - Some During an interview on 12/11/23, at 2:00 p.m. the Nursing Home Administrator confirmed the facility failed to ensure resident rights to make informed decisions and choices about important aspects of residents' health, safety and welfare by making certain residents understand the conditions of a binding arbitration agreement and failed to ensure the agreement is explained to the resident and his or her representative in a form and manner that he or she understands, for three of seven residents. 28 Pa. Code 201.24 (b) admission Policy 28 Pa. Code 201.14(a) Responsibility of Licensee 28 Pa. Code 201.18(b)(2) Management 28 Pa. Code 201.29(a)(j) Resident Rights 395434 Page 11 of 12 395434 12/11/2023 Wecare at MT Lebanon Rehabilitation and Nrsg Ctr 350 Old Gilkeson Road Pittsburgh, PA 15228

F 0848 Provide a neutral and fair arbitration process and agree to arbitrator and venue. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of the facility's admission agreement and staff interviews, it was determined that the facility failed to ensure a neutral and fair arbitration process by ensuring both the resident or his or her representative, and the facility agree on the selection of a neutral arbitrator. Residents Affected - Some Findings include: Review of facility's admission Agreement packet, which contained the document Voluntary Arbitration Agreement, indicated that Accordingly, any dispute arising out of relating to the provision of services by the Facility to [NAME] Resident, Resident ' s admission to the Facility, Resident ' s contracts with the Facility or the subject matter thereof, any breach of contract, including any dispute regarding the execution, validity or scope of this Arbitration Agreement or any of its clauses, will be resolved through arbitration administered by [name of arbitrator services company which the facility utilizes] and conducted pursuant to the [arbitrator] Rules of Procedure for Arbitration. The facility's arbitration agreement failed to provide for the selection of a neutral arbitrator agreed upon by both parties as one is designated in the facility arbitration agreement, in accordance with §483.70(n)(2)(iii). (Regulatory guidance defines a neutral Arbitrator as an impartial, or unbiased third-party decision maker, contracted with, and agreed to by both parties to resolve their dispute. To ensure a neutral arbitrator is selected, the facility should avoid even the appearance of bias, partiality, or a conflict of interest, and should promptly disclose to the resident or his or her representative the extent of any relationship which exists with an arbitrator or arbitration services company, including how often the facility has contracted with the arbitrator or arbitration service, and when the arbitrator or arbitration service has ruled for or against the facility). During an interview on 12/11/23, at 2:00 p.m. the Nursing Home Administrator confirmed the language of the arbitration agreement may appear not to afford the selection of a neutral arbitrator as it indicates that all arbitrations are administered by the facility's contracted arbitration service. 28 Pa. Code 201.14(a) Responsibility of Licensee 28 Pa. Code 201.18(b)(2) Management 28 Pa. Code 201.29(a)(j) Resident Rights 395434 Page 12 of 12