Health inspection·July 25, 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 facility policy review, observations, clinical record review, staff interviews, and facility documentation review, it was determined that the facility failed to ensure care and services are provided in accordance with professional standards of practice that will meet each resident's physical, mental, and psychosocial needs for four of 12 residents reviewed (Residents 4, 9, 10, and 12). Residents Affected - Some Findings include: Review of facility policy, titled Medication Administration Section 7.1 General Guidelines, dated January 2024, revealed Medications are administered as prescribed in accordance with manufacturers' specifications, good nursing principles and practices; 1. Medications are administered in accordance with written orders of the prescriber .14. medications are administered within 60 minutes of scheduled time. Observation of third floor on July 25, 2024, at 11:30 AM, revealed that Employee 1 (Licensed Practical Nurse [LPN]) and Employee 2 (LPN) were administering medications to residents. During an interview with Employee 1 on July 25, 2024, at 11:31 AM, Employee 1 indicated that the LPN was still administering morning medications and that the they had two more residents (Residents 2 and 3) to administer medications to. Employee 1 further indicated that the they were a new employee at the facility and that the they were not sure of the timeframe in which the they had to pass medications, but thought the they had from 7 AM to 10 AM to pass the residents' morning medications. During an interview with Employee 2 on July 25, 2024, at 11:34 AM, Employee 2 indicated that they had just administered the last Resident their morning medications (Resident 4). Employee 2 indicated that they were not aware of a timeframe in which they had to administer medications, but indicated I try to get them done before lunch. Observation of Arcadia unit on July 25, 2024, at 11:36 AM, revealed that Employee 3 (Licensed Practical Nurse) was administering medications to residents. During an interview with Employee 3 on July 25, 2024, at 11:36 AM, Employee 3 indicated that they were still administering morning medications to residents. Employee 3 indicated that they still needed to administer medications to eight more residents (Residents 5, 6, 7, 8, 9, 10, 11, and 12). Employee 3 further stated that they were running behind. Review of Resident 4's clinical record revealed diagnoses that included right above the knee amputation and diabetes mellitus type II (disease that occurs when your blood glucose, also called blood sugar, is too high, but does not require the use of insulin) with neuropathy (a group of diseases Page 1 of 4 395440 395440 07/25/2024 Camp Hill Skilled Nursing and Rehabilitation Ctr 1700 Market Street Camp Hill, PA 17011

F 0684 Level of Harm - Minimal harm or potential for actual harm resulting from damaged or malfunctioning of nerves that causes weakness, numbness and pain in hands and feet). Review of Resident 4's physician orders revealed an order for gabapentin capsule 300 mg (milligrams) give 300 mg by mouth three times a day for neuropathy, dated March 6, 2023. Residents Affected - Some Review of Resident 4's July Medication Administration Record (MAR) revealed that their gabapentin was scheduled to be administered at 9:00 AM, 1:00 PM, and 8:00 PM. Review of Resident 4's Medication Administration Audit Report provided by the facility from July 18-25, 2024, revealed that the Resident received their prescribed gabapentin doses as follows: 1) on July 19, 2024, received their 9:00 AM dose at 10:15 AM (1 hour and 15 minutes past the prescribed time); 2) on July 20, 2024, received their 9:00 AM dose at 10:28 AM (1 hour and 28 minutes past the prescribed time) and received their 1:00 PM dose at 2:15 PM (1 hour and 15 minutes past the prescribed time); 3) on July 24, 2024, received their 9:00 AM dose at 11:48 AM (2 hours and 48 minutes past the prescribed time) and received their 1:00 PM dose at 1:34 PM (only 1 hour and 46 minutes between doses had lapsed); and 4) on July 25, 2024, received their 9:00 AM dose at 11:25 AM (2 hours and 25 minutes past the prescribed time) and received their 1:00 PM dose at 12:57 PM (only 1 hour and 32 minutes between doses had lapsed). Review of Resident 9's clinical record revealed diagnoses that included hypertension (high blood pressure) and heart failure (condition that develops when your heart doesn't pump enough blood for your body's needs). Review of Resident 9's physician orders revealed an order for Coreg oral tablet 6.25 mg (Carvedilol) give 12.5 mg by mouth every 12 hours for hypertension Hold for SBP (systolic blood pressure) less than 120, dated October 18, 2023. Review of Resident 9's July MAR revealed that their coreg was scheduled to be administered at 9:00 AM and 9:00 PM. Further review of Resident 9's July MAR revealed that the Resident was administered their prescribed coreg outside of the physician ordered parameters as follows: 1) July 1, 2024, at 9:00 AM, their BP was 115/52; 2) July 7, 2024, at 9:00 PM, their BP was 105/52; 3) July 10, 2024, at 9:00 AM, their BP was 106/73; 4) July 11, 2024, at 9:00 PM, their BP was 112/79; 395440 Page 2 of 4 395440 07/25/2024 Camp Hill Skilled Nursing and Rehabilitation Ctr 1700 Market Street Camp Hill, PA 17011

F 0684 5) July 14, 2024, at 9:00 AM, their BP was 108/91; Level of Harm - Minimal harm or potential for actual harm 6) July 18, 2024, at 9:00 AM, their BP was 119/60; and 7) July 19, 2024, at 9:00 AM, their BP was 108/53. Residents Affected - Some Review of Resident 9's Medication Administration Audit Report provided by the facility from July 18-25, 2024, revealed that the Resident received their prescribed coreg doses as follows: 1) on July 18, 2024, received their 9:00 AM dose at 12:37 PM (3 hours and 37 minutes past the prescribed time) and their 9:00 PM dose at 8:52 PM (only 8 hours and 15 minutes between doses had lapsed); 2) on July 20, 2024, received their 9:00 AM dose at 12:54 PM (3 hours and 54 minutes past the prescribed time) and their 9:00 PM dose at 9:00 PM (only 8 hours and 6 minutes between doses had lapsed); 3) on July 22, 2024, received their 9:00 AM dose at 12:35 PM (3 hours and 35 minutes past the prescribed time) and their 9:00 PM dose at 8:30 PM (only 7 hours and 55 minutes between doses had lapsed); and 4) July 25, 2024, 2024, received their 9:00 AM dose at 12:20 PM (3 hours and 20 minutes past the prescribed time). Review of Resident 10's clinical record revealed diagnoses that included generalized osteoarthritis (degeneration of joint cartilage and the underlying bone, causing pain and stiffness especially in the hip, knee, and thumb joints) and vascular dementia (brain damage caused by multiple strokes which causes memory loss in older adults). Review of Resident 10's physician orders revealed an order for acetaminophen 325 mg give two tablets orally every 12 hours for pain, dated March 1, 2021. Review of Resident 10's July 2024 MAR revealed that their acetaminophen was scheduled to be administered at 9:00 AM and 9:00 PM. Review of Resident 10's Medication Administration Audit Report provided by the facility from July 18-25, 2024, revealed that the Resident received their prescribed acetaminophen doses as follows: 1) July 20, 2024, received their 9:00 AM dose at 11:57 AM (2 hours and 57 minutes past the prescribed time) and their 9:00 PM dose at 8:57 PM (only 9 hours between doses had lapsed); 2) July 22, 2024, received their 9:00 AM dose at 11:09 AM (2 hours and 9 minutes past the prescribed time) and their 9:00 PM dose at 8:31 PM (only 9 hours and 22 minutes between doses had lapsed); and 3) July 25, 2024, received their 9:00 AM dose at 11:55 AM (2 hours and 55 minutes past the prescribed time). 395440 Page 3 of 4 395440 07/25/2024 Camp Hill Skilled Nursing and Rehabilitation Ctr 1700 Market Street Camp Hill, PA 17011

F 0684 Level of Harm - Minimal harm or potential for actual harm Review of Resident 12's clinical record revealed diagnoses that included Parkinson's disease (progressive and irreversible neurological disease that causes decreased control of the nervous system resulting in stiffness, slowing of movement, and uncontrolled bodily movements) and dementia (a chronic disorder of the mental processes caused by brain disease, marked by memory disorders, personality changes, and impaired reasoning). Residents Affected - Some Review of Resident 12's physician orders revealed an order for carbidopa-levodopa oral tablet 25-100 mg give one tablet by mouth four times a day for Parkinson's disease, dated December 28, 2022. Review of Resident 12's July 2024 MAR revealed that their carbidopa-levodopa was scheduled to be administered at 9:00 AM, 1:00 PM, 5:00 PM, and 9:00 PM. Review of Resident 12's Medication Administration Audit Report provided by the facility from July 18-25, 2024, revealed that the Resident received their prescribed carbidopa-levodopa doses as follows: 1) July 22, 2024, received their 9:00 AM dose at 10:16 AM (1 hour and 16 minutes past the prescribed time) and received their 1:00 PM dose at 12:12 PM (only 1 hour and 56 minutes between doses had lapsed); 2) July 23, 2024, received 9:00 AM dose at 10:26 AM (1 hour and 26 minutes past the prescribed time) and received their 1:00 PM dose at 1:12 PM (only 2 hours and 46 minutes between doses had lapsed); 3) July 24, 2024, received 1:00 PM dose at 2:32 PM (1 hour and 32 minutes past the prescribed time) and received their 5:00 PM dose at 4:22 PM (only 1 hour and 50 minutes between doses had lapsed); and 4) July 25, 2024, received their 9:00 AM dose at 11:52 AM (2 hours and 52 minutes past the prescribed time) and received their 1:00 PM dose at 12:45 PM (only 53 minutes between doses had lapsed). During an interview with the Nursing Home Administrator (NHA) and Director of Nursing (DON) on July 25, 2024, at 3:10 PM, the DON indicated that she would expect nurses to administer medications at the prescribed times and to follow physician ordered parameters for medication administration. The NHA indicated that medication nurses should notify the Registered Nurse Supervisor(s) if they need assistance in completing the administration of medications timely. 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 201.18(b)(1) Management 28 Pa. Code 211.10(c) Resident Care Policies 28 Pa. Code 211.12(c)(d)(1)(2)(5) Nursing Services 395440 Page 4 of 4