Health inspection·June 7, 2024

F 0658 Ensure services provided by the nursing facility meet professional standards of quality. Level of Harm - Minimal harm or potential for actual harm Based on review of the Pennsylvania Professional Nursing Practice Act, facility policy and procedure, observations, and staff interviews it was determined the facility failed to ensure that staff met the professional standards for a licensed nurse during medication administration for one of three residents reviewed (Resident 201). Residents Affected - Few Findings include: The Professional Code, Title 49, Professional and Vocational Standards (Pennsylvania Professional Nursing Practice Act), Chapter 21.145(a) states that the Licensed Practical Nurse (LPN) is prepared to function as a member of the health-care team by exercising sound nursing judgment based on preparation, knowledge, and experience in nursing competency. The LPN participates in the planning, implementing, and evaluating nursing care, using focused assessment in settings where nursing takes place. Review of Chapter 21.145 (3) indicates, an LPN shall follow the written, established policies and procedures of the facility that are consistent with the Act. Review of the facility's policy titled Administering Medications, dated April 1, 2022, revealed medication should all be administered in a safe and timely manner, and as prescribed. Residents may self-administer their own medications only if the physician, in conjunction with the Interdisciplinary Care Planning Team, has determined that they have the decision-making capacity to do so safely. Review of Resident 201's Minimum Data Set (MDS- standardized assessment tool that measures health status in long-term care residents) dated March 17, 2024, revealed resident had severe cognitive impairment. Observation conducted on June 5, 2024 at 9:15 a.m. of the medication administration with licensed nurse Employee E3 supervised by licensed nurse Employee E4. Employee E3 crushed medications Aspirin 81mg (medication used to treat pain, and inflammation) one tablet, Amlodipine 5 mg (medication used to treat high blood pressure), Olanzapine 7.5 mg (An anti-psychotic medication), and Oxycodone 5mg (medication used to treat severe pain) then poured it into an Ensure drink. Employee E3 stirred the drink with a straw gave the drink to Resident 201 then left the room. Employee E3 marked the medications as administered in the EMR (Electronic Medical Record) and then proceeded to the next resident for medication administration. Observation conducted on on June 5, 2024, at 9:39 a.m., of Resident 201 sitting in bed, Ensure drink observed on the garbage can. While in the presence of licensed nurses Employee E3 and E4, Ensure drink was observed with 10 cc of liquid left in the container. Employee E4 confirmed that the ordered medications were not administered fully to the resident. (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 4 Event ID: 395454 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 395454 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/07/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkhouse Rehabilitation and Nursing Center 1600 Black Rock Road Royersford, PA 19468 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)