Health inspection·May 5, 2023

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. Based on review of grievances lodged with the facility and resident and staff interviews, it was determined that the facility failed to provide care in an environment, which promotes each resident's quality of life, by failing to respond timely to residents' request for assistance as reported by nine residents out of nine interviewed (Residents 39, 240, 290, 291, 45, 90, 84, 14, and 76). Findings include: Review of a Resident Concern Form dated April 18, 2023, revealed that a grievance was filed on behalf of the residents attending Resident Council. The grievance indicated that residents complained that facility staff does not respond timely to their requests for assistance via the nurse call bell system and do not meet their needs in a timely manner. During interview with Resident 291 on May 2, 2023 at 12:30 PM, the resident expressed concerns that staff do not respond to call bells timely. The resident explained that waits for staff to respond to call bells are long, frequently more than 30 minutes. The resident further stated that the staff may respond to the call bell, but then state they say they'll be back in a minute and don't come back, to provide the needed care or service. During interview with Resident 39 on May 3, 2023, at 9:30 AM, the resident stated that staff takes a long time to respond to call bells, a very long time. The resident also stated that sometimes I cant even find it (call bell)-they put in up there (pointing to headboard). During interview with Resident 290 on May 3, 2023, at 10:20 AM, the resident stated that sometimes it takes forty-five minutes to an hour to get help from staff and that staff has informed her that she can't use the call bell unless it's an emergency. During interview with Resident 240 on May 3, 2023, at 10:33 AM, revealed that the call bell response times were long, at times, and the resident has waited 30-minutes or more before staff would respond. The resident reported that she was prescribed a water pill for her swelling and as a result needs to urinate more frequently. The resident explained that she needs staff assistance with toileting needs and when her husband visits she asks him to go out into the hallway or to the nurse's station to look for staff to take her to the bathroom. During a Resident Council meeting conducted with five cognitively intact residents on May 3, 2023, at 10:45 AM, all five residents in attendance voiced complaints with untimely staff response to their requests for assistance via the nursing call bell system to meet their needs and provide care in a timely manner. Page 1 of 3 395462 395462 05/05/2023 Brookmont Healthcare and Rehabilitation Center 510 Brookmont Drive Effort, PA 18330

F 0550 Level of Harm - Minimal harm or potential for actual harm Interview with the Nursing Home Administrator (NHA) on May 4, 2023, at 1:45 PM, confirmed that he was aware that residents had concerns with long call bell response times, that call light responses were not always timely and the facility expects that requests for assistance were to be completed in a timely manner to ensure that the resident's quality of life was maintained. Residents Affected - Some 28 Pa. Code 211.12 (a)(c)(d)(4)(5) Nursing Services 28 Pa. Code 201.29 (j) Resident rights 28 Pa. Code 201.18 (e)(1) Management 395462 Page 2 of 3 395462 05/05/2023 Brookmont Healthcare and Rehabilitation Center 510 Brookmont Drive Effort, PA 18330

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a review of select facility policy and clinical records, and staff interview, it was determined that the facility failed to thoroughly assess and evaluate bladder function and implement individualized approaches to restore normal bladder function to the extent possible for one out of 19 sampled residents (Resident 189). Findings include: A review of facility policy entitled Incontinence Care Guidelines last reviewed on March 29, 2023, indicated the purpose of the incontinence care guidelines is to restore urinary continence without catheter whenever possible, avoid potential urinary tract infections, restore bowel continence whenever possible, improve the morale of the resident, restore the resident's dignity, and manage bowel and or bladder incontinence. Further it is indicated upon admission residents are assessed for incontinence and the resident's voiding pattern are monitored over several days to determine the continent status. The three-day bowel bladder record will be utilized to establish voiding and bowel movement patterns to assist in establishing a plan of care. A review of Resident 189's clinical record revealed that the resident was admitted to the facility on [DATE], with diagnoses that included chronic kidney disease, need for assistance with personal care, and diabetes. A review of the resident's admission bowel and bladder assessment dated [DATE], indicated that the resident was continent of bowel and bladder and a three-day bowel and bladder tracker was to be initiated. A review of the resident's three-day bowel and bladder tacking revealed that the facility failed to conduct the three-day tracking to assess bowel and bladder function to accurately identify the resident's toileting needs and appropriateness of a planned/scheduled/ or restorative toileting program. A review of the resident's bladder activity from April 14, 2023, until the time the resident was discharged to the hospital on April 24, 2023, revealed that the resident was incontinent of urine 17 times during that 10 day period. The facility failed to evaluate the resident's bladder activity in an effort to identify potential patterns of incontinence or voiding patterns and develop an individualized toileting plan to restore bladder function to the extent possible for the resident. Interview with the Nursing Home Administrator on May 4, 2023, at 12:38 PM confirmed that the facility failed to thoroughly assess bladder function and accurately identify the residents' toileting needs. 28 Pa. Code 211.12(a)(c)(d)(1)(3)(5) Nursing services 395462 Page 3 of 3