Health inspection·November 8, 2023

F 0558 Reasonably accommodate the needs and preferences of each resident. Level of Harm - Minimal harm or potential for actual harm Based on observations and resident and staff interviews it was determined that the facility failed to accommodate residents' need for ready access to the call bell system to request staff assistance for one resident (Resident B1) and timely accommodation of the residents' needs for assistance in accordance with the residents' needs out of seven sampled. (B1 and B2). Residents Affected - Few Findings include: Observation on November 8, 2023, at 10:00 a.m. revealed that Resident B1, a cognitively intact resident, was seated in her wheelchair at the end of her bed, next to the closet. The resident's call bell was clipped behind her bed and was not within reach of the resident. The resident was dressed in a hospital gown and had no socks on her feet. There was an overbed table in front of her. Her bare feet were observed resting on the metal bar at the bottom of the overbed table. During an interview at the time of the observation, Resident B1 stated that her nurse aide had cleaned her, dressed her and placed her out of bed into her wheelchair. The resident stated that her socks were on her bed when the nurse aide got her up, but not there now. She also stated that her slippers were thrown under bed. She stated that she would prefer to have her socks and slippers on at this time. Resident B1 also stated that she is often seated at the end of her bed with her call bell out of reach. She stated that she has to rely on her roommate to use the call bell to call staff if she needs assistance. Resident B1 stated that when she is in bed and has access to the call bell, the wait time for call bell response is from 30 minutes to an hour, especially on the night shift. An interview at the same time with Resident B2, Resident B1's roommate, revealed that Resident B2 stated that staff's response to residents' call bell are often greater than 30 minutes. She stated that she recently had to wait 1 hour for staff assistance. During an interview November 8, 2023 at 10:30 A.M. Resident B3 stated that she often waits 30 minutes for staff to respond to her call bell and provided needed assistance. Interview with the Director of Nursing on November 8, 2023, at approximately 2:00 PM confirmed that residents' call bells should be within reach of the resident and that the observed call bell placement was not within the residents' reach failing to accommodate the resident's need to summon staff assistance when required. The DON also confirmed the facility's expectation that residents should be dressed properly and call bells should be answered promptly by staff. 28 Pa. Code 211.12 (d)(5) Nursing services Page 1 of 5 395462 395462 11/08/2023 Brookmont Healthcare and Rehabilitation Center 510 Brookmont Drive Effort, PA 18330

F 0558 28 Pa. Code 201.29 (a) Resident rights Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 395462 Page 2 of 5 395462 11/08/2023 Brookmont Healthcare and Rehabilitation Center 510 Brookmont Drive Effort, PA 18330

F 0574 The resident has the right to receive notices in a format and a language he or she understands. 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 clinical records and facility documentation and staff interview, it was determined the facility failed to provide information orally and in writing regarding changes in Medicare eligibility and coverage in a language and format the resident understood for one of four reviewed (Resident CR1). Residents Affected - Few Finding include: Clinical record review revealed that Resident CR1 was admitted to the facility on [DATE] with diagnoses which included an acute myocardial infarction (heart attack). An admission Minimum Data Set assessment (MDS - a federally mandated standardized assessment process conducted at specific intervals to plan resident care) dated October 4, 2023, revealed that the resident was cognitively intact with a BIMS score of 14 (Brief Interview for Mental Status - a tool to assess cognitive function - a score of 13-15 indicates cognitively intact). Upon admission the resident's primary insurance payer was noted to be a Medicare Advantage plan. On October 1, 2023, the primary insurance payer was changed to traditional Medicare. Further review of the clinical record revealed a facility untitled form dated September 29, 2023, which noted a request to disenroll the resident from the resident's Medicare Advantage plan so that the resident may be covered under her original Medicare benefits. The documented request indicated that the resident was currently a resident of a nursing home. The request was for the Medicare Advantage plan policy to be terminated on September 30, 2023, and the document was signed by the resident. Interview with the facility's director of marketing on November 8, 2023, at 2:20 PM confirmed that during review of admission paperwork residents are educated about copays and insurance coverage. The director of marketing confirmed that the request form to change the resident's insurance was signed by the resident after a conversation with the resident about insurance coverage. The director of marketing failed to provide documented evidence that a copy of the form was provided to the resident or the resident representative and that the resident and resident representative were fully informed of the consequences of changing insurances and deadlines for switching back to the Medicare Advantage plan after the resident's discharge from the skilled nursing facility to continue that coverage if desired. Interview with the administrator on November 8, 2023, at 3:00 PM failed to provide documented evidence that the required information for the resident to make an informed decision regarding changing Medicare coverage was provided orally and in writing in sufficient detail, and in a language and manner the resident understood. 28 Pa. Code 201.29 (a)(c) Resident rights 395462 Page 3 of 5 395462 11/08/2023 Brookmont Healthcare and Rehabilitation Center 510 Brookmont Drive Effort, PA 18330

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 clinical record review and resident and staff interview, it was determined that the facility failed to provide person-centered care for diabetes management and medication administration and blood glucose monitoring for one resident out of four sampled (Resident A1). Residents Affected - Some Findings include: A review of the clinical record revealed Resident A1 was admitted to the facility on [DATE], with diagnoses to include diabetes. A quarterly Minimum Data Set assessment (MDS - a federally mandated standardized assessment process conducted at specific intervals to plan resident care) dated September 15, 2023, revealed that the resident was cognitively intact with a BIMS score of 13 (Brief Interview for Mental Status - a tool to assess cognitive function - a score of 13-15 indicates cognitively intact). During interview with Resident A1 on November 8, 2023, at 12:30 PM the resident stated that at times she receives her Metformin medication (anti-diabetic medication) late in the morning and that her morning blood glucose check is not always completed by staff before breakfast. A physician order dated April 12, 2023, was noted for Metformin HCL (oral anti-diabetic medication) 500 mg by mouth twice daily for diabetes. A physician order dated May 30, 2023, was noted for Humalog Insulin 100 unit/ml inject as per sliding scale if the resident's blood sugar was between: 200-250 give 4 units; 251-300 give 6 units; 301-350 give 8 units; 351-400 give 10 units; 401-450 give 12 units; 451-500 give 14 units, subcutaneously (injection given in the fatty tissue just under the skin) every morning (before or after breakfast not specified in the physician order) and at bedtime for Diabetes. Review of Resident A1's November 2023 Medication Administration record (MAR) revealed that Metformin 500 mg was scheduled for administration to the resident at 8:30 AM and 4:30 PM. Review of Resident A1's November Medication Administration Audit Report revealed that on November 4, 2023, Metformin scheduled for 8:30 AM, was administered at 10:21 AM and the accucheck was completed at 10:21 AM; on November 5, 2023, Metformin scheduled for 8:30 AM, was given at 9:39 AM; on November 7, 2023, Metformin, scheduled for 8:30 AM, was given at 10:42 AM, and the accucheck was completed at 10:41 AM; on November 8, 2023, Metformin scheduled for 8:30 AM, was given at 9:36 AM and the accucheck was completed at 9:17 AM. During an interview on November 8, 2023, at 1:30 PM, the director of nursing (DON) confirmed that Resident A1's Metformin was to be given within one hour of the scheduled medication time and Resident A1's morning accucheck was to be completed prior to breakfast for consistent diabetes management. 28 Pa Code 211.12 (c)(d)(1)(3)(5) Nursing services 395462 Page 4 of 5 395462 11/08/2023 Brookmont Healthcare and Rehabilitation Center 510 Brookmont Drive Effort, PA 18330

F 0807 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure each resident receives and the facility provides drinks consistent with resident needs and preferences and sufficient to maintain resident hydration. Based on observation, clinical record review and staff and resident interview it was determined that the facility failed to provide drinks consistent with resident needs and preferences for four out of seven residents sampled (Residents B1, B2, B3, and A1). Findings include: Observation on November 8, 2023, at approximately 10 A.M., Resident B1, a cognitively intact resident, was observed in her room, seated in her wheelchair. Resident B1's roommate, Resident B2, a cognitively intact resident, was in her room, lying in her bed at the time. Interview with both residents at that time revealed that these residents expressed concerns that during the 11 P.M. to 7 A.M. shift, nursing staff passes water to them, but then they often do not receive fresh water during the 7 A.M. to 3 P.M. and the 3 P.M. to 11 P.M. shifts. Both residents stated that they are often thirsty and would like fresh water provided to them on each shift of nursing duty. An observation at the time of the interview revealed that each resident's water cup was empty. An interview November 8, 2023 at approximately 10:30 A.M., with Resident B3, a cognitively intact resident, revealed that the resident stated that she gets fresh water on the 11 P.M. to 7 A.M. shift from the nursing staff. She stated that she often does not receive fresh water on the other two shifts, days and evening. She stated that her water cup was currently empty and she would like fresh water on each shift of nursing duty. When observed at that time, the resident's water cup was empty. Interview with Resident A1, a cognitively intact resident, on November 8, 2023 at 12:30 PM revealed that the resident stated that nursing staff does not always provide fresh water on each shift. Resident A1 stated that she does drink water and that water is usually only provided on the 11 PM to 7 AM shift and not during days and evenings as she would prefer. During an interview November 8, 2023, at approximately 2 P.M., the Nursing Home Administrator confirmed that nursing staff are to provide residents fresh water on each shift of nursing duty. 28 Pa. Code 211.12 (d)(3)(5) Nursing services 28 Pa. Code 201.29 (a) Resident rights 395462 Page 5 of 5