Health inspection·May 16, 2025

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of the facility's abuse prohibition policy, clinical records, information submitted by the facility, and select investigative reports and staff interviews, it was determined the facility failed to assure that one resident (Resident 28) out of 36 sampled were free from physical abuse perpetrated by another resident (Resident 133). Findings include: A review of facility policy titled Facility Abuse Policy last reviewed by the facility on April 22, 2025, revealed it is the policy of the facility to not tolerate abuse, neglect, mistreatment, exploitation of residents, or misappropriation of resident property by anyone. The policy defines abuse as the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain, or mental anguish. Willful, as used in this definition of abuse, means the individual must have acted deliberately, not that the individual must have intended to inflict injury or harm. A review of Resident 178's clinical record revealed he was admitted to the facility on [DATE], with a diagnosis which included Multiple Sclerosis (a chronic autoimmune disorder that affects the central nervous system) and Cellulitis (a bacterial infection that affects the inner layers of the skin). A review of the resident's Quarterly Minimum Data Set Assessment (MDS - a federally mandated standardized assessment conducted at specific intervals to plan resident care) dated February 20,2025, indicated the resident was severely cognitively impaired With a BIMS score of 5 (Brief Interview for Mental Status - a tool to assess cognition, a score of 0-7 indicates severe cognitive impairment). A review of Resident 133's clinical record revealed the resident was admitted to the facility on [DATE], with diagnoses which included unspecified sequelae of cerebral infarction (refers to the long term affects and complications that can occur after a stroke ), aphasia (a communication disorder that results from damage to parts of the brain that is responsible for language and affects a person's ability to speak) and vascular dementia (a type of dementia caused by brain damage from impaired blood flow to the brain ). A review of the resident's Quarterly Minimum Data Set assessment dated [DATE], indicated the resident had impaired cognitive function. The assessment indicated Resident 133 had a BIMS score of 99 (Brief Interview for Mental Status - a tool to assess cognition, a score of 99 indicates the resident did not provide or was unable to provide the answers to complete this section). Page 1 of 14 395464 395464 05/16/2025 Forest Hills Rehabilitation & Healthcare Center 1000 Evergreen Avenue Weatherly, PA 18255

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Nursing notes from December 2024 through January 2025 documented a pattern of physically aggressive behaviors, including yelling, throwing items, banging fists against the medication cart, and exhibiting threats to others. On January 3, 2025, at 10:00 PM, staff responded to loud yelling from the shared room of Resident 133 and another resident. Resident 133 was removed and placed on one-to-one supervision. Subsequently, a nursing note on January 4, 2025, at 12:26 AM documented that Resident 133 allegedly struck his roommate, Resident 178, twice in the chest with a closed fist. Review of the mandatory abuse report dated for January 4, 2025, revealed staff responded to the room occupied by Residents 178 and 33 when they heard yelling. Resident 33 was found at the bedside of Resident 178 and noted to be yelling. Resident 133 was immediate removed to the hallway. Further review revealed Resident 178 stated he was laying in his bed when Resident 133 came over and started to yell at him, then punched him twice, once in the arm and once in the chest. Resident 178 was assessed with no injuries to be noted. A review of nursing documentation revealed a nursing note dated January 8,2025 at 3:38 PM revealed the Interdisciplinary Team met to discuss Resident 133's one to one supervision status. Resident 133's agitation and yelling were noted to be during the 3:00 PM to 11:00 PM shift and was noted to be calm and sleeping during the 11:00 PM to 7:00 AM shift. Resident 133 was to remain a one-to-one supervision for both day and evening shifts but was changed to every 15-minute checks for the night shift. Review of Resident 133's care plan dated March 1, 2024, and revised February 3,2025, identified issues related to behaviors of refusing showers, care and medications. Continued review revealed Resident 133 was identified having behaviors of being aggressive towards staff and other residents, throwing items (bed side table, cabinets, chairs), slamming doors, banging his head off the wall or kicking the side rails, and purposely placing himself on the floor. Further review of the care plan revealed interventions to include, monitor behavior episodes and attempt to determine underlying cause, attempt to redirect resident when exhibiting behaviors, re-approach resident when behaviors have deescalated, attempt distraction during behavioral episodes by offering a coloring activity, converse about baseball, offer a snack, assist with getting the resident to a quiet area to self soothe, take resident for a walk. A new intervention dated April 11, 2025, stated that Resident 133 was to receive 1:1 observation on the day and evening shifts and every 15-minute checks overnight. A review of Resident 28's clinical record revealed the resident was admitted to the facility on [DATE], with diagnoses which included major depressive disorder (a mood disorder characterized by persistent feeling of sadness and loss of interest in activities once enjoyed). and essential hypertension (high blood pressure). A review of the resident's Quarterly Minimum Data Set assessment dated [DATE], indicated the resident was cognitively intact with a BIMS score of 15 (Brief Interview for Mental Status - a tool to assess cognition, a score of 13-15 indicates cognition was intact). On April 16, 2025, at 3:30 AM, a physical altercation occurred between Resident 133 and Resident 28 in their shared room. According to nursing documentation, Resident 133 threw water and a cup at 395464 Page 2 of 14 395464 05/16/2025 Forest Hills Rehabilitation & Healthcare Center 1000 Evergreen Avenue Weatherly, PA 18255

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Resident 28 near the bathroom door, then slapped Resident 28 in the face. Resident 28 attempted to disengage but returned the slap before staff intervened. Both residents were assessed, and no physical injuries were documented. Resident 133 was relocated to a different room following the incident. A review of Resident 133's hourly observation log for April 16, 2025, revealed inconsistencies. CNA documentation indicated that the resident was observed sleeping at both 3:00 AM and 4:00 AM. However, this contradicts the timeline of the incident, and no evidence was provided that every-15-minute checks were performed as required by the care plan. An interview with the Director of Nursing (DON) conducted on May 16, 2025, at 11:00 AM confirmed the facility did not maintain consistent or effective supervision of Resident 133 during the overnight shift and failed to ensure safety protocols were followed. The DON acknowledged that the lack of supervision directly contributed to a slap in the face of Resident 28. 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 201.18(e)(1) Management 28 Pa. Code 201.29(a)(c) Resident Rights 28 Pa. Code 211.12(c)(d)(5) Nursing Services 395464 Page 3 of 14 395464 05/16/2025 Forest Hills Rehabilitation & Healthcare Center 1000 Evergreen Avenue Weatherly, PA 18255

F 0658 Ensure services provided by the nursing facility meet professional standards of quality. 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, facility policy review and staff interview, it was determined the facility failed to ensure that nursing services met professional standards of quality according to the Pennsylvania Code Title 49, Professional and Vocational Standards, by failing to implement nursing practices for the administration of an intravenous medication via central venous catheter for one of 36 residents reviewed (Resident 105). Residents Affected - Some Findings include: According to the Pennsylvania Code Title 49, Professional and Vocational Standards Department of State, Chapter 21 State Board of Nursing, Chapter 21.145 Functions of the LPN (Licensed Practical Nurse) requires the following: The LPN is prepared to function as a member of the health care team by exercising sound nursing judgement based on preparations, knowledge, skills, understandings and past experiences in nursing situations. The LPN participates in the planning, implementation and evaluation of nursing care in settings where nursing takes place. (b) The LPN administers medication and carries out the therapeutic treatment ordered for the patient in accordance with the following: (d) The Board recognizes codes of behavior as developed by appropriate practical nursing associations as the criteria for assuring safe and effective practice. Chapter 21.145 b. IV therapy curriculum requirements: (f) An LPN may perform only the IV therapy functions for which the LPN possesses the knowledge, skill and ability to perform in a safe manner, except as limited under § 21.145 a (relating to prohibited acts), and only under supervision as required under paragraph (1). (1) An LPN may initiate and maintain IV therapy only under the direction and supervision of a licensed professional nurse or health care provider authorized to issue orders for medical therapeutic or corrective measures (such as a CRNP, physician, physician assistant, podiatrist or dentist). (g) An LPN who has met the education and training requirements of § 21.145 b (relating to IV therapy curriculum requirements) may perform the following IV therapy functions, except as limited under § 21.145 a and only under supervision as required under subsection (f): (1) Adjustment of the flow rate on IV infusions. (2) Observation and reporting of subjective and objective signs of adverse reactions to any IV administration and initiation of appropriate interventions. 395464 Page 4 of 14 395464 05/16/2025 Forest Hills Rehabilitation & Healthcare Center 1000 Evergreen Avenue Weatherly, PA 18255

F 0658 (3) Administration of IV fluids and medications. Level of Harm - Minimal harm or potential for actual harm (4) Observation of the IV insertion site and performance of insertion site care. Residents Affected - Some (5) Performance of maintenance. Maintenance includes dressing changes, IV tubing changes, and saline or heparin flushes. (6) Discontinuance of a medication or fluid infusion, including infusion devices. (7) Conversion of a continuous infusion to an intermittent infusion. (8) Insertion or removal of a peripheral short catheter. (9) Maintenance, monitoring and discontinuance of blood, blood components and plasma volume expanders. (10) Administration of solutions to maintain patency of an IV access device via direct push or bolus route. (11) Maintenance and discontinuance of IV medications and fluids given via a patient-controlled administration system. (12) Administration, maintenance and discontinuance of parenteral nutrition and fat emulsion solutions. (13) Collection of blood specimens from an IV access device. A review of a facility policy titled Administering Medications by IV last reviewed by the facility on April 22, 2025, revealed the facility is to verify the nursing staff scope of practice and competency requirements for this procedure with the State Nurse Practice Act. Clinical record review revealed that Resident 105 was admitted to the facility on [DATE], with diagnosis to include intracranial abscess and granuloma (collection of pus that develops in the brain due to an infection) and adult failure to thrive (gradual decline in health characterized by weight loss, decreased appetite, poor nutrition and inactivity), and was admitted to the facility with a PICC line (a peripherally inserted central catheter a long catheter introduced through a vein in the arm and passed through to the larger veins into the heart). Physicians orders dated April 12, 2025, revealed an order to administer Ceftriaxone Sodium (antibiotic medication) Injection Solution Reconstituted 250 MG. Use 2 grams intravenously (IV) every 12 hours for abscess until May 9, 2025. Infuse 2 grams into a venous catheter (PICC) every 12 hours. A review of the April 2025 Medication Administration Record (MAR) revealed that between April 13 through April 30, 2025, Employee 5, LPN, Employee 6, LPN, Employee 7, LPN, Employee 8, LPN, Employee 9, LPN, Employee 10, LPN, and Employee 14, LPN signed the MAR as administering the IV antibiotic medication to Resident 105 through the PICC line. A review of the May 2025 MAR revealed that between May 1 through May 8, 2025, Employee 9, LPN, Employee 10, LPN, Employee 11, LPN, Employee 12, LPN, Employee 13, LPN, and Employee 14, LPN signed the 395464 Page 5 of 14 395464 05/16/2025 Forest Hills Rehabilitation & Healthcare Center 1000 Evergreen Avenue Weatherly, PA 18255

F 0658 MAR as administering the IV antibiotic medication to Resident 105 through the PICC line. Level of Harm - Minimal harm or potential for actual harm The facility was unable to produce any documentation verifying that these LPNs had completed the required IV therapy education and training in accordance with §21.145 (b). There was no evidence of current competency validation, supervision documentation, or internal training specific to PICC line administration. Residents Affected - Some During an interview conducted on May 15, 2025, at approximately 10:50 AM, the Director of Nursing (DON) confirmed that the facility did not provide education or training regarding administration of medications through PICC lines to LPNs. The DON further stated that it was the facility's policy that only RNs were permitted to administer medications via PICC lines. Despite this, multiple LPNs administered IV antibiotics through a central venous access device (PICC line) to Resident 105 over a 26-day period. There was no documented oversight by an RN or qualified healthcare provider, and no documentation existed confirming the LPNs met the education, training, or supervision requirements stipulated in the Pennsylvania Nurse Practice Act. 28 Pa. Code 201.20(a) Staff Development. 28 Pa Code 211.12(c)(d)(1)(2)(3)(5) Nursing services. 395464 Page 6 of 14 395464 05/16/2025 Forest Hills Rehabilitation & Healthcare Center 1000 Evergreen Avenue Weatherly, PA 18255

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. 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, observations, and resident and staff interviews it was determined the facility failed to provide the necessary staff assistance with activities of daily living to maintain good personal grooming for residents dependent on staff assistance for nail care for two of five residents sampled (Residents 25 and 141). Residents Affected - Few Findings include: Review of the clinical record revealed that Resident 25 was admitted to the facility on [DATE], with diagnoses which include dementia (group of symptoms affecting intellectual and social abilities severely enough to interfere with daily functioning). Review of a quarterly Minimum Data Set Assessment (MDS- a federally mandated standardized assessment process conducted at specific intervals to plan resident care) dated May 5, 2024, indicated the resident had a BIMS score (Brief Interview for Mental Status - a tool to assess cognitive function) of 2 (a score of 0-7 indicates severe cognitive impairment) and required substantial/maximal assistance (staff does more than half the effort) with personal hygiene. Observations of Resident 25 conducted on May 13, 2025, at 12:15 PM and May 15, 2025, at 9:45 AM revealed the fingernails on the resident's left hand were dirty with a build-up of a dark colored debris under the nails. Interview with employee 2 (Registered Nurse Regional Consultant) on May 15, 2025, at 9:45 AM confirmed that Resident 25's fingernails were dirty. Review of the clinical record revealed that Resident 141 was admitted to the facility on [DATE], with diagnoses which include vascular dementia (a form of dementia caused by an impaired supply of blood to the brain). Review of an annual MDS dated [DATE], indicated the resident had a BIMS score of 10 (a score of 8-12 indicates moderate cognitive impairment) and required substantial/maximal assistance for personal hygiene. Observations of Resident 141 on May 13, 2025, at 12:50 PM and May 15, 2025, at 9:50 AM revealed that the fingernails on the resident's right hand were long and there was a build-up of dark colored debris under the nails. During interview with Resident 141 on May 15, 2025, at 9:50 AM the resident revealed that he is able to trim the fingernails on his left hand but does not have enough strength to trim the fingernails on his right hand. Interview with the assistant director of nursing on May 15, 2025, at approximately 10:30 AM confirmed that staff were to provide residents' nail care to maintain good personal grooming and hygiene. 28 Pa Code 211.12 (d)(5) Nursing services 395464 Page 7 of 14 395464 05/16/2025 Forest Hills Rehabilitation & Healthcare Center 1000 Evergreen Avenue Weatherly, PA 18255

F 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. 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, select facility policy, and staff interviews it was determined the facility failed to timely provide care and services, consistent with professional standards of practice, to promote healing of pressure ulcer development for one of four residents reviewed. (Resident 10) Residents Affected - Few Findings: Quality, the pressure ulcer best practice bundle incorporates three critical components in preventing pressure ulcers: Comprehensive skin assessment, Standardized pressure ulcer risk assessment and care planning and implementation to address the areas of risk. The American College of Physicians (ACP) is a national organization of internists, who specialize in the diagnosis, treatment, and care of adults. The largest medical-specialty organization and second-largest physician group in the United States) Clinical Practice Guidelines indicate that the treatment of pressure ulcers should involve multiple tactics aimed at alleviating the conditions contributing to ulcer development (i.e. support surfaces, repositioning and nutritional support); protecting the wound from contamination and creating and maintaining a clean wound environment; promoting tissue healing via local wound applications, debridement and wound cleansing; using adjunctive therapies; and considering possible surgical repair. Review of the facility Pressure Ulcer Policy last reviewed April 22, 2025, indicated staff will examine the skin of a new admission for ulcerations or alterations in skin. The physician will authorize pertinent orders related to wound treatments, including wound cleansing and debridement approaches, dressings, and application of topical agents if indicated for the type of skin alteration. Review of the clinical record revealed that Resident 10 was admitted to the facility on [DATE], with diagnoses which included multiple sclerosis (chronic autoimmune disease that affects the brain and spinal cord) and a pressure ulcer to the right hip. A review of the admission Evaluation dated December 31, 2024, noted that Resident 10 required the assistance of two staff for bed mobility. However, there was no documented evidence that a turning and repositioning program was initiated upon admission, despite the presence of an existing pressure ulcer and the resident's dependence on staff for bed mobility. Review of Resident 10's January Task Documentation Report revealed that a turning and repositioning every two hours program was not implemented until January 3, 2025 (three days after admission). Review of a Wound Evaluation note dated December 31, 2024, upon admission to the facility documented the presence of a Stage 4 (full-thickness skin and tissue loss with exposed bone, muscle, or tendon) pressure ulcer on the right hip which measured 1 cm length by 1cm width by 0.8 cm depth with undermining (wound edges are separated from the surrounding healthy tissue, creating a pocket beneath the wound surface) 1 cm at 12 o'clock, no odor, 20% granulation (tissue that will fill in a wound that is healing), 30% slough (dead tissue separating from living tissue, a mass of dead tissue), and no pain. The note indicated a new treatment was ordered. However, further review of the clinical record revealed no physician orders for wound treatment to 395464 Page 8 of 14 395464 05/16/2025 Forest Hills Rehabilitation & Healthcare Center 1000 Evergreen Avenue Weatherly, PA 18255

F 0686 the Stage 4 pressure ulcer dated December 31, 2024. Level of Harm - Minimal harm or potential for actual harm The first available treatment order for the right hip pressure ulcer was dated January 3, 2025 (three days after the resident was admitted to the facility), noted an order to cleanse right hip with soap and water, pat dry, pack loosely with ¼ inch iodoform (antiseptic agent) gauze (type of wound packing where a sterile gauze strip is impregnated with iodoform and used to fill the wound cavity) and cover with bordered dressing once daily. Residents Affected - Few An interview conducted with Employee 4, Registered Nurse Wound Care Nurse, on May 16, 2025, at approximately 11:00 AM, failed to produce documented evidence that a wound treatment was implemented upon admission as indicated in the Wound Evaluation dated December 31, 2024. During an interview conducted with the Director of Nursing on May 16, 2025, at approximately 11:30 AM, the DON was unable to provide documentation that timely wound care and pressure ulcer interventions were initiated to promote healing of Resident 10's Stage 4 pressure ulcer upon admission. 28 Pa. Code 211.10(d) Resident care policies 28 Pa. Code 211.12 (a)(c)(d)(1)(5) Nursing services. 28 Pa. Code 211.5(f)(i)(viii) Medical records. 395464 Page 9 of 14 395464 05/16/2025 Forest Hills Rehabilitation & Healthcare Center 1000 Evergreen Avenue Weatherly, PA 18255

F 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of clinical records, select facility policy, and resident and staff interview, it was determined the facility failed to consistently provide restorative nursing services as planned to maintain mobility for one resident (Resident 141) out of 36 residents sampled. Findings include: Review of the facility Restorative Nursing Services Policy last reviewed April 22, 2025, indicated residents will receive restorative nursing care as needed to help promote optimal safety and independence. Residents may be started on a restorative nursing program upon admission, during the course of stay, or when discharged from rehabilitative care. Restorative goals and objectives are individualized and resident-centered and are outlined in the resident's plan of care. The resident or representative will be included in determining goals and plan of care. Review of the clinical record revealed that Resident 141 was admitted to the facility on [DATE], with diagnoses which include vascular dementia (a form of dementia caused by an impaired supply of blood to the brain), diabetes, and congestive heart failure (chronic condition in which the heart does not pump blood as well as it should). Review of an annual Minimum Data Set Assessment (MDS- a federally mandated standardized assessment process conducted at specific intervals to plan resident care) dated February 28, 2025, indicated the resident had a BIMS score (Brief Interview for Mental Status - a tool to assess cognitive function) of 10 (a score of 8-12 indicates moderate cognitive impairment) and the resident had the ability to walk 10 feet with supervision or touching assistance, but refused to walk 50 feet or 150 feet in a hall or similar space. During an interview with Resident 141 on May 13, 2025, at approximately 12:30 PM the resident stated that he feels like he is getting weaker and is not being ambulated by staff on a consistent basis. Review of Resident 141's Physical Therapy Discharge summary dated [DATE], revealed the resident met his goal to ambulate 150 feet using a RW (rolling walker- wheeled mobility aid designed to provide support and stability for individuals with difficulty walking, featuring wheels for easy movement without lifting) with stand by assistance. A restorative nursing program for ambulation with RW 150 feet with contact guard and wheelchair follow was recommended for the resident. Review of Resident 141's care plan in effect at the time of the survey ending May 16, 2025, failed to reveal as per facility policy an individualized and resident-centered care plan with restorative goals and objectives to address the resident's restorative ambulation program which was recommended by therapy. Review of Resident 141's December 2024 through May 14, 2025, Task Documentation Reports revealed a Restorative Ambulation Task to ambulate the resident 150 feet with RW and wheelchair follow on the 7:00 AM to 3:00 PM shift. Further review of the reports revealed that staff documented resident refusal or NA (not applicable) on most days. Further review of the clinical record revealed no documented evidence the resident's restorative 395464 Page 10 of 14 395464 05/16/2025 Forest Hills Rehabilitation & Healthcare Center 1000 Evergreen Avenue Weatherly, PA 18255

F 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some ambulation program was reevaluated based on the resident's noted refusals and not being offered to ambulate as indicated by the documentation of the nurse aide on the resident's Task Documentation Reports. During interview with Resident 141 in the presence of Employee 3 (RN Unit Manager) on May 15, 2025, at approximately 10:00 AM the resident confirmed he is not being provided the opportunity to ambulate. Interview with the Director of Nursing on May 15, 2025, failed to provide documented evidence that Resident 141's restorative ambulation program was implemented and being monitored in a manner to ensure the resident's goals for ambulation are met to the extent possible as per facility policy. 28 Pa. Code: 211.5(f)(viii) Medical records 28 Pa Code 211.12(c)(d)(5) Nursing services 395464 Page 11 of 14 395464 05/16/2025 Forest Hills Rehabilitation & Healthcare Center 1000 Evergreen Avenue Weatherly, PA 18255

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, review of select facility policy and clinical records, and staff interviews, it was determined the facility failed to adhere to acceptable storage and labeling for multi-dose medications in one of four medication carts observed (Master Hall Three). Findings include: Review of the facility policy titled Medication Labeling and Storage last reviewed by the facility April 22, 2025, indicated that multi-use vials that have been opened or accessed (e.g. needle punctured) are dated and discarded within 28 days unless the manufacturer specifies a shorter or longer date for the open vial. An observation of the medication cart located on Master Hall Three unit on May 14,2025 at 9:20 AM, in the presence of Employee 15 (Registered Nurse) of medication stored in the medication cart, revealed two (2) multi-dose insulin pens of Insulin Aspart ( a rapid acting insulin medication used to lower blood sugar ) and Insulin Glargine (a long acting insulin medication used to lower blood sugar) that had been opened and available for use, but not dated when initially opened. An interview with Employee 15 (RN) on May 14, 2025 at 9:30 AM confirmed both multi dose insulin pens: Insulin Aspart and Insulin Glargine were opened, and available for use, and not dated. Interview with the Director of Nursing (DON) on May 14,2025, at approximately 11:00 AM, confirmed the facility failed to adhere to acceptable storage and labeling practices for multi-dose medications. 28 Pa. Code 211.9(a)(1)(k) Pharmacy services 28 Pa. Code 211.12(c)(d)(1)(5) Nursing services 395464 Page 12 of 14 395464 05/16/2025 Forest Hills Rehabilitation & Healthcare Center 1000 Evergreen Avenue Weatherly, PA 18255

F 0791 Provide or obtain dental services for each resident. 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, payor source data, and resident and staff interview, it was determined the facility failed to provide timely and necessary dental services for two residents (Resident 48 and 103) and failed to provide routine dental for one resident (Resident 55) out of 36 residents reviewed who were Medicaid recipients. Residents Affected - Some Findings included: A review of Resident 48's clinical record revealed the resident was admitted to the facility on [DATE], with diagnoses to include Type 2 diabetes (trouble controlling blood sugar and using it for energy), chronic obstructive pulmonary disease (lung disease that blocks airflow and makes it difficult to breathe), and congestive heart failure (weakness of the heart that leads to build-up of fluid in the lungs and surrounding body tissues). A quarterly Minimum Data Set Assessment (MDS a federally mandated standardized assessment conducted at specific intervals to plan resident care) dated April 23, 2025, indicated the resident was moderately cognitively impaired with a BIMS score of 10 (brief interview for mental status, a tool to assess the residents' attention, orientation, and ability to register and recall new information, a score of 8-12 indicates moderate cognitive impairment). Review of Resident 48's Dental Summary Report dated July 22, 2024, revealed the resident had an emergency dental exam due to complaints of pain and food getting stuck in his teeth. The probable cause of resident's complaints was identified as cavities and poor contact of teeth #30 and #31. Treatment recommendations were to extract decayed teeth. Review of Resident 48's Dental Summary Report dated October 18, 2024, revealed the resident was scheduled for an extraction. The procedure was not performed as the resident was to receive an antibiotic one hour prior to the appointment and the facility failed to administer the medication. The dentist reported she spoke with the nurse and the nurse stated she was unaware that he was to be given an antibiotic. Extraction was to be reschedule for another visit. At the time of the survey ending May 16, 2025, the facility was unable to provide documented evidence that a follow-up visit was rescheduled with the dentist for Resident 48 to undergo the extraction procedure as recommended by the dentist. A review of Resident 103's clinical record revealed the resident was admitted to the facility on [DATE], with diagnoses to include dementia (a chronic or persistent disorder of the mental processes caused by brain disease or injury and marked by memory disorders, personality changes, and impaired reasoning), type 2 diabetes, and moderate protein-calorie malnutrition (a condition caused by not getting enough calories or the right amount of protein and nutrients needed for health). A significant change of status MDS dated [DATE] indicated the resident was severely cognitively impaired. Nursing documentation dated November 12, 2024, at 9:36 PM revealed that the LPN (licensed practical nurse) reported that Resident 103 lost her upper denture. Her diet was downgraded to mechanical soft. The Physician and Resident Representative (RP) were notified. 395464 Page 13 of 14 395464 05/16/2025 Forest Hills Rehabilitation & Healthcare Center 1000 Evergreen Avenue Weatherly, PA 18255

F 0791 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Nurse documentation dated November 26, 2024, at 1:22 PM revealed that the RP was made aware the dentist was scheduled onsite to see the resident on December 9, 2024, for dentures. Review of Resident 103's Dental Summary Report dated December 9, 2024, revealed the resident was not seen by the dentist as the resident was brought to the clinic and refused to be seen. The dentist indicated on the report that Resident 103 stated she did not want dentures. There was no documented evidence the RP was notified of the outcome of dental visit and the resident's refusal for dentures. Nursing documentation dated February 4, 2025, at 4:29 PM revealed the RP expressed concern that the resident never got her new dentures. The nurse discussed with the RP about the resident refusing to be seen by the dentist. The RP reported she believes it was a bad day for the resident and would like for the facility to try and have her seen by the dentist again. The RP stated that dentures were always very important to the resident, and she thinks she may eat more if she had dentures. At the time of the survey ending May 16, 2025, the facility was unable to provide documented evidence that Resident 103 was scheduled for a dental appointment for dentures at the request of the RP on February 4, 2025. A review of Resident 55's clinical record revealed the resident was admitted to the facility on [DATE], with diagnoses to include metabolic encephalopathy (chemical imbalance in the blood that affects the brain which can cause loss of memory and difficulty coordinating motor tasks) and moderate protein-calorie malnutrition. An annual MDS dated [DATE], indicated the resident was cognitively intact with a BIMS of 14 (a score of 13-15 indicates cognitively intact responses). During an interview with Resident 55 on May 13, 2025, at 12:00 PM she reported she has not seen a dentist in the past year while residing in the facility. There was no documented evidence at the time of the survey ending May 16, 2025, the resident had been offered dental services in the past year. During an interview on May 15, 2025, at approximately 11:00 AM the Director of Nursing (DON) was unable to produce documentation to demonstrate that routine dental was provided for Resident 55 or that timely and appropriate dental services were provided for Resident 48 and 103. The DON could not explain the delay in the dental referral or the prolonged timeline for dental services. 28 Pa Code 211.12 (c)(d)(3)(5) Nursing services 395464 Page 14 of 14