Health inspection·November 2, 2023

F 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm Based on observation, clinical record review, and staff interviews, it was determined that the facility failed to ensure that the resident assessment accurately reflected the resident's status for two of 21 residents reviewed (Residents 70 and 85). Residents Affected - Few Findings include: Review of Resident 70's clinical record revealed diagnoses that included Alzheimer's with early onset (gradually progressive brain disorder that causes problems with memory, thinking, and behavior) and anxiety disorder (mental disorder characterized by feelings of worry about future events and/or fear in reaction to current events). Observation of Resident 70 on October 30, 2023, at 9:39 AM, revealed her wandering throughout the nursing unit. Review of Resident 70's current plan of care revealed that she had a care plan for elopement, where it was noted that she is a wanderer and wanders aimlessly. This information was updated to Resident 70's care plan on October 2, 2023. Review of Resident 70's behavior tracking documentation revealed that she exhibited wandering behavior on October 4, 2023. Review of Resident 70's October 6, 2023, quarterly MDS (Minimum Data Set - an assessment tool to review all care areas specific to the resident such as a resident's physical, mental, or psychosocial needs) revealed that this assessment was not coded to indicate that Resident 70 exhibited wandering behavior during the look back period (seven day period prior to the assessment date). During an interview with the Nursing Home Administrator (NHA) on November 2, 2023, at 1:28 PM, he agreed that the MDS assessment should have been coded to indicate that Resident 70 exhibited wandering behavior. Review of Resident 85's clinical record revealed diagnoses that included Parkinson's disease (long-term movement disorder where the brain cells that control movement start to die and cause changes in how one moves, feels, and acts) and dementia (loss of memory, language, problem-solving, and other thinking abilities that are severe enough to interfere with daily life). Review of nursing progress note dated July 28, 2023, revealed Resident 85 experienced a fall on that date, where she obtained a laceration to her right pointer finger and a hematoma (localized collection of blood outside the blood vessels, due to either disease or trauma including injury or Page 1 of 5 395475 395475 11/02/2023 Homeland Center 1901 North Fifth Street Harrisburg, PA 17102

F 0641 surgery, and may involve blood continuing to seep from broken capillaries) to her left forehead. Level of Harm - Minimal harm or potential for actual harm Review of Resident 85's August 23, 2023 quarterly MDS revealed that it was not coded to indicate that Resident 85 experienced any fall with injury since the prior assessment was completed. Residents Affected - Few Review of Resident 85's assessment submissions revealed that the prior applicable assessment was completed on May 26, 2023. During an interview with the NHA on November 2, 2023, at 11:58 AM, he confirmed that Resident 85's August 23, 2023, MDS was coded incorrectly. 28 Pa. Code 211.12(d)(1)(5) Nursing services 395475 Page 2 of 5 395475 11/02/2023 Homeland Center 1901 North Fifth Street Harrisburg, PA 17102

F 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm Based on observation, facility policy review, clinical record review, and staff interviews, it was determined that the facility failed to ensure that residents receive necessary treatment and services, consistent with professional standards of practice, to promote healing and prevent infection of a pressure ulcer for one of two residents reviewed for pressure ulcers (Resident 16). Residents Affected - Few Findings Include: Review of facility policy, titled Wound Care and Dressing Change, revised January 2020, revealed Clean portion of surface before placing supplies on table. Wash hands and don gloves .Undress wound, assess area and cleanse and appropriately dispose of soiled dressing. Remove gloves and sanitize hands. [NAME] new gloves. Apply new treatment as ordered. Review of Resident 16's clinical record revealed diagnoses that included dementia (a group of thinking and social symptoms that interferes with daily functioning) and stage 4 pressure ulcer of the sacrum (localized damage to the skin and/or underlying soft tissue usually over a bony prominence; stage 4 is full-thickness skin and tissue loss). Review of Resident 16's current physician orders revealed a treatment order dated October 21, 2023, to cleanse the sacral pressure ulcer with sea cleanse (a saline-based solution for cleansing and irrigating acute and chronic wounds), apply Mesalt to wound (a type of dressing used for wound healing), and cover with foam. Observation of Resident 16's wound care on November 1, 2023, at 8:12 AM, revealed Employee 2 (Registered Nurse) cleansed Resident 16's bedside table. Employee 2 then applied gloves. Employee 2 did not perform hand hygiene prior to applying the gloves. Employee 2 then removed Resident 16's old dressing and discarded it. Next, Employee 2 removed her gloves and applied new gloves. Employee 2 did not perform hand hygiene after removing her old gloves and prior to applying new gloves. Employee 2 then cleansed Resident 16's wound with sea cleanse, removed her gloves, and applied new gloves. Employee 2 did not perform hand hygiene after removing her old gloves and prior to applying new gloves. Employee 2 then applied Mesalt to Resident 16's wound bed and applied the foam dressing. At the conclusion of the wound care, Employee 2 removed her gloves and performed hand hygiene. During an interview with the Nursing Home Administrator and Director of Nursing (DON) on November 2, 2023, at 1:28 PM, the DON stated that hand hygiene should have been performed between glove changes. 28 Pa. Code 211.12(d)(1)(2)(3)(5) Nursing services 395475 Page 3 of 5 395475 11/02/2023 Homeland Center 1901 North Fifth Street Harrisburg, PA 17102

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observations, facility policy review, clinical record review, and staff interviews, it was determined that the facility failed to maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the transmission of communicable diseases and infections for three of 21 residents reviewed (Residents 13, 16, and 61). Residents Affected - Some Findings include: Review of facility provided policy, titled Homeland Center Infection Prevention and Control Manual, Transmission-Based Precaution, dated 2021, revealed, It is essential both to communicate transmission-based precautions to all health care personnel and for personnel to comply with requirements. Pertinent signage (i.e., isolation precautions) and verbal reporting between staff can enhance compliance with transmission-based precautions to help minimize the transmission of infections within the facility. Review of Resident 13's medical record revealed diagnoses that included urinary tract infection (UTI - an infection in any part of the urinary system) and Chronic obstructive pulmonary disease (COPD - a common, preventable, and treatable disease that is characterized by persistent respiratory symptoms like progressive breathlessness and cough). Review of Resident 13's medical record revealed a urine culture and sensitivity result that was positive for Escherichia coli (E. coli- a bacterial infection) that was reported on October 29, 2023, at 10:48 AM. Observation of Resident 13's room on October 30, 2023, at 1:27 PM, revealed a PPE (personal protective equipment) caddie being hung on the Resident's door. Further observation revealed that no signage was hung with instructions on what type of precautions needed to be followed or what PPE should be used. Further observation of Resident 13's room on October 31, 2023, at 8:15 AM, revealed that no signage was hung with instructions on what type of precautions needed to be followed or what PPE should be used at that time. Review of Resident 13's physician's orders on November 1, 2023, revealed a current physician order for contact isolation for seven days to start on October 30, 2023, at 4:00 PM. Interview with the Director of Nursing (DON) on November 2, 2023, at 1:31 PM, revealed that the facility should have had signage hanging outside of Resident 13's room indicating what type of PPE needed to be used. Review of Resident 16's clinical record revealed diagnoses that included dementia (a group of thinking and social symptoms that interferes with daily functioning) and stage 4 pressure ulcer of the sacrum (localized damage to the skin and/or underlying soft tissue usually over a bony prominence; stage 4 is full-thickness skin and tissue loss). Observation of Resident 16's wound care on November 1, 2023, at 8:12 AM, revealed Employee 2 (Registered Nurse) removing Resident 16's old, soiled dressing and placing it in the trashcan. Observation of the old dressing revealed wound drainage present. At the conclusion of the dressing change, 395475 Page 4 of 5 395475 11/02/2023 Homeland Center 1901 North Fifth Street Harrisburg, PA 17102

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Employee 2 left the room, but did not remove the trash, with the soiled dressing in it, from Resident 16's room. During an interview with Employee 3 (Registered Nurse, Infection Preventionist) on November 2, 2023, at 9:33 AM, Employee 3 stated that, at the conclusion of wound care, the nurse should tie the trash bag shut, remove it from the room, and take it to the soiled utility room. During an interview with the Nursing Home Administrator (NHA) and DON on November 2, 2023, at 1:28 PM, the DON stated that the trash bag with the soiled dressing should have been removed from Resident 16's room at the conclusion of the dressing change. Review of Resident 61's clinical record revealed diagnoses that included UTI and hypertension (elevated blood pressure). Review of Resident 61's nursing progress notes revealed a note on October 27, 2023, stating that the Resident's urine culture returned positive for UTI and VRE (vancomycin-resistant Enterococcus; an infection with bacteria that are resistant to the antibiotic called vancomycin), and that Resident 61 was placed on contact isolation. Review of Resident 61's physician orders revealed an order dated October 27, 2023, to write a progress note every shift related to antibiotic usage for UTI VRE and contact isolation. Observation of Resident 61's room on October 30, 2023, at 11:29 AM and again at 1:56 PM, revealed a PPE caddy hanging just inside Resident 61's room. Further observations failed to reveal any signage on the outside of Resident 61's room stating that Resident 61 was on contact precautions. Observation of Resident 61's room on October 31, 2023, at 9:03 AM, revealed the PPE caddy present, but no signage present. Observation on October 31, 2023, at 9:46 AM, revealed a contact precautions sign had been placed on the outside of Resident 61's room. During an interview with the NHA and DON on November 1, 2023, at approximately 1:15 PM, they were made aware of Resident 61 not having contact precaution signage outside of his room until October 31, 2023, at 9:46 AM. During an interview with Employee 3 on November 2, 2023, at 9:31 AM, Employee 3 stated that signage should be placed at the same time the PPE caddy is placed. During a follow up interview with the NHA and DON on November 2, 2023, at 12:06 PM, they were again made aware of the surveyor's concern with the lack of contact precautions signage for Resident 61's room. The NHA stated he had a concern with that as well. 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services 395475 Page 5 of 5