Health inspection·September 7, 2023

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 a review of clinical records and staff interview it was determined that the facility failed to provide person-centered quality care by failing to follow physician orders for medication administration and accurately monitor bowel activity and administration of the bowel protocol as prescribed for one resident out of seven 7 sampled (Resident 11). Residents Affected - Few Findings include: A review of the clinical record revealed that Resident 11 was admitted to the facility on [DATE], with diagnoses to include, stiff-man syndrome (a rare autoimmune neurological disorder that most commonly causes muscle stiffness and painful spasms that come and go and can worsen over time.) and chronic pain. The resident had physician orders dated August 28, 2023, for MS Contin (an opioid medication for pain) 15 milligrams (mg) by mouth two times a day (8:00 a.m. and 8:00 p.m.) for chronic pain, and Pregabalin (Lyrica- used to treat pain caused by nerve damage) 75 mg by mouth two times a day (9:00 a.m. and 9:00 p.m.) for chronic pain. Review of Resident 11's Medication Administration Record (MAR) for August 2023, revealed that both medications were given on August 28, 2023, at 8:00 p.m. and 9:00 p.m. respectively. The August 2023 MAR indicated that MS Contin and Pregabalin were not given on August 29, 2023, at 8:00 a.m. and 9:00 a.m. as scheduled, and documentation on the MAR noted to see nurses notes. Review of nurses notes dated August 29, 2023 at 9:00 a.m. indicated that the MS Contin was not available for administration to the resident, but failed to indicate why the Pregabalin was not given. Interview with the Director of Nursing on September 7, 2023 at 11:15 a.m. revealed that the resident arrived at the with two doses of each of the above medications. The resident was one dose of each on the day of admission, August 28, 2023, but the DON was unable to state why the second dose of each drug was not administered to the resident on August 29, 2023 at 8:00 a.m. and 9:00 a.m. as scheduled. Resident 11 had current physician orders in effect during August 2023 and thru the time of the survey ending September 7, 2023, for the following bowel regimen: Milk of Magnesia (MOM) Suspension 400 MG/5ML (Magnesium Hydroxide), give 30 ml by mouth as needed for constipation at bedtime on day 3. Page 1 of 2 395484 395484 09/07/2023 Kadima Rehabilitation & Nursing at Luzerne 463 North Hunter Hwy Drums, PA 18222

F 0684 Level of Harm - Minimal harm or potential for actual harm Bisacodyl Suppository 10 MG, Insert 1 suppository rectally as needed for Constipation at bedtime, 24 hours after MOM Ineffective. Fleet Enema, 7-19 GM/118 ML (Sodium Phosphates), insert 1 dose, rectally as needed for constipation 7-3 on day 5, 12 hours after suppository is ineffective. Residents Affected - Few Review of the resident's Documentation Survey Report for August 2023 and September 2023 revealed that Resident 11 had a bowel movement on August 29, 2023, on the 7 AM to 3 PM shift at 11:34 a.m. The resident's next bowel movement was four days later on September 2, 2023, during the 3 PM to 11 PM shift at 9:03 p.m. The resident had another bowel movement on September 4, 2023, on the 7 AM to 3 PM shift at 12:59 p.m. Review of Resident 11's MAR's for August 2023 and September 2023 indicated the resident received MOM on September 1, 2023, at 11:04 p.m. and a Bisacodyl Suppository on September 3, 2023 at 6:13 a.m. Nurses notes confirmed the MOM was given on September 1, 2023 at 11:04 p.m. However ,a nurses note on September 2, 2023 at 9:18 a.m. indicated the MOM was effective. Nurses note on September 3, 2023 at 6:13 a.m. indicated that the resident received a Bisacodyl Suppository because the MOM was ineffective. Nurses note on September 3, 2023 at 3:02 p.m. indicated that the Bisacodyl Suppository was ineffective. A nurse's note dated September 5, 2023, at 10:56 a.m. indicated that the resident had a large bowel movement on September 4, 2023, with no complaints of pain or discomfort. However another nurses note on September 5, 2023, at 2:41 p.m. indicated that a fleets enema was administered for no bowel movement and it was unsuccessful. Interview with the Director of Nursing on September 7, 2023, at 12:45 p.m. revealed that the DON was unable to state why the resident received a Bisacodyl Suppository on September 3, 2023, at 6:13 a.m. when staff noted that the resident had a bowel movement on September 2, 2023, on the 3 PM to 11 PM shift at 9:03 p.m. The DON was unable to explain the inconsistent nursing documentation of the resident's bowel activity whereas nurses notes indicated the resident had a bowel movement on September 4, 2023, and then on September 5, 2023, at 2:41 p.m. nursing noted that a fleet enema was administered for no bowel movement and it was unsuccessful. 28 Pa. Code 211.12 (c)(d)(5) Nursing services 28 Pa. Code 211.5 (f) Medical records 395484 Page 2 of 2