Health inspection·December 20, 2023

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. Based on a review of clinical records, resident, family and staff interviews it was determined that the facility failed to provide care in a manner and environment that promotes each residents' quality of life by failing to respond timely to residents' requests for assistance, which negatively impacted the residents' quality of life in the facility as evidenced by three of 8 residents interviewed (Residents 1, 6, and 7). Findings include: A review of Resident 1's clinical record revealed admission to the facility on December 1, 2023, for short term rehab therapy services with diagnoses of cerebral infarction (stroke). The resident was assessed as cognitively intact. During an interview on December 20, 2023, at approximately 12:30 PM, Resident 1 and her husband stated that she has waited from 30 minutes up to an hour for staff to respond to her call bell and provide assistance when requested. Resident 1 stated that these long waits for staff to respond to her requests for assistance have occurred multiple times since her admission to the facility at the beginning of the month. She stated that the extended call bell wait times are very hard for her to experience because she needed to be toileted and it is uncomfortable to wait so long for staff assistance. During an interview on December 20, 2023, at approximately 12:45 PM, Resident 6, a cognitively intact resident, stated that she waits from 30 minutes or more for staff to respond to her call bell and provide needed assistance. The resident stated that the long waits for staff assistance occur mostly on the second and third shifts of nursing duty. During an interview on December 20, 2023, at approximately 12:55 PM, Resident 7, a cognitively intact resident, stated that wait times for staff to respond to the resident's call bell and provide assistance, are at times 30 minutes or longer. The resident stated that the long waits occur mostly on the second and third shift of nursing duty. Interview with the Nursing Home Administrator on December 20, 2023, at approximately 1 p.m., confirmed that the residents should be treated with respect and dignity and provided timely care in an environment that promotes their quality of life. 28 Pa. Code 201.29 (a) Resident Rights 28 Pa. Code 201.18 (e)(1) Management Page 1 of 5 395493 395493 12/20/2023 Julia Ribaudo Extended Care Center 1404 Golf Park Drive Lake Ariel, PA 18436

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 Based on observations, clinical record review and resident and staff interview it was determined that the facility failed to provide services necessary to maintain adequate personal hygiene of residents who need assistance with activities of daily living for three out of 8 residents reviewed. (Residents 1, 2 and 3). Residents Affected - Some Findings include: A review of Resident 1's clinical record revealed admission to the facility on December 1, 2023, with diagnoses of cerebral infarction (stroke). The resident was cognitively intact and admitted for short term therapy services. A review of the resident's clinical record and initial care plan revealed no evidence of the resident's shower or bathing schedule or preferences. A review of the facility's shower schedule binder revealed that Resident 1 was to receive a shower on Wednesdays during the 7 AM. to 3 PM shift and Saturdays on the 3 PM to 11 PM. A review of the resident's bathing record conducted during the survey of December 20, 2023, revealed that Resident 1 was showered only once since her admission to the facility on December 1, 2023. The resident was showered on December 16, 2023, according to the bathing record. During an interview conducted on December 20. 2023 at 1:15 PM Resident 1 and her husband confirmed that the resident had only received one shower since her admission to the facility, on December 1, 2023, to the date of the survey, on December 20, 2023. Resident 1 stated that she was scheduled to be discharged from the facility the next day, December 21, 2023. Both Resident 1 and her husband stated that they were upset that she was showered only once during her stay at the facility. A review of the clinical record of Resident 3 revealed admission to the facility on November 22, 2023, with diagnoses to include hypertension. Further review of the resident's clinical record revealed that Resident 3 was to receive a shower on Tuesdays on the dayshift and on Saturday on the evening shift. A review of the resident's bathing record for November 2023 and December 2023 revealed that the resident was showered on November 23, 2023. The resident's next documented shower was on December 1, 2023, 8 days later. The resident received a shower on December 12, 2023, and then not again until December 19, 2023, 7 days later. A review of the clinical record of Resident 2 revealed admission to the facility on October 28, 2022, with diagnoses to include Alzheimers disease. The resident was severely cognitively impaired and required staff assistance for activities of daily living. Further review of the resident's clinical record revealed that the resident was to receive a shower on Thursdays on the dayshift and Monday during the evening shift. A review of the resident's bathing record for December 2023 revealed that staff documented that the resident had been showered twice a week on her designated shower days as planned. 395493 Page 2 of 5 395493 12/20/2023 Julia Ribaudo Extended Care Center 1404 Golf Park Drive Lake Ariel, PA 18436

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some An observation conducted on December 20, 2023 at approximately 10:30 AM revealed Resident 2 was seated in a wheelchair at the nurses station. Her fingernails were observed to be long and jagged as well as chipped and peeling fingernail polish. Attempts to interview the resident to discuss her showers and nail care were unsuccessful as the resident was unable to communicate her ADL needs to the surveyor. Interview with the Nursing Home Administrator on December 20, 2023, at approximately 2:45 PM revealed that the facility was unable to demonstrate that residents are showered at the planned and desired frequency and provided nail care to maintain good personal hygiene and grooming. 28 Pa Code 211.12 (d)(5) Nursing services. 395493 Page 3 of 5 395493 12/20/2023 Julia Ribaudo Extended Care Center 1404 Golf Park Drive Lake Ariel, PA 18436

F 0689 Level of Harm - Minimal harm or potential for actual harm Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Based on observation and staff interview, it was determined that the facility failed to ensure the facility was free from potential accident hazards and obstacles to safe mobility assistance devices. Residents Affected - Few Findings include: According to §483.90(i)(3) Facilities must equip corridors with firmly secured handrails on each side of the corridor (Secured handrails means handrails that are firmly affixed to the wall). An observation of the E hallway on December 20, 2023 at 10 A.M. and again at 1 P.M. revealed 3 rollator walkers, 5 wheelchairs, a resident room arm chair, a stool and a large linen cart were lined up blocking access to the handrails on the right side of the corridor. These items completely obstructed resident access to the hand railing on the right side of the hallway. Observations at that time revealed multiple residents self-propelling in wheelchairs in the hallway. During an interview December 20, 2023 at 1:30 P.M. the Nursing Home Administrator confirmed that the handrails on the right side of hallway were obstructed and that residents did not have unimpeded access to the handrails on the right side of the corridor to assist with ambulation and mobility on that side of the hall. 28 Pa. Code 201.18 (e)(2.1) Management 395493 Page 4 of 5 395493 12/20/2023 Julia Ribaudo Extended Care Center 1404 Golf Park Drive Lake Ariel, PA 18436

F 0732 Post nurse staffing information every day. Level of Harm - Potential for minimal harm Based on observation and staff interview, it was determined that the facility failed to correctly post nurse staffing information. Residents Affected - Many Findings include: According to §483.35(g)(2) Posting requirements. (i) The facility must post the nurse staffing data on a daily basis at the beginning of each shift. Observation upon entrance to the facility's nursing units on December 20, 2023 at 9 AM revealed that the posted nursing time was dated December 20, 2023, and was completed for a 24 hour time frame to include day shift and the projected staffing for the evening shift and night shifts. During an interview December 20, 2023 at approximately 1 P.M., the Nursing Home Administrator and the Director of Nursing confirmed that the posted nursing time was posted for the entire 24 hour period and not posted at the beginning of each shift of nursing duty. 28 Pa. Code: 211.12 (c) Nursing Services 395493 Page 5 of 5