Health inspection·January 18, 2024

F 0576 Ensure residents have reasonable access to and privacy in their use of communication methods. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and staff interviews, it was determined that the facility failed to ensure residents had access to a telephone that afforded privacy for residents during telephone calls on two out of two resident units. Residents Affected - Some Findings include: Observation of the Countryside nursing station on January 18, 2024, at approximately 10:50 AM revealed no telephones intended for resident use that afforded the residents privacy during telephone calls. Interview with Employee 1 (nurse aide) on January 18, 2024, at approximately 10:52 AM revealed that the residents may use the corded telephone located behind the nursing station. The resident may sit behind the nurses station or staff place the phone on the counter for the resident to reach. Employee 1 confirmed there is no area for the residents to have a private conversation while at the nurses station. Employee 1 explained that the facility previously had cordless phones for the residents use however the phones stopped working and they were never replaced. Observation of the Grandview nursing station on January 18, 2024, at approximately 11:05 AM revealed no telephone for resident use that afforded privacy during resident phone calls. Observation revealed a corded telephone located in the Activities Room across from the Grandview nursing station. Interview with Employee 2 (Activities Director) on January 18, 2024, at 11:10 AM revealed that if the Activities room is empty, staff can close the door and the resident may have a private conversation, but that may not always be the situation when a resident wishes to use the phone. Employee 2 stated employees allow residents to use their personal employee cell phones for private telephone calls if they are in bed or unable to get to the nurses station or activities room. Interview with Employee 3 (licensed practical nurse) on January 18, 2024, at 11:12 AM revealed that the facility previously had cordless phones for resident use, but the connection was poor and calls were unable to be maintained. The facility disconnected the cordless phones for resident use and did not obtain replacements. Resident access to telephones was limited to nurses' stations alone and failed to meet the provisions of the regulatory requirement. The facility failed to provide reasonable access to the use of a telephone without being overheard such as providing cordless telephones or phones with telephone [NAME] in residents' rooms. Interview with the Nursing Home Administrator on January 18, 2024, at approximately 3:05 PM Page 1 of 4 395493 395493 01/18/2024 Julia Ribaudo Extended Care Center 1404 Golf Park Drive Lake Ariel, PA 18436

F 0576 confirmed that the facility stopped providing the residents' cordless phones for their use and no longer maintained telephone access that afforded residents privacy during telephone conversations. Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code 201.18(b)(2)(e)(1) Management Residents Affected - Some 28 Pa. Code 201.29(a) Resident rights 395493 Page 2 of 4 395493 01/18/2024 Julia Ribaudo Extended Care Center 1404 Golf Park Drive Lake Ariel, PA 18436

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of clinical records and staff interview, it was determined that the facility failed to timely notify the resident's interested representative of a change in condition for one resident out of 12 sampled (Resident A1). Findings include: A review of the clinical record revealed that Resident A1 was admitted to the facility on [DATE], with diagnoses which included schizoaffective disorder ( is a mental health disorder that is marked by a combination of schizophrenia symptoms, such as hallucinations or delusions, and mood disorder symptoms, such as depression or mania), diabetes and anxiety. A review of the resident's recorded monthly weights revealed that on November 7, 2023, the resident's weight was noted as 195 lbs. The resident's next recorded monthly weight was dated December 6, 2023, revealed that the resident's weight decreased to 171 lbs. The resident lost 24 lbs, a significant weight loss of 12% loss of body weight, in one month. A dietary note dated December 6, 2023, indicated that the resident's weight had decreased to 171 lbs and the plan was to add a house nutritional supplement, 120 ml, four times a day. The resident's attending physician was notified. According to nursing documentation the resident's interested representative representative, a daughter, was not notified of the resident's significant weight loss until December 13, 2023, at 1:39 PM at which time she expressed concerns regarding the resident's mental health. The resident's significant weight loss was identified on December 6, 2023, but the resident's representative was not informed until a week later on December 13, 2023. An interview with the Nursing Home Administrator on January 18, 2024, at approximately 2:00 PM confirmed the facility failed to timely notify the resident's representative of the resident's significant weight loss. 28 Pa Code 211.12 (d)(3) Nursing services 395493 Page 3 of 4 395493 01/18/2024 Julia Ribaudo Extended Care Center 1404 Golf Park Drive Lake Ariel, PA 18436

F 0687 Provide appropriate foot care. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of clinical records and staff interview, it was determined that the facility failed to consistently provide timely and necessary foot care for one of eight residents sampled (Resident A1). Residents Affected - Few Findings include: Review of Resident A1's clinical record revealed that the resident was admitted to the facility on [DATE], with diagnoses to include diabetes and deep vein thrombosis (blood clot in a deep vein). Review of clinical records revealed Resident A1 was admitted to the hospital on [DATE]. A review of the hospital podiatry (foot doctor) consultation report dated December 22, 2023, at 12:00 PM, revealed that the reason for the consult was Nails in disarray. The report stated that the Patient has elongated nails with what looks like a traumatic avulsion of the right 4th nail. Elongated nails that appear painful for the patient. Elongated nails x 9 b/l LE (bilateral lower extremities) that are thickened and with subungual debris noted (debris under to toenails). Further review of the resident's clinical record revealed no evidence that during the resident's stay at the facility from May 18, 2023, through hospitalization on December 19, 2023, that that Resident A1 received podiatry care in the facility and the necessary foot care. Interview with the Nursing Home Administrator on January 18, 2024, at approximately 3:00 PM confirmed that the facility was unable to provide documented evidence that Resident A1 had been provided routine podiatry and foot care as a resident in the facility. 28 Pa. Code 211.12 (d)(3)(5) Nursing Services 395493 Page 4 of 4