Health inspection·January 13, 2023

F 0580 Level of Harm - Minimal harm or potential for actual harm Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. Based on clinical record review and staff interview it was determined the facility failed to notify the physician about a resident's status for one of 24 residents reviewed. (Resident 59) Residents Affected - Few Findings Include: Review of Resident 59's physician orders revealed an order for a PT/INR (study of the amount of time it take for blood to clot and determine the effectiveness of blood thinning medication). Further review of Resident 59's clinical record revealed the resident did not have the blood drawn as ordered. Further review of the clinical record revealed there was no documented evidence the physician was notified of the laboratory study not being completed as ordered. Interview with the Director of Nursing on January 13, 2023 at 11:00 a.m. confirmed the physician was not notified the PT/INR was not completed as ordered. 28 Pa. Code 201.18(b)(1) Management 28 Pa. Code 211.5(f) Clinical records 28 Pa. Code 211.12(c)(d) (1)(3)(5) Nursing services Page 1 of 6 395498 395498 01/13/2023 Wesley Enhanced Living Main Line Rehab and Skd Nsg 100 Halcyon Drive Media, PA 19063

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **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 develop a care plan for anticoagulants for one of two residents reviewed (Resident 16) Findings include: Review of Resident 16's clinical record revealed an active diagnosis of Paroxysmal Atrial Fibrillation (an irregular, often rapid heart rate that commonly causes poor blood flow). Resident 16 has a cardiac Pacemaker (a device implanted in the chest to help control the heartbeat). Review of Resident 16's clinical record revealed an active order for Apixaban, Tablet 5mg, twice daily (used to treat and prevent blood clots and to prevent strokes). Review of Resident 16's admission Minimal Date Set assessment (MDS- an assessment of care needs) dated December 28, 2022, revealed Resident 16 takes anticoagulant medication daily. Review of Resident 16's electronic medication administration record (eMAR) revealed Resident 16 was receiving Apixaban twice daily since his admission on [DATE]. Review of Resident 16's current care plan goals and interventions failed to reveal a care plan developed to address the resident's anticoagulant usage. Interview conducted with the Director of Nursing at approximately 10:56 A.M. confirmed that the resident did not have a care plan developed for anticoagulants. 28 Pa Code 211.10(d) Resident care policies 28 Pa Code 211.11(d) Resident care plan 28 Pa. Code 211.12(c) Nursing services 395498 Page 2 of 6 395498 01/13/2023 Wesley Enhanced Living Main Line Rehab and Skd Nsg 100 Halcyon Drive Media, PA 19063

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Based on clinical record review, review of facility documentation, and staff interview, it was determined that the facility failed to ensure adequate supervision during a transfer and an elopement for two of 20 residents reviewed (Residents 4 and 110). Findings include: Review of Resident 4's clinical record revealed a care plan identifying the resident as having an ADL (activities of daily living) deficient due to the resident's diagnosis of dementia. The care plan had an intervention added on April 22, 2018 for the resident indicated a two person assist for transfers using a sit-to-stand lift. Review of Resident 4's progress notes revealed a nursing note dated October 15, 2022, which stated: skin tear to resident's left posterior leg. Nurse called to resident's room by resident's [nurse aide] having been informed that resident had some bleeding to a lower extremity. Nursing assessed resident to find skin tear to left posterior leg. Resident unable to narrate how he sustained the injury. Skin tear noted with moderate bleeding at the time of assessment. Pressure applied to site. Steri strips and absorbent dressing applied, area wrapped with kerlix. Review of facility documentation revealed the investigation concluded that the nurse aide Employee E3 was transferring Resident 4 using the sit-to-stand lift without a second staff person present to assist. Interview with the Director of Nursing on January 13, 2023, at 10:49 a.m. confirmed the nurse aide Employee E3 did not follow Resident 4's plan of care and transferred the resident without the assistance of a second staff person. Review of facility policy and procedure titled Wandering and Elopements, Revised March 2019, revealed if an employee observes a resident leaving the premises he/she should attempt to prevent the resident from leaving in a courteous manner; get help from other staff members in the immediate vicinity, if necessary; and instruct another staff member to inform the Charge Nurse or Director of Nursing Services that a resident is attempting to leave or has left the premises. Review of facility assessments revealed an elopement assessment for resident 11 completed on July 27, 2022 indicating the resident was not a risk for elopement. Review of Resident 110's admission minimum data set (MDS- periodic assessment of resident needs) assessment completed August 3, 2022 revealed the resident had a Brief Interview for Mental Status score of 15 indicating no cognitive impairment. Review of Resident 110's progress notes revealed a nursing entry dated August 3, 2022 stating This morning resident packed some bags and said he was going back home. He took his bags into the dining room and the staff informed him that those doors were locked. He sat there for awhile but then got up and headed toward the exit to the rest of the community. The staff made multiple attempts to redirect him while still in skilled but he argued and would not accept redirection. The CNA (Certified Nurse Aide) followed him to the front door of the community where she was still attempting to redirect him and was joined by some nursing students and security. He could not be coaxed to return to the 395498 Page 3 of 6 395498 01/13/2023 Wesley Enhanced Living Main Line Rehab and Skd Nsg 100 Halcyon Drive Media, PA 19063

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few skilled unit. The CNA continued to follow him out of the building where he continued walking and entered a door near his IL apartment. He had thrown his belongings onto the ground which the CNA picked up. When they got to the apartment he unlocked the door then immediately slammed the door and locked it. The CNA stayed outside for a few minutes but then returned to the unit to inform the nurse what had happened. By the time she returned to the unit on-coming nurse, OT (Occupational Therapy) and the Director of Wellness had started over to the apartment with a key. When they arrived at the apartment he was not longer there. They called his cell phone to determine his location. He had taken his car and was driving. He was instructed to pull over which he did and he was able to tell them where he was. They drove and found him to bring him back to the facility along with his car. He returned stating that he had made a big mistake. Review of Investigation completed by the facility revealed a written statement from the CNA who followed the resident to his apartment revealing she thought he was safe in his apartment and was not aware the resident had a car or had any intention to leave the campus. Further review of the clinical record revealed the resident was discharged back to his Independent Living Apartment on August 30, 2022. Interview with the Director of Nursing and the Nursing Home Administrator revealed the resident was found approximately one mile from the facility. Further interview confirmed the resident was not provided proper supervision when the CNA left the apartment to come back to the facility. 28 Pa. Code 201.29(c) Resident rights 28 Pa. Code 211.10(d) Resident care policies 395498 Page 4 of 6 395498 01/13/2023 Wesley Enhanced Living Main Line Rehab and Skd Nsg 100 Halcyon Drive Media, PA 19063

F 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. Based on clinical record review, it was determined that the facility failed to ensure the physician provided clinical rationales for declining consultant pharmacist recommendations for one of five residents reviewed for unnecessary medications (Resident 55). Findings include: Review of Resident 55's Physician Recommendation from the consultant pharmacist dated November 18, 2022, revealed the pharmacist recommended: The order for Bupropion SR [(antidepressant)] 150 mg, which is the sustained release 12 hour formulation and the directions read: 'Give 2 tablet by mouth in the morning for depression.' Will you consider reviewing this order, to verify if the 12 hour sustained release formulation should continue or if it should be changed to Bupropion XL 150 mg, which is the Extended release 24 hour formulation; but if no changes are to be made, please document your reason why below. Further review of Resident 55's Physician Recommendation from November 18, 2022, revealed the physician signed the recommendation on November 21, 2022, and wrote disagree under the response. The physician's failure to provide clinical rationale for declining the consultant pharmacist's recommendation for Resident 55 was discussed and confirmed with the Director of Nursing on January 13, 2023, at 10:50 a.m. 28 Pa. Code 201.18(b)(1)(2) Management 395498 Page 5 of 6 395498 01/13/2023 Wesley Enhanced Living Main Line Rehab and Skd Nsg 100 Halcyon Drive Media, PA 19063

F 0770 Provide timely, quality laboratory services/tests to meet the needs of residents. Level of Harm - Minimal harm or potential for actual harm Based on clinical record review and staff interview it was determined the facility failed to complete laboratory studies as ordered by the physician for two of 24 residents reviewed. (Resident 48 and 59) Residents Affected - Few Findings Include: Review of Resident 48's Progress Notes revealed a nursing entry dated January 3, 2023 at 3:55 p.m. stating, resident noted with hematuria (blood in the urine). Resident denies having lower abdominal pain, burning or painful urination, no odor. MD made aware and ordered CBC (Complete Blood Count- counts the number of different cells in the blood) and UA C+S (urine tested for infection). Review of Resident 48's physician orders revealed an order dated January 3, 2023 for a CBC. Review of Resident 48's lab results revealed there were no results for a CBC on January 4, 2023. Further review of Progress notes revealed a physician entry dated January 10, 2023 at 10:50 a.m. stating CBC not done as ordered Interview with the Director of Nursing on January 13, 2023 at 10:48 a.m. confirmed the CBC was not drawn as ordered by the physician. Review of Resident 59's physician orders revealed an order for a PT/INR (study of the amount of time it take for blood to clot and determine the effectiveness of blood thinning medication). Further review of Resident 59's clinical record revealed the resident did not have the blood drawn as ordered. Interview with the Director of Nursing on January 13, 2023 at 11:00 a.m. PT/INR was not completed as ordered. 28 Pa. Code 211.12(c)(d) (1)(3)(5) Nursing services 395498 Page 6 of 6