Health inspection·March 10, 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 clinical record review and staff interview, it was determined that the facility failed to ensure that a physician's order was implemented for one of 31 sampled residents. (Resident 97) Residents Affected - Few Findings include: Clinical record review revealed that Resident 97 was admitted to the facility on [DATE], with diagnoses that included diabetes and end stage renal disease. Review of the clinical record revealed the resident was transported to another location for hemodialysis at 9:00 a.m. on Mondays, Wednesdays, and Fridays. Review of a physician order, dated June 26, 2022, revealed that the resident was to have an insulin injection of 7 units of Humalog insulin solution twice a day with the first dose scheduled at 11 a.m. Review of the Medication Administration Records for January 2023, revealed that the medication was not given eight times, February 2023, the medication was not given six times and March 2023, the medication was not given three times. In an interview on March 10, 2023, at 10:21 a.m., the Director of Nursing stated the physician order was not followed and there was no documentation to support the physician was notified the resident was missing the 11 a.m. doses due to dialysis. 28 Pa. Code 211.12(d)(1)(5) Nursing services. Page 1 of 3 395499 395499 03/10/2023 Tremont Health & Rehabilitation Center 44 Donaldson Road Tremont, PA 17981

F 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review, observation, and staff interview, it was determined that the facility failed to implement interventions to prevent contractures for one of six sampled residents with limited range of motion. (Resident 147) Findings include: Clinical record review revealed that Resident 147 had diagnoses that included Parkinson's disease and aphasia (loss of ability to understand or express speech). Review of the Minimum Data Set assessment dated [DATE], revealed that Resident 147 had cognitive impairments, and had functional limitation in range of motion on one side of the upper and lower extremities, and required extensive assistance from staff for most activities of daily living. On January 26, 2023, a physician ordered that staff apply a left palm guard during morning care and remove it with evening care. Observations on March 7, 2023, at 12:21 p.m., March 8, 2023 at 11:40 a.m., and 12:21 p.m., and March 9, 2023 at 10:45 a.m., revealed that Resident 147 did not have the left palm guard in the left hand and the hand was clenched in a fist. In an interview on March 10, 2023, at 11:30 a.m., the Rehabilitation Director, confirmed the left palm guard was ordered due to Resident 147's muscle contracture of the left hand. In an interview on March 10, 2023 at 11:12 a.m., the Director of Nursing confirmed that Resident 147 should have been wearing the left palm guard. CFR 483.25(c)(2) Mobility Previously cited 5/21/21 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services. 395499 Page 2 of 3 395499 03/10/2023 Tremont Health & Rehabilitation Center 44 Donaldson Road Tremont, PA 17981

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on facility policy review, clinical record review, and staff interview, it was determined that the facility failed to provide services to restore function to residents identified with a decline in bladder and bowel continence for one of 31 sampled residents. (Resident 67) Findings include: Review of the facility policy entitled, Continence Management Program, dated October 20, 2022, revealed that based on the resident's comprehensive assessment, all residents who were incontinent would receive appropriate treatment and services to restore continence to the extent possible. Clinical record review revealed that Resident 67 had diagnoses that included lack of coordination and abnormalities of gait and mobility. The Minimum Data Set (MDS) assessment dated [DATE], indicated that the resident was always continent of bladder and bowel. Review of the MDS assessments dated November 5, 2022, and February 5, 2023, revealed that Resident 67 had a decline in continence and had become occasionally incontinent of bladder and frequently incontinent of bowel. Evaluations for continence and retraining dated November 17, 2022, and February 17, 2023, failed to identify the resident's decline in continence. Nurse Aide documentation for 30 days prior to March 10, 2023, reflected that the resident continued to experience occasional episodes of urinary incontinence and frequent episodes of bowel incontinence. There was a lack of documentation to support that services were provided to address Resident 67's decline in bladder and bowel function. During an interview on March 10, 2023, at 10:21 a.m., the Director of Nursing confirmed that a decline in continence should have been evaluated and resulting interventions implemented. 28 Pa. Code 211.12(d)(1)(5) Nursing services. 395499 Page 3 of 3