Health inspection·February 23, 2024

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 clinical record review and observation, it was determined that the facility failed to provide assistance with dining in a manner that promoted and maintained dignity for three residents in two of four dining rooms. (Residents 9, 91, 205) Findings include: Clinical record review revealed that Resident 9 had diagnoses that included Alzheimer's dementia, unspecified protein-calorie malnutrition, and gastro-esophageal reflux disease without esophagitis. Review of the Minimum Data Set (MDS) assessment, dated November 28, 2023, revealed that the resident had cognitive impairment. Review of Resident 9's care plan revealed the resident was to be seated upright in a chair with the assistance of one staff member while eating. On February 21, 2024, from 8:32 a.m. until 8:54 a.m., Nurse Aide (NA) 1 was observed standing while assisting Resident 9 with breakfast. Clinical record review revealed that Resident 91 had diagnoses that included diabetes mellitius. Review of the MDS assessment, dated February 20, 2024, revealed that the resident had cognitive impairment and needed staff assistance with eating. Review of Resident 91's care plan revealed that staff was to assist him with self-feeding and provide verbal cueing with meals. On February 21, 2024, from 8:30 a.m. through 8:45 a.m., NA 2 was observed standing while assisting Resident 91 with breakfast. Clinical record review revealed that Resident 205 had diagnoses that included heart failure and chronic kidney disease. Review of the MDS assessment, dated November 28, 2023, revealed that the resident had cognitive impairment and needed staff assistance with eating. Review of the Therapy Staff Education form revealed that staff was to assist Resident 205 with meals. On February 21, 2024, from 8:30 a.m. through 8:45 p.m. and from 11:45 a.m. through 12:00 p.m., NA 3 was observed standing while assisting Resident 205 with breakfast and lunch. 28 Pa. Code 211.12(d)(1)(5) Nursing services. Page 1 of 3 395499 395499 02/23/2024 Tremont Health & Rehabilitation Center 44 Donaldson Road Tremont, PA 17981

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 clinical record review and staff interview, it was determined that the facility failed to develop and implement an individualized person-centered care plan to meet each resident's needs as related to a diagnosis of post traumatic stress disorder and as identified in the comprehensive assessment for two of 31 sampled residents. (Residents 8, 21) Findings include: Clinical record review revealed that Resident 8 had diagnoses that included post traumatic stress disorder (PTSD), depression, and Fourier's gangrene (tissue death). Review of a psychiatric consultation dated December 20, 2023, revealed Resident 8 was a combat veteran with PTSD. Review of the Resident Centered Care/All About Me Information Form dated February 3, 2024, revealed the resident had triggers from past trauma that included loud noises, fireworks, and cars backfiring. Resident 8's care plan did not include interventions to address the resident's PTSD diagnosis and related triggers to prevent re-traumatization. Clinical record review revealed that Resident 21 was admitted to the facility on [DATE], with diagnoses that included major depressive disorder and anxiety disorder. The Minimum Data Set assessment Care Area Assessment summary dated December 11, 2023, noted that the resident's psychotropic drug use was to be addressed in the care plan. There was no documented evidence that interventions to address Resident 21's psychotropic drug use were included in the care plan. In an interview on February 23, 2024, at 9:34 a.m., the social worker (SW1) confirmed the identified areas were not addressed in Residents 8 or 21's care plans. 28 Pa. Code 211.12(c)(d)(1)(3)(5) Nursing services. 395499 Page 2 of 3 395499 02/23/2024 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 and resident interview, it was determined that the facility failed to provide restorative nursing services to prevent a reduction in range of motion and/or to improve or maintain mobility on a consistent basis for one of 31 sampled residents. (Resident 147) Findings include: Clinical record review revealed that Resident 147 had diagnoses that included repeated falls and colon cancer. The Minimum Data Set assessment dated [DATE], indicated that the resident was not cognitively impaired and required staff assistance for activities of daily living. Review of the physical therapy Discharge summary dated [DATE], revealed that the resident required staff assistance for transfers and walking. The physical therapist recommended a restorative nursing program for Resident 147. Staff was to assist the resident to walk 150 feet daily with a walker while staff followed with a wheelchair. Review of Resident 147's current care plan revealed that he was dependent on staff assistance for transfers and that he was to walk 150 feet with staff assistance. In an interview on February 20, 2024, at 12:00 p.m., Resident 147 stated that staff did not offer to walk him consistently, he desired to walk daily, and that he would not refuse an offer to walk. Review of nursing documentation from January 27, 2024, through February 22, 2024, revealed there was a lack of documentation to support that the resident received restorative nursing services on February 4, 9, 11, 20, and 22, 2024. CFR 483.25(c)(2) Mobility Previously cited 3/10/23 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services. 395499 Page 3 of 3