Health inspection·June 1, 2023

F 0584 Level of Harm - Minimal harm or potential for actual harm Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. Based on observation, it was determined that the facility failed to provide a safe, sanitary and comfortable environment on two of four nursing units. (Nursing units D-1A and D-1B) Residents Affected - Few Findings include: Observation throughout the facility during all days of the survey revealed the following: A lift (used to transfer residents from surface to surface) labeled 450 on Unit D-1A had dirty wheels. A lift labeled 600 on Unit D-1B had dirty wheels Observations on May 30, 2023, at 12:07 p.m., and May 31, 2023, at 12:25 p.m., revealed the oxygen concentrator filter was dusty and dirty. Resident 35 was observed using the oxygen concentrator on May 30, 2023, at 2:10 p.m. 28 Pa. Code 201.18(b)(3) Management. Page 1 of 5 395507 395507 06/01/2023 Elm Terrace Gardens 660 North Broad Street Lansdale, PA 19446

F 0623 Level of Harm - Potential for minimal harm Residents Affected - Many Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. **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 notify the resident, the resident's representative(s), and the local ombudsman of the transfer and the reasons for transfer in writing for seven of seven sampled residents who were transferred to the hospital. (Residents 2, 20, 23, 35, 55, 62, 66) Findings include: Clinical record review revealed that Resident 2 was transferred and admitted to the hospital on [DATE], and April 28, 2023, after a change in condition. There was no documented evidence that the resident, the resident's responsible party, and the ombudsman were provided written information regarding the resident's transfer to the hospital. Clinical record review revealed that Resident 20 was transferred and admitted to the hospital on [DATE], after a change in condition. There was no documented evidence that the resident, the resident's responsible party, and the ombudsman were provided written information regarding the resident's transfer to the hospital. Clinical record review revealed that Resident 23 was transferred and admitted to the hospital on [DATE], after a change in condition. There was no documented evidence that the resident, the resident's responsible party, and the ombudsman were provided written information regarding the resident's transfer to the hospital. Clinical record review revealed that Resident 35 was transferred and admitted to the hospital on [DATE], February 1, 2023, and May 17, 2023, after a change in condition. There was no documented evidence that the resident, the resident's responsible party, and the ombudsman were provided written information regarding the resident's transfer to the hospital. Clinical record review revealed that Resident 55 was transferred and admitted to the hospital on [DATE], after a change in condition. There was no documented evidence that the resident, the resident's responsible party, and the ombudsman were provided written information regarding the resident's transfer to the hospital. Clinical record review revealed that Resident 62 was transferred and admitted to the hospital on [DATE], after a change in condition. There was no documented evidence that the resident, the resident's responsible party, and the ombudsman were provided written information regarding the resident's transfer to the hospital. Clinical record review revealed that Resident 66 was transferred and admitted to the hospital on [DATE], after a change in condition. There was no documented evidence that the resident, the resident's responsible party, and the ombudsman were provided written information regarding the resident's transfer to the hospital. In an interview on May 31, 2023, at 12:38 p.m., the Director of Nursing stated that the identified residents, residents' representatives, and the local ombudsman were not notified in writing of the transfer to the hospital. 395507 Page 2 of 5 395507 06/01/2023 Elm Terrace Gardens 660 North Broad Street Lansdale, PA 19446

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 a care plan with interventions to address an identified problem area for two of 18 sampled residents. (Residents 58, 68) Findings include: Clinical record review revealed that Resident 58 had diagnoses that included depression. Physician orders dated May 18, 2023, directed staff to administer antidepressant medications (fluoxetine and bupropion) daily for depression. Review of the Minimum Data Set (MDS) assessment dated [DATE], revealed that the resident was administered antidepressant medications on five occasions during the review period. Review of the Care Area Assessment (CAA) summary identified the use of antidepressant medications as a problem to be care planned. Review of the care plan revealed there were no interventions included to address the use of antidepressant medication. In an interview on June 1, 2023, at 10:51 a.m., the Director of Nursing (DON) confirmed there had been no care plan developed for the use of antidepressant medications for Resident 58. Clinical record review revealed that Resident 68 was admitted to the facility on [DATE], with diagnoses that included fatigue fracture of vertebra, sacral and sacrococcygeal region (broken pelvis), dorsalgia (back pain), and legal blindness. Review of the MDS assessment dated [DATE], revealed that the resident had urinary incontinence and decreased mobility. The CAA identified urinary incontinence and pressure ulcer as problem areas to be care planned. Review of Resident 68's current care plan did not include interventions to address urinary incontinence or the pressure ulcer. In an interview on June 1, 2023, at 10:56 a.m., the DON confirmed that there had been no care plan developed to address these CAA areas for Resident 68. 28 Pa. Code 211.11(d) Resident care plan. 28 Pa. Code 211.12(d)(5) Nursing services. 395507 Page 3 of 5 395507 06/01/2023 Elm Terrace Gardens 660 North Broad Street Lansdale, PA 19446

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 Based on clinical record review and staff interview, it was determined that the facility failed to ensure physician's orders were implemented for two of 19 sampled residents. (Residents 58, 62) Residents Affected - Few Findings include: Clinical record review revealed that Resident 58 had diagnoses that included hypertension and dementia. A physician's order dated May 18, 2023, directed staff to administer a medication for high blood pressure (diltiazem) once daily unless the heart rate was less than 65 beats per minute (bpm). A review of the May 2023, medication administration record (MAR) revealed that staff administered the medication when the heart rate was less than 65 bpm on two occasions. In an interview on June 1, 2023, at 10:51 a.m., the Director of Nursing (DON) confirmed that the medication was administered outside of the established parameters for Resident 58. Clinical record review revealed that Resident 62 had diagnoses that included hypotension. A physician's order dated April 25, 2023, directed staff to administer a medication (fludrocortisone acetate) once daily unless the systolic blood pressure (SBP) was greater than 140 millimeters of mercury (mmHg). On May 17, 2023, the physician ordered to withhold the medication if the SBP was greater than 110 mmHg. Review of the May 2023 MAR revealed staff administered the medication 14 times outside of the established parameters. A physician's order dated April 5, 2023, directed staff to administer a medication (midodrine) once daily unless the SBP was greater than 140 mmHg. On May 16, 2023, the physician ordered to withhold the medication if the SBP was greater than 110 mmHg. Review of the May 2023 MAR revealed staff administered the medication six times outside of the established parameters In an interview on June 1, 2023, at 11:33 a.m., the DON confirmed that the medications were administered outside of established parameters for Resident 62. 28 Pa. Code 211.12(d)(1)(5) Nursing services. 395507 Page 4 of 5 395507 06/01/2023 Elm Terrace Gardens 660 North Broad Street Lansdale, PA 19446

F 0810 Provide special eating equipment and utensils for residents who need them and appropriate assistance. 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 observation, it was determined that the facility failed to ensure that adaptive equipment was provided to two of 19 sampled residents. (Residents 21, 44) Residents Affected - Few Findings include: Clinical record review revealed that Resident 21 had diagnoses that included Parkinson's disease, hemiplegia and hemiparesis following a cerebral infarction affecting the right dominant side (weakness or the inability to move on one side of the body after a stroke), and anxiety. Review of the Minimum Data Set (MDS) assessment dated [DATE], revealed that Resident 21 required limited assistance with eating and had a functional limitation in range of motion on one side of his upper extremities. A physician's order dated March 30, 2023, directed staff to serve the resident a puree diet on a sectioned plate with a left curved spoon with built up handle. Observation on May 30, 2023, from 12:28 p.m., through 1:00 p.m., revealed Resident 21 was served lunch on a regular plate. Resident 21 was observed on May 31, 2023, from 10:18 a.m., through 10:35 a.m., in bed with breakfast and had a regular spoon and a regular plate. Resident 21 proceeded to eat breakfast with the regular spoon, spilling food onto the table and clothing protector. Resident 21 was not provided a sectioned plate and left curved spoon with built up handle as the physician had ordered. Clinical record review revealed that Resident 44 had diagnoses that included depression, anxiety, dementia, and dysphagia. Review of the MDS assessment dated [DATE], revealed that the resident required supervision for eating. Review of the care plan revealed the resident was at risk for weight loss and interventions included that staff provide a scoop dish with meals. A physician's order dated January 28, 2022, directed staff to serve the resident a puree diet on a scoop dish. Observation on May 31, 2023, at 12:07 p.m., through 12:40 p.m., revealed the resident was served a puree diet on a regular plate. The resident proceeded to eat the meal from a regular plate and food items were spilling onto the resident's clothing protector. Resident 44 was not provided with a scoop dish per the plan of care or physician's order. 28 Pa. Code 211.12(d)(1)(5) Nursing services. 395507 Page 5 of 5