Health inspection·June 14, 2023

F 0558 Reasonably accommodate the needs and preferences of each resident. Level of Harm - Minimal harm or potential for actual harm Based on observations, review of clinical records and facility policies and staff and resident interviews, it was determined that the facility failed to ensure water was accessible to one of 54 residents (Resident R1), and failed to ensure the call bell was accessible for resident use for four of 54 residents (Residents R1, R2, R3 and R4). Residents Affected - Some Findings include: Review of the Serving Drinking Water policy, dated 1/04/22 revealed .(11). place the water pitcher and cup within easy reach of the resident . Review of the Call System, Resident policy, dated 1/04/22, stated each resident is provided with a means to call staff directly for assistance from his/her bed, from toileting/bathing facilities and from the floor. Review of Resident R1's clinical record revealed an admission date of 2/14/22, with diagnoses that included Alzheimer's disease, high blood pressure, anxiety, and stomach and kidney problems. During observations on 6/13/23 at 9:48 a.m., at 11:07 a.m., and at 11:55 a.m. Resident R1's water cup was sitting on the night stand behind Resident R1. The cup of water was not located in an area that the Resident could reach the water. During an interview at 11:55 with Resident R1 at 11:55 a.m., Resident R1 confirmed that they did not have any water available. When asked if he/she was thirsty, Resident R1 replied yes. During an interview at 11:58 a.m., the Director of Nursing (DON) confirmed that Resident R1's water was not within reach of the resident and the DON provided the resident with the water. Resident R1 took the water provided and began to drink it. During observations on 6/13/23, at 1:22 p.m., Resident R3's call bell was located behind their back while sitting in a chair. At the time of the observation, Resident R3 confirmed they could not reach the call bell. Observation on 6/13/23, at 1:25 p.m. revealed that Resident R1's call bell was on the floor under the wheelchair. At the time of the observation, Resident R1 confirmed they could not reach the call bell. Observation on 6/13/23, at 1: 33 p.m. revealed that Resident R2's call bell was rolled up and placed behind the resident on the bedside table. Resident R2 confirmed they could not reach the call bell. Page 1 of 4 395510 395510 06/14/2023 Grove Manor 435 North Broad Street Grove City, PA 16127

F 0558 Level of Harm - Minimal harm or potential for actual harm Observation on 6/13/23, at 1:40 p.m. revealed that Resident R4's call bell was not within reach of the resident. During an interview on 6/13/23, at 1:45 p.m., Licensed Practical Nurse Employee E1 confirmed that Residents R1, R2, R3, and R4's call bells were not within reach of the residents. Residents Affected - Some 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 201.18(b)(1) Management 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services 395510 Page 2 of 4 395510 06/14/2023 Grove Manor 435 North Broad Street Grove City, PA 16127

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm Based on observations, review of clinical records and staff interviews, it was determined that the facility failed to ensure that bedside oxygen concentrators were maintained in a clean and sanitary manner for nine of 15 residents (Residents R4, R5, R6, R7, R9, R10, R12, R13, and R14). Residents Affected - Some Findings include: Review of the Departmental (Respiratory Therapy)- Prevention of Infection policy dated 1/04/22, revealed (7) change the oxygen cannula and tubing every seven days, or as needed .(9) wash filters from oxygen concentrators every seven days with soap and water. Rinse and squeeze dry. Review of Resident R4's clinical record revealed an admission date of 1/30/23, with diagnoses that included respiratory issues. A physician's order dated 2/03/23, revealed change and label tubing weekly every day shift every Friday. Review of Resident R5's clinical record revealed an admission date of 9/13/21, with diagnoses that included heart and breathing problems. A physician's order dated 9/09/22, revealed change and label tubing weekly every day shift every Friday. Review of Resident R6's clinical record revealed an admission date of 7/24/22, with diagnoses that included heart failure and shortness of breath. A physician's order dated 7/29/22, revealed change oxygen tubing weekly on Friday. Review of Resident R7's clinical record revealed an admission date of 5/04/21, with diagnoses that included lung problems and nodule in lung. A physician's order dated 12/10/21, revealed change and label tubing weekly every day shift every Friday. Review of Resident R9's clinical record revealed an admission date of 5/31/23, with diagnoses that included heart failure and high blood pressure. A physician's order dated 6/02/23, revealed change and label tubing weekly every day shift every Friday. Review of Resident R10's clinical record revealed an admission date of 3/25/23, with diagnoses that included lung and circulation problems, seizures, diabetes. A physician's order dated 6/09/23, revealed change and label tubing weekly every day shift every Friday. Review of Resident R12's clinical record revealed an admission date of 1/03/22, with diagnoses that included lung problems and high blood pressure. A physician's order dated 6/03/23, revealed change and label tubing weekly every day shift every Friday. Review of Resident R13's clinical record revealed an admission date of 12/2/22, with diagnoses that included heart problems and infection in the lung. A physician's order dated 4/07/23, revealed change and label tubing weekly every day shift every Friday. Review of Resident R14's clinical record revealed an admission date of 3/10/23, with diagnoses that included heart problems and lung infection. A physician's order dated 4/14/23, revealed change and label tubing weekly every day shift every Friday. During an interview on 6/13/23, at 11:07 a.m. Licensed Practical Nurse (LPN) Employee E1 confirmed 395510 Page 3 of 4 395510 06/14/2023 Grove Manor 435 North Broad Street Grove City, PA 16127

F 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some that the oxygen tubing was not labeled with the change date and the filters had accumulation of dust and debris on the oxygen concentrators for Residents R4, R5, R6, R7, R9, R12 and R13. During an inteview on 6/13/23, at 11:38 a.m. LPN Employee E2 confirmed that the oxygen tubing was not labeled with the change date and the filters had accumulation of dust and debris on the oxygen concentrators for Residents R10 and R14. 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 201.18(b)(1) Management 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services 395510 Page 4 of 4