Health inspection·September 10, 2024

F 0791 Provide or obtain dental services for each resident. Level of Harm - Minimal harm or potential for actual harm Based on clinical record review, observation, and staff and resident interview, it was determined that the facility failed to assist residents to obtain routine dental care for four of eight residents reviewed (Residents 1, 2, 6, and 7). Residents Affected - Some Findings include: Clinical record review for Resident 1 revealed documentation by the facility's consultant dental hygienist provider dated September 8, 2023, that recommended prophylactic adult dental cleaning every six months; and that the next scheduled visit would be March 8, 2024. Documentation by the facility's consultant dentist provider dated October 10, 2023, November 9, 2023, February 27, 2024, and March 21, 2024, continued to indicate that the treatment plan for Resident 1 was adult prophylactic cleaning every six months and that the next scheduled visit would be March 8, 2024. Resident 1's medical record contained no evidence that she received a dental cleaning on March 8, 2024. Interview with the Nursing Home Administrator, the Director of Nursing, Employee 1 (medical records), and Employee 2 (social worker), on September 10, 2024, at 3:04 PM confirmed that Resident 1's medical record contained no evidence of dental prophylactic cleaning for 12 months. The interview confirmed that Resident 1's responsible party notified Employee 2 that an appointment for a dental prophylactic cleaning was missed on July 21, 2024. The facility had no evidence that staff acted upon the notification of the missed appointment. Employee 2 confirmed that Resident 1's responsible party notified her of a second missed appointment on August 22, 2024. Documentation by Employee 1 dated August 22, 2024, at 2:06 PM indicated that Resident 1's responsible party expressed frustration regarding Resident 1's oral health. The documentation indicated that the next available appointment with the dental hygienist would be December 17, 2024 (more than 15 months since her last cleaning). The facility failed to obtain routine dental services covered under the State plan for Resident 1. Interview with, and observation of, Resident 2 on September 10, 2024, at 10:20 AM indicated that she had a denture on her top jaw and natural teeth on the bottom jaw. Resident 2 stated that, .one time, long ago, last year, someone looked in (her) mouth, said she needed a new plate, and never came back. Resident 2 stated that she knew that she needed a new denture because she has had to use, glue (denture paste), to keep them secured in her mouth. Resident 2 denied that anyone has ever Page 1 of 3 395512 395512 09/10/2024 Sunbury Skilled Nursing and Rehabilitation Center 901 Court Street Sunbury, PA 17801

F 0791 professionally cleaned her natural teeth. Level of Harm - Minimal harm or potential for actual harm Clinical record review for Resident 2 revealed documentation by the facility's consulting dentist dated October 10, 2023, that Resident 2, .has an old extremely worn F/ (facility unable to define F/). She says she has a /P (partial denture) did not bring today that does not seat. PA filed for new F/P. Will make /P over broken number 27 in absence of symptoms . The recommended treatment was for prophylactic cleaning every six months and fabrication of full upper denture (DFU); fabrication of partial lower denture (DPL). Residents Affected - Some Resident 2's clinical record contained no evidence that Resident 2 received the recommended dental treatments since the October 10, 2023, assessment. Care plan meeting documentation dated August 30, 2024, at 2:52 PM indicated that neither Resident 2 nor Resident 2's representative attended the meeting. The documentation recorded by Employee 2 indicated that Resident 2 declined dental services. Interview with the Nursing Home Administrator, the Director of Nursing, Employee 1, and Employee 2, on September 10, 2024, at 3:04 PM confirmed that the facility had no consent form documentation (Request for Service form by the facility's contracted dental provider) that indicated Resident 2 declined dental services or any progress note documentation that Resident 2 was offered, but declined, services by the dentist after October 10, 2023. Interview with and observation of Resident 6 on September 10, 2024, at 10:55 AM revealed that she had natural teeth and it had, been a while, since she had her teeth professionally cleaned. Clinical record review for Resident 6 revealed documentation by Employee 1 on October 10, 2023, at 1:07 PM and November 13, 2023, at 9:26 AM that Resident 6 declined services by the consulting dental provider. A Request for Service form by the facility's contracted dental provider dated April 9, 2024, indicated that Resident 6 requested dental services. There was no further documentation in Resident 6's medical record that she was offered, but declined, dental services after November 13, 2023. Interview with the Nursing Home Administrator, the Director of Nursing, Employee 1, and Employee 2, on September 10, 2024, at 3:04 PM indicated that Resident 6 was, on the schedule for September, but had no evidence of any dental services offered in the 10 months since November 13, 2023. Interview with and observation of Resident 7 on September 10, 2024, at 11:03 AM revealed that she has upper and lower natural teeth, she feels that she has some loose teeth on the bottom jaw, and she stated that she has not had routine dental care. Documentation by the facility's contracted dentist dated December 19, 2023, indicated Resident 7 had 15 missing teeth, and that the mobility of her remaining teeth was within normal limits. The recommended treatment plan was for an annual exam (due December 19, 2024) and a periodic oral exam (due June 19, 2024). There was no evidence in Resident 7's clinical record that she received an oral exam by the dentist 395512 Page 2 of 3 395512 09/10/2024 Sunbury Skilled Nursing and Rehabilitation Center 901 Court Street Sunbury, PA 17801

F 0791 in the nine months after December 19, 2023. Level of Harm - Minimal harm or potential for actual harm Interview with the Nursing Home Administrator, the Director of Nursing, Employee 1, and Employee 2, on September 10, 2024, at 3:04 PM indicated Resident 7 was on the dental schedule for September. The interview confirmed that the last assessment by the dentist was December 19, 2023. Residents Affected - Some 483.55(b)(1)-(5) Routine/emergency Dental Srvcs in Nfs Previously cited deficiency 7/10/24 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services 395512 Page 3 of 3