Health inspection·November 30, 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 Based on clinical record and facility documentation review and resident/staff interview, it was determined that the facility failed to timely treat a burn and failed to follow a physician medication parameter for two of 33 residents reviewed (Residents 32 and 58). Residents Affected - Few Findings include: Interview with Resident 32 on November 28, 2023, at 9:10 a.m. revealed the resident had a burn on her abdomen from spilling coffee in September. Review of Resident 32's progress notes revealed a nurse's note dated September 10, 2023, at 10:31 a.m. which stated: notified by aide that resident had a skin area on upper abdomen. Upon arrival to room, this nurse noted 4x4 gauze pad on abdomen and once removed, a slightly red non-opened area noted (measured 4cm W x 4 ½ L). Resident stated 'I burnt myself with coffee on [September 8] a blister appeared and it popped [September 9, 2023.]' Nursing supervisor notified. Cleansed area with [normal saline], applied [triple antibiotic ointment], and covered with bordered gauze. Review of facility documentation revealed on September 8, 2023, at approximately 11:00 a.m., the resident spilled coffee on herself during a coffee social witnessed by Employee E3. Review of facility documentation dated September 12, 2023, revealed Employee E3 received individualized education for failing to report the burn to nursing. Review of facility witness statement from nurse aide Employee E4 revealed on September 8, 2023, the employee noticed a blister on Resident 32's abdomen while putting the resident to bed. Nurse aide Employee E4 notified licensed nurse Employee E5 about the area. Review of facility documentation dated September 12, 2023, revealed licensed nurse Employee E5 failed to assess Resident 32 after nurse aide Employee E4 notified them about the area. Review of Resident 32's September 2023 Treatment Administration Record revealed that a treatment was not started on the burn until September 10, 2023. Interview with the Director of Nursing on November 30, 2023, at approximately 11:45 a.m. confirmed that Employee E3's failure to report the burn initially and licensed nurse Employee E5's failure to assess Resident 32 resulted in a two-day delay in treating Resident 32's burn. Review of Resident 58's physician order dated October 25, 2023, revealed an order for Midodrine (medication to treat low blood pressure that causes severe dizziness and fainting) HCL Oral tablet 5mg (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 4 Event ID: 395519 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 395519 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Green Meadows Nursing & Rehabilitation Center 283 East Lancaster Avenue Malvern, PA 19355 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)