Health inspection·December 6, 2022

F 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review, resident interview, and staff interview, it was determined that the facility failed to provide showers as scheduled/preferred to one of 22 sampled residents. (Resident 51) Findings include: Clinical record review revealed that Resident 51 had diagnoses that included muscle weakness. Review of the Minimum Data Set assessment dated [DATE], revealed that the resident was totally dependent on staff for bathing. In an interview on December 5, 2022, at 11:55 a.m., Resident 51 stated that he preferred a shower and staff did not always offer to provide a shower per his schedule. Review of the bathing schedule revealed that Resident 51 was scheduled to receive a shower every Wednesday and Saturday during the evening shift. There was a lack of documentation to support that Resident 51 was offered a shower four of nine times in October 2022, and two of nine times in November 2022. In an interview on December 6, 2022, at 12:22 p.m., the Director of Nursing stated there was no evidence that the resident was bathed/showered in accordance with the schedule. 28 Pa. Code 201.29(j) Resident rights. 28 Pa. Code 211.12(d)(1)(5) Nursing services. Page 1 of 4 395521 395521 12/06/2022 Langhorne Gardens Health & Rehabilitation Center 350 Manor Avenue Langhorne, PA 19047

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 **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 ensure physician's orders were implemented for one of 22 sampled residents. (Resident 97) Residents Affected - Few Findings include: Clinical record review revealed that Resident 97 had diagnoses that included diabetes mellitus. Review of the Minimum Data Set assessment dated [DATE], revealed that Resident 97 required extensive assistance from staff for activities of daily living. A physician's order dated June 23, 2022, directed staff to administer insulin lispro solution three units, three times daily for diabetes. Staff were to hold the medication if the resident's blood sugar was below 150 milligrams per deciliter (mg/dl). Review of the medication administration records for October, November, and December 2022, revealed that staff administered the insulin 79 of 121 times when the resident's blood sugar was less than 150 mg/dl. In an interview on December 6, 2022, at 10:29 a.m., the Director of Nursing confirmed that staff administered the insulin outside of the established parameters. CFR 483.25 Quality of care Previously cited 9/6/22 28 Pa. Code 211.12(d)(1)(5) Nursing services. 395521 Page 2 of 4 395521 12/06/2022 Langhorne Gardens Health & Rehabilitation Center 350 Manor Avenue Langhorne, PA 19047

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review, staff interview, and resident interview, it was determined that the facility failed to ensure that a physician ordered medication was obtained from the pharmacy for one of 22 sampled residents. (Resident 31) Findings include: Clinical record review revealed that Resident 31 had diagnoses that included diabetes. Review of the Minimum Data Set assessment dated [DATE], revealed the resident had no memory impairment and received insulin injections. On November 3, 2022, the physician ordered staff to administer Lantus insulin 50 units two times a day. The ongoing care plan revealed the resident was to be administered insulin as ordered by the physician to control unstable blood sugar related to diabetes. During an interview on December 4, 2022, at 12:55 p.m., the Resident stated the morning dose of insulin was not received and that doses were missed in the past. Review of medication administration records revealed the resident did not receive the Lantus insulin on November 19, 2022, at 9:00 a.m., and 5:00 p.m., and December 4, 2022, at 9:00 a.m. During an interview on December 4, 2022, at 1:05 p.m., LPN 1 stated the insulin was ordered from the pharmacy but was not delivered in time for that morning's dose. Review of nursing documentation for the dates of the missed insulin doses revealed that the medication had not been delivered from the pharmacy. CFR 483.45 Pharmacy Services Previously cited 1/12/22 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services. 395521 Page 3 of 4 395521 12/06/2022 Langhorne Gardens Health & Rehabilitation Center 350 Manor Avenue Langhorne, PA 19047

F 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation and staff interview, it was determined that the facility failed to prepare, store, and serve food under sanitary conditions in the kitchen. Residents Affected - Many Findings include: Observations during the tour of the kitchen on December 4, 2022, at 9:44 a.m., revealed the following: an open, unsealed bag of thickener powder and a bag of granola with a use by date of August 4, 2022. The dispenser nozzle for the juice machine was directly on a box of cranberry juice and a wet substance had dripped onto three boxes of food items below the nozzle. During observation of the low temperature dish machine, a strip was utilized to test the sanitizer concentration following three dishwashing cycles. The sanitizer concentration was less than 50 parts per million (ppm) on each test. Observations during a subsequent tour of the kitchen on December 4, 2022, at 10:55 a.m., revealed the sanitizer concentration continued to be less than 50 ppm on repeat testing. There were various particles of debris and a white substance on the floor of the walk-in refrigerator. There was a frozen substance on the floor of the walk-in freezer. In an interview on December 5, 2022, at 1:01 p.m., the Director of Dietary Services confirmed that the dish machine did not dispense sanitizer or achieve the appropriate concentration of sanitizer solution during the observations on December 4, 2022. 28 Pa. Code 201.18(b)(3) Management. 395521 Page 4 of 4