Health inspection·November 30, 2023

F 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm Based on clinical record review, observations, and staff interview, it was determined that the facility failed to provide interventions to prevent pressure ulcers for one of 29 sampled residents. (Resident 57) Residents Affected - Few Findings include: Clinical record review revealed that Resident 57 had diagnoses that included aphasia, hemiplegia, and hemiparesis affecting the right dominant side following a cerebral infarction (difficulty communicating combined with muscle weakness and paralysis on the right side of the body after a stroke), dementia, unspecified,(a mild or mixed form of cognitive impairment), and diabetes mellitus (a disease that affects how the body uses blood sugar). Review of the Minimum Data Set assessment, dated November 6, 2023, revealed that Resident 57 had cognitive impairment, required extensive assistance from staff for bed mobility and dressing, and was at risk for developing pressure ulcers/injuries. On February 9, 2023, the physician ordered that Prevalon boots (a soft boot to elevate heels and reduce pressure) were to be placed on both feet while the resident was in bed for prevention of skin breakdown. Review of the care plan revealed that the resident was at risk for alteration in skin integrity due to right-sided weakness secondary to a stroke. There was an intervention for staff to elevate his heels and provide Prevalon boots when in bed . Observation on November 28, 2023, at 9:50 a.m., November 29, 2023, at 9:45 a.m. and 10:45 a.m., November 30, 2023, at 11:45 a.m. and at 1:35 p.m, revealed Resident 57 was in bed without Prevalon boots In an interview on November 30, 2023, at 12:25 p.m., the Director of Nursing confirmed that Resident 57 should have had the Prevalon boots applied to his feet while in bed. 28 Pa Code 211.12 (d)(1)(5) Nursing services. Page 1 of 4 395521 395521 11/30/2023 Langhorne Gardens Health & Rehabilitation Center 350 Manor Avenue Langhorne, PA 19047

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review, observation, and staff interview, it was determined that the facility failed to implement safety interventions for one of five residents at risk for falls. (Resident 103) Findings include: Clinical record review revealed Resident 103 had diagnoses that included seizures, traumatic brain injury, and anxiety. The Minimum Data Set assessment dated [DATE], revealed Resident 103 required staff assistance for bed mobility and transfers. Review of the care plan identified that the resident was at risk for falls related to confusion. Review of progress notes dated September 30, 2023, revealed the resident was found on the floor after an attempt to stand and self transfer. The care plan was revised at that time and included an intervention for staff to place fall mats to both sides of the bed while the resident was in bed. Observations on November 29, 2023, at 11:16 a.m., and November 30, 2023, at 9:34 a.m. and 11:00 a.m., revealed Resident 103 was in bed and there was only one fall mat in place on one side of the bed. In an interview on November 30, 2023, at 11:52 a.m., the Director of Nursing confirmed Resident 103 should have had fall mats on both sides of the bed. 28 Pa. Code 211.12(d)(1)(5) Nursing services. 395521 Page 2 of 4 395521 11/30/2023 Langhorne Gardens Health & Rehabilitation Center 350 Manor Avenue Langhorne, PA 19047

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy, clinical record review, and observation, it was determined that the facility failed to ensure that adequate catheter care was provided for one of three sampled residents with an indwelling urinary catheter. (Resident 78) Findings included: Review of the facility policy entitled, Indwelling Urinary Catheter Care Procedures, dated January 10, 2023, revealed that when a resident had a urinary catheter, an intervention was to prevent the urine in the tubing and drainage bag from flowing back into the bladder. Staff was to ensure that the urinary drainage bags be held or positioned lower than the bladder at all times, but not on the floor. Clinical record review revealed that Resident 78 was admitted to the facility on [DATE], with diagnoses that included stroke and urine retention. The Minimum Data Set assessment dated [DATE], indicated that the resident required extensive assistance from staff for activities of daily living and had an indwelling urinary catheter. The current care plan revealed that Resident 78 had an indwelling catheter and was at increased risk for infection. On November 28, 2023, from 1:47 p.m. to 2:10 p.m., Resident 78 was observed in bed with her catheter drainage bag hanging off the bed and directly touching the floor. 28 Pa. Code 211.12(d)(1)(5) Nursing services. 395521 Page 3 of 4 395521 11/30/2023 Langhorne Gardens Health & Rehabilitation Center 350 Manor Avenue Langhorne, PA 19047

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on facility policy review, observation, and staff interview, it was determined that the facility failed to properly store food and maintain sanitary conditions in the dietary department and on one of two unit pantries. (Green wing) Findings include: Review of the policy entitled, Storage of Dry Food, last reviewed January 10, 2023, revealed that food was to be stored in a manner to avoid contamination and protect food quality. Review of the policy entitled, Storage of Refrigerated Foods, last reviewed January 10, 2023, revealed that refrigerated items were to be labeled and dated and bulk condiments were to be dated with date opened. Observations during the kitchen tour on November 27, 2023, beginning at 9:35 a.m., revealed the following: In dry storage, there were three large bins. One bin contained several packages of pasta, loose pasta that had spilled from a package, and multiple condiment packets. The second bin contained undated pasta packages and condiment packets. The third bin contained flour and the lid did not cover the length of the bin, which exposed the flour to the air. In the walk in cooler, there was an opened container of barbecue sauce that was not dated. In the trayline cooler, there were two pitchers of cranberry and orange juice that were not dated or labeled. There were two cups of poured prune juice that were not dated or labeled. In the freezer, there were two packages of spinach removed from the original packaging and not dated. In an interview on November 27, 2023, at 10:00 a.m., the Food Service Director confirmed the items should have been labeled and dated and were not. Observation of the [NAME] wing unit pantry on November 29, 2023, at 11:10 a.m., revealed the inside of the microwave contained dried food debris and a black substance. Inside the refrigerator, there were multiple rust spots that were along the length of the back panel. The water drain line inside the refrigerator had a brown substance. In an interview on November 29, 2023, at 11:20 a.m., Licensed Practical Nurse (LPN) 1 confirmed the microwave and refrigerator were used for residents, CFR 483.60(i) Food Safety Requirement Previously cited 12/6/22 28 Pa. Code 201.14(a) Responsibility of licensee. 28 Pa. Code 201.18(e)(2.1) Management. 395521 Page 4 of 4