Health inspection·February 8, 2024

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. Based on review of facility records and policy, review of clinical records, and the Long-Term Care Facility Resident Assessment Instrument 3.0 User's Manual 2019 (RAI-assessment guide use to plan the provision of care for residents), observations, and resident and staff interviews, it was determined that the facility failed to ensure that a resident's dignity was maintained for nine of 24 residents reviewed (Residents R1, R11, R13, R26, R36, R44, R48, R66, and R78). Findings include: Review of Resident Rights Inservice provided by the Registered Nurse (RN) Regional Director on 2/07/24, at approximately 11:00 a.m. revealed The Residents' [NAME] of Rights, The Nursing Home Reform Act established the following rights for nursing home residents: The right to be treated with dignity; The right to exercise self-determination; The right to communicate freely; Receive adequate and appropriate care; To be treated with consideration, respect, and dignity; and Participate in community activities, both inside and outside the nursing home. Review of the facility policy, Resident Communication System and Call Light Policy dated 1/17/24, revealed It is the policy of the facility to provide residents with a means of communicating with staff. A call system is installed in each resident room and toilet/bath areas. The facility responds to resident needs and requests. Procedure: 3. Staff will respond to call lights promptly. Answering Call Lights - General Guidelines: 1. Upon entering a resident room, turn off the call light. 6. Some residents may not be able to use their call light. Staff will check these residents more frequently. 8. Answer the resident's call light as soon as possible. 9. Be courteous when answering call lights. Steps in Procedure: 1. Turn off the call light. 2. Identify yourself and call the resident by his/her name (use Mr. or Mrs.) and ask 'how may I help you?' 3. Listen to the resident's request. 4. Do what the resident requests, if capable/allowed. Otherwise seek assistance of charge nurse or someone who can assist. If you have promised the resident you will return with an item or information, do so promptly. Resident R78's clinical record revealed an admission date of 9/12/22, with diagnoses that included urinary tract infection, sepsis (a life-threatening complication of an infection), diabetes mellitus (a group of diseases that result in too much sugar in the blood), and gastro-esophageal reflux disease (a digestive disease in which the stomach acid irritates the food pipe lining.) Review of the RAI manual instructions for Section C0500 Brief Interview for Mental Status (BIMS) revealed that a score of 13-15 identified a resident as cognitively intact and a score of 8-12 identified a resident as moderately impaired, and a score of 0-7 as severely impaired. Page 1 of 14 395536 395536 02/08/2024 Edison Manor Nursing & Rehabilitation Center 222 West Edison Avenue New Castle, PA 16101

F 0550 Level of Harm - Minimal harm or potential for actual harm Revies of the Minimum Data Set (MDS-a periodic assessment of resident care needs) Section C0500 dated 1/23/24, revealed Resident R78 with a BIMS score of 12. Resident R78's Section GG0170 dated 1/23/24, Functional Abilities and Goals for Mobility, indicated that Resident R78's ability to transfer to and from a bed to a chair/wheelchair is independent (resident completes the activity by themselves with no assistance from a helper). Residents Affected - Some During an interview on 2/05/24, at 11:45 a.m. Resident R78 indicated he/she is frustrated over the way staff talk to him/her. Resident R78 verbalized, When I do need help with something, the staff are very rude to me. They tell me I am selfish. During an interview on 2/05/24, at 1:30 p.m., Resident R1 revealed that when staff respond to call light activation and the resident requests assistance, the responding staff act very irritated and make the resident feel as though they are a nuisance. During an interview on 2/05/24, at 2:20 p.m., Resident R11 revealed that they don't like to use their call bell or ask for assistance because the staff talk down to them and belittle them for interrupting them. Interviews during a Resident Council meeting on 2/06/24, at 10:30 a.m. revealed four of five residents (R13, R48, R66, and R78) in attendance with concerns of when they put their call bells on, staff will come into their room, turn the call bell off and not return. The residents further indicated after they turn their call bells back on, it could take an hour for staff to respond. Resident R36's clinical record revealed an admission date of 7/12/23, with diagnoses that included diabetes mellitus, interstitial cystitis (a chronic painful bladder condition), unsteadiness on feet, and muscle weakness. The MDS Section C0500 dated 11/08/23, indicated Resident R36 is alert and oriented with a BIMS score of 15. The Point of Care ADL Category Report (MDS 3.0) dated 2/07/24, indicated that Resident R36 for Transfers and Toilet use, was identified as limited assistance (one-person physical assist) and eating as supervision (set up assistance). During an interview on 2/06/24, at 12:10 p.m. Resident R36 indicated that staff are rude and do not answer his/her call bell timely. Resident R36 further indicated his/her roommate will often have to go get staff to assist in his/her needs due to being blind. On 2/08/24, at 10:45 a.m. Resident R36 verbalized, it took an hour for someone to answer my call bell last night. Resident R26's clinical record revealed an admission date of 11/29/23, with diagnoses that included end stage renal disease (kidneys are not functioning properly), anemia (deficiency of healthy red blood cells), and muscle weakness. The MDS Section C0500 dated 1/14/24, indicated Resident R26 is alert and oriented with a BIMS score of 15. Resident R26's Section GG0130 dated 1/14/24, Functional Abilities and Goals for Self-Care indicated Resident R26's ability to shower/bathe self requires partial/moderate assistance. During a interview on 2/07/24, at approximately 12:00 p.m. Resident R26 indicated that he/she was placed in the shower room and the Nursing Assistant (NA) threw a washcloth at him/her and said, wash yourself. The NA then left him/her unassisted in the shower room for an extended period of time. 395536 Page 2 of 14 395536 02/08/2024 Edison Manor Nursing & Rehabilitation Center 222 West Edison Avenue New Castle, PA 16101

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Resident R44's clinical record revealed an admission date of 2/26/23, with diagnoses that included intestinal obstruction, anxiety, malignant neoplasm of the bronchus or lung (cancer), and hyperlipidemia (high cholesterol). The MDS Section C0500 dated 11/15/23, indicated Resident R44 is alert and oriented with a BIMS score of 15. The Point of Care ADL Category Report (MDS 3.0) dated 11/15/23, indicated that Resident R44 for Transfers and Toilet hygiene was identified as dependent (helper does all of the effort. Resident does none of the effort to complete the activity). During an interview on 2/06/24, at 9:45 a.m. Resident R44 indicated he/she placed his/her call bell on at 9:00 a.m. due to being incontinent of stool. Resident R44 verbalized, They just came in and turned my call bell off and left. They do this all the time. They call me selfish and that I think I am a princess. They told me they are going to teach me to be patient. Resident R44 turned his/her call bell back on at 9:50 a.m. awaiting staff to return to his/her room. A further interview and observation at 10:10 a.m. revealed Resident R44 resting in bed still incontinent of stool. Resident R44 indicated staff came back into his/her room and turned the call bell off and left. During an interview with RN Supervisor Employee E7 on 2/06/24, at 10:15 a.m. Resident R44 revealed to the RN Supervisor that staff were turning his/her call bell off for the past hour and he/she needed incontinence care. RN Supervisor Employee E7 further confirmed that Resident R44's call bell was not on and Resident 44's needs were not addressed in a dignified timely manner. Observations on 2/07/24, at approximately 10:45 a.m. revealed Licensed Practical Nurse (LPN) Employee E8 speaking loudly with a harsh tone to Resident R44 regarding care being provided during a meal. LPN Employee E8 was overheard speaking loudly to Resident R44 stating, It is a state regulation that care cannot be provided during a meal. The Infection Control RN interrupted LPN Employee E8 and requested him/her to step out of Resident R44's room and stop talking. The Infection Control RN further confirmed that LPN Employee E8 was not speaking to Resident R44 in a dignified manner. An interview with the RN Regional Director on 12/07/24, at 12:20 p.m. confirmed that staff should always respond to resident call bells and needs in a dignified and timely manner. 28 Pa. Code 201.29(a) Resident Rights 395536 Page 3 of 14 395536 02/08/2024 Edison Manor Nursing & Rehabilitation Center 222 West Edison Avenue New Castle, PA 16101

F 0661 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge. Based on review of facility policy, clinical record review and staff interview, it was determined that the facility failed to complete a discharge summary, which includes a recapitulation of the resident's stay, the resident's discharge status, reconciliation of all medications, and post-discharge plan for two of three closed records reviewed (Resident CR108 and Resident CR159). Findings include: Review of a facility policy dated 1/17/24, entitled Discharge Planning Policy indicated that when a discharge is anticipated, the facility will develop a Discharge Summary that includes summaries of the resident's stay, the resident's status at discharge, medication reconciliation, and summary of the resident's post-discharge plan of care. Resident CR108's closed clinical record revealed an admission date of 11/17/23, with diagnoses that included diabetes (condition related to inadequate insulin and high blood sugars), Chronic Obstructive Pulmonary Disease (COPD - a condition that obstructs air flow in the lungs with symptoms of difficulty breathing, coughing and shortness of breath), and muscle weakness. Resident CR108's clinical record revealed the resident was discharged from the facility against medical advice on 12/3/23. Further review of Resident CR108's clinical record lacked evidence of a discharge summary being completed. Resident CR159's closed clinical record revealed an admission date of 6/30/23, with diagnoses that included repeated falls, anxiety, and muscle weakness. Resident CR159's clinical record revealed the resident was discharged from the facility against medical advice on 10/31/23. Further review of Resident CR159's clinical record lacked evidence of a discharge summary being completed. An interview on 2/8/24, at 12:37 p.m. with the Regional Director of Clinical Services, confirmed that Resident CR108 and CR159's closed clinical records lacked evidence of a discharge summary being completed. 28 Pa. Code 211.5(d)(f)(xi) Medical records 395536 Page 4 of 14 395536 02/08/2024 Edison Manor Nursing & Rehabilitation Center 222 West Edison Avenue New Castle, PA 16101

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm Based on a review of facility documents and clinical records, and the Long-Term Care Facility Resident Assessment Instrument 3.0 User's Manual 2019 (RAI-assessment guide use to plan the provision of care for residents), observations, and staff interviews, it was determined the facility failed to ensure dependent residents are assisted with meals for two of 24 residents reviewed (Residents R40 and R105). Residents Affected - Few Findings include: No policy was provided regarding the facility's responsibility to ensure a dependent resident receives care/treatment. Review of the Resident Rights Inservice, provided by the Regional Director on 2/07/24, approximately 11:00 a.m. revealed The Residents' [NAME] of Rights, The Nursing Home Reform Act established the following rights for nursing home residents: Receive adequate and appropriate care, Right to Dignity, Respect, and Freedom; and to be treated with consideration, respect, and dignity. Resident R40's clinical record revealed an admission date of 5/02/22, with diagnoses that included acute respiratory failure with hypoxia (caused by a disease or injury that affects your breathing), metabolic encephalopathy (a problem in the brain caused by a chemical imbalance in the blood), severe protein-calorie malnutrition (a condition that happens when the nutrients the body receives don't meet its needs, tissues are broken down and functions are shut down), and down syndrome (a genetic chromosome disorder causing developmental and intellectual delays). Review of the RAI manual instructions for Section C0500 Brief Interview for Mental Status (BIMS) revealed that a score of 13-15 identified a resident as cognitively intact and a score of 8-12 identified a resident as moderately impaired, and a score of 0-7 as severely impaired. Review of the Minimum Data Set (MDS-a periodic assessment of resident care needs) Section C0500 dated 1/23/24, revealed that Resident R40 was severely impaired with a BIMS score of 0/15. Resident R40's Section GG0130 dated 1/23/24, Self-Care: indicated Resident R40 was dependent on staff for eating (helper does all the effort and resident does none). During an observation on 2/05/24, at 12:15 p.m. Resident R40's lunch tray was observed sitting on his/her bedside tray with him/her resting in bed. Further observations on 2/05/24, at 12: 55 p.m. revealed staff picking of second-floor resident lunch trays and Resident R40's lunch tray still sitting on his/her bedside table untouched with him/her resting in bed. During an interview at 2/05/24, at 12:55 p.m. with Registered Nurse (RN) Supervisor Employee E9 revealed that staff did not assist Resident R40 with his/her lunch and that Resident R40 was dependent on staff for assistance with meals. During an interview on 2/07/24, at 12:20 p.m. the RN Regional Director confirmed that Resident R40 should have been assisted with his/her lunch meal immediately when it was brought to his/her room, and it was too long of a wait to consume the meal. Resident R105's clinical record revealed an admission date of 1/23/24, with diagnoses that included acute kidney failure (a condition when the kidneys cannot suddenly filter waste from the blood), 395536 Page 5 of 14 395536 02/08/2024 Edison Manor Nursing & Rehabilitation Center 222 West Edison Avenue New Castle, PA 16101

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few history of falling, anemia (a condition when the blood does not have enough healthy red blood cells and hemoglobin (a protein) to carry oxygen though the blood), and muscle weakness. Review of the MDS Section C0500 dated 1/26/24, revealed that Resident R105 is severely impaired with a BIMS score of 5/15. Resident R105's Section GG0130 dated 1/26/24, Self-Care: indicated Resident R105 is setup or clean-up assistance by staff for eating (helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity). During an observation with the Director of Nursing (DON) on 2/08/24, at 12:45 p.m. the DON confirmed that Resident R105 could not open his/her milk carton on the lunch tray sitting at Resident 105's bedside. Resident R105 was observed reaching for an old milk carton full of milk and a glass half full of a liquid that appeared to be a juice or tea. The older beverage containers were observed to have fruit flies on them. The DON confirmed Resident R105's lunch tray was left at his/her bedside and that Resident R105 did need staff assistance to consume his/her meal, but it was not provided. The DON further confirmed that Resident R105 was attempting to drink from old beverages left from an earlier time in the morning with fruit flies surrounding them and staff did not discard when delivering the new lunch tray. 28 Pa. Code 211.12(d)(1)(2)(5) Nursing Services 395536 Page 6 of 14 395536 02/08/2024 Edison Manor Nursing & Rehabilitation Center 222 West Edison Avenue New Castle, PA 16101

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. Based on review of facility policy, clinical records, and the Long-Term Care Facility Resident Assessment Instrument 3.0 User's Manual 2019 (RAI-assessment guide used to plan the provision of care for residents), observations, and resident and staff interviews, it was determined that the facility failed to ensure medications were administered in accordance with professional standards for one of 24 residents reviewed (Resident R78). Findings include: Review of facility policy, General Dose Preparation and Medication Administration, dated 1/17/24, revealed 1. Facility staff should comply with Facility policy, Applicable Law and the State Operations Manual when administering medications. 3. Dose Preparation: Facility should take all measures required by Facility policy and Applicable Law, including but not limited to the following: 3.10 Facility staff should not leave medications or chemicals unattended. 5. During medication administration, Facility staff should take all measures required by Facility policy and Applicable Law, including, but not limited to the following: 5.10 Observe the resident's consumption of the medications (s). Review of Resident R78's clinical record revealed an admission date of 9/12/22, with diagnoses that included urinary tract infection, sepsis (a life-threatening complication of an infection), diabetes mellitus (a group of diseases that result in too much sugar in the blood), and gastro-esophageal reflux disease (a digestive disease in which the stomach acid irritates the food pipe lining.) Review of the RAI manual instructions for Section C0500 Brief Interview for Mental Status (BIMS) revealed that a score of 13-15 identified a resident as cognitively intact and a score of 8-12 identified a resident as moderately impaired, and a score of 0-7 as severely impaired. The Minimum Data Set (MDS-a periodic assessment of resident care needs) Section C0500 dated 1/23/24, indicated Resident R78 with a BIMS score of 12. Review of Resident R78's MAR (Medication Administration Record) for February 2024 revealed that on February 5, 2024, 07:00 - 11:45 the following medications were documented as given: Ascorbic acid 1000 milligrams (mg) tablet oral, Cholecalciferol (Vitamin D3) 50 micrograms (mcg) (2,000 unit) tablet oral, Effexor XR (venlafaxine-medication to treat depression) capsule extended release 24 hr 75 mg oral, Metformin (medication to treat diabetes) tablet extended release 24 hr 500 mg oral. Observation of the second-floor unit on 2/05/24, at 11:35 a.m. revealed Resident R78 asleep in bed with medications in a cup on his/her bedside table. Further observations revealed Resident R78 waking up to view the medications in the cup in front of him/her and stating, Oh I guess these are my medications. An interview on 2/05/24, at 11:40 a.m. with the second-floor nurse, Registered Nurse (RN) Employee E7 confirmed the medications, as noted above, were delivered to Resident R78 earlier in the morning. RN Employee E7 confirmed the medications were left unattended and not consumed by Resident R78. RN Employee E7 confirmed the medications should not be left unattended by the nurse responsible for the medication administration. An interview with the Nursing Home Administrator on 2/06/24, at 12:50 p.m. confirmed medications should be observed consumed by a resident when administered and not left unattended by nursing staff. 395536 Page 7 of 14 395536 02/08/2024 Edison Manor Nursing & Rehabilitation Center 222 West Edison Avenue New Castle, PA 16101

F 0755 28 Pa. Code 211.9(a)(1) Pharmacy services Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code 211.10(c) Resident care policies 28 Pa. Code 211.12 (d)(1) Nursing services Residents Affected - Few 395536 Page 8 of 14 395536 02/08/2024 Edison Manor Nursing & Rehabilitation Center 222 West Edison Avenue New Castle, PA 16101

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on review of facility policy, observations and staff interview, it was determined that the facility failed to label multi-dose containers of tuberculin solution (used to test for the disease tuberculosis) with the date they were opened in one of two medication storage rooms (Third Floor medication room). Findings include: Review of a facility policy entitled, Storage and Expiration dating of Medication, Biologicals dated January 2022, indicated that staff should record the date opened on the primary medication container when the medication has a shortened expiration date once opened. The packaging for the tuberculin solution indicated that any unused solution was to be discarded after 28 days once opened. Observation on 2/05/24, at 12:32 p.m. of the Third Floor medication room refrigerator revealed an opened multi-dose vial of tuberculin solution without a date when it was opened. At that time, Licensed Practical Nurse (LPN) Employee E6 confirmed that the multi-dose vial of tuberculin solution did not identify an open date. The LPN was able to confirm at that time that the date was not on the open multi dose vial of tuberculin solution. 28 Pa. Code 211.9(a)(1) Pharmacy services 395536 Page 9 of 14 395536 02/08/2024 Edison Manor Nursing & Rehabilitation Center 222 West Edison Avenue New Castle, PA 16101

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 review of facility policies, observations, and staff interviews, it was determined that the facility failed to maintain sanitary food service operations for one of one kitchens. Residents Affected - Many Findings include: Review of facility policy entitled, Dish Machine Use, last reviewed 1/17/2024, revealed Prior to use, verify temperature and/or chemical sanitizer concentration are within specifications provided by the dish machine manufacturer (see note). If requirements are not met, immediately discontinue use of the dish machine and notify the person in charge. Review of facility policy entitled, Storage of refrigerated foods, last reviewed 1/17/2024, revealed All refrigerated items must be stored at least six inches above the floor and eighteen inches from the refrigerator ceiling and sprinkler heads. Store all food/leftovers in covered, approved, food grade containers. Refrigerated, TCS foods, prepared and held for more than 24 hours will be marked to indicate the date the food will be consumed or discarded. Prepared TCS foods will be held a maximum of seven days with the day of preparation counted as day one. Review of facility policy entitled, Storage of dry food, last reviewed 1/17/2024, revealed Dry storage rooms will be neat and orderly. when original packaging is opened, food must be stored in containers intended for food that are durable, leak proof, that can be sealed or covered. Except when holding food that can be unmistakably recognized such as dry pasta, these containers will be identified with the common name of the food item and date opened. During an initial tour of the facility's kitchen on 2/5/2024, at 11:30 a.m., with the facility's Registered Dietitian (RD), the following was identified: While checking the walk-in refrigerator, there was a bag of cooked beef on the second shelf with a date of 1/22/2024; a pan of cooked vegetables covered with a date of 1/28/2024; and a bag of pureed food stored in a bag with a date of 1/31/2024; a full crate of chocolate milk for use with an expiration date of 2/3/2024. Upon observation of the walk-in freezer it was revealed that there were food items stored in boxes sitting on the floor of the freezer. It was also observed that there were food items and debris on the floor of the freezer. Upon observation of the dry food storage area, it was revealed that there were food wrappers, containers of juice, crumbs of food, saltine crackers, and graham crackers on the floor. Upon checking the food items on the shelves, it was observed that a box of taco shells were sitting on the top shelf unsealed and open to air with no opened or use by date. During an interview with the RD on 2/5/2024 at the time of the observations, it was confirmed that the food items were stored past the use-by date or expiration date and should have been thrown away, the food items needed to be stored off of the floors, and the floors of food storage areas need to be swept and cleaned of food crumbs and debris to create a sanitary environment. Upon observation of the dish machine on 2/7/2024, at 12:45 p.m., it was confirmed that the dish machine was a low temp machine requiring sanitizer. Upon checking the temperature, while staff members were washing dishes, it was confirmed that the wash temperature was 124 degrees Farenheit (F), and 395536 Page 10 of 14 395536 02/08/2024 Edison Manor Nursing & Rehabilitation Center 222 West Edison Avenue New Castle, PA 16101

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many the rinse temperature was 136 degrees F. Upon checking the sanitizer with chlorine strips, it was confirmed that there was no reading on the strips after multiple checks, and the sanitizer pump was not pumping sanitizer. Upon checking the verification sheet which staff documents prior to use, it was confirmed it was not filled out and not checked by the staff. Upon interview, on 2/7/2024, at 12:55 p.m. it was confirmed by the Regional RD and the Interim Dietary Manager, that the sanitizer to the low temp washing machine was not working properly, and the staff did not check the machine prior to washing dishes. 28 Pa. Code 211.6(f) Dietary services 395536 Page 11 of 14 395536 02/08/2024 Edison Manor Nursing & Rehabilitation Center 222 West Edison Avenue New Castle, PA 16101

F 0814 Dispose of garbage and refuse properly. Level of Harm - Potential for minimal harm Based on observations and staff interview, it was determined that the facility failed to properly store and contain refuse. Residents Affected - Many Findings include: Initial observation of the dumpster located at the side of the facility by the parking lot on February 5, 2024, at 11:45 a.m., revealed that the dumpster was full of garbage bags with flies flying around the dumpster bags. The dumpsters do not have a privacy fence around the dumpsters exposing them to the parking lot. The sliding doors on both sides of the dumpster were observed to be open exposing the waste to visitors or employee parking. Open waste bins also expose the facility to possible pest and rodent issues. During an interview with the Registered Dietitian on February 5, 2024, at 11:50 a.m., it was confirmed that the dumpster doors were open exposing the garbage to the facility parking lot, and possible pest infestation. During an observation of the dumpster on February 6, 2024, at 8:45 a.m., it was observed that the dumpster doors were again left open exposing garbage to the parking lot area and potential pests. 28 Pa. Code 201.14(a) Responsibility of licensee 395536 Page 12 of 14 395536 02/08/2024 Edison Manor Nursing & Rehabilitation Center 222 West Edison Avenue New Castle, PA 16101

F 0840 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Employ or obtain outside professional resources to provide services in the nursing home when the facility does not employ a qualified professional to furnish a required service. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review and resident and staff interview, it was determined that the facility failed to schedule an appointment for outside services for one of 24 residents reviewed in a timely manner (Resident R99). Findings include: Resident R99's clinical record revealed an admission date of 10/27/2023, with diagnoses that inlcuded cervical (neck) spinal problems, difficulty walking, muscle weakness, cervical spinal fusion and pain disorder. During an interview on 2/6/2024, at 1:55 p.m. Resident R99 revealed that facility staff were to schedule an appointment within one week of admission with an orthopedic surgeon (medical doctor that focuses on bones, muscles, joints, and nerves) specializing in spinal care, but that they failed to make the appointment until nearly a month after admission, prolonging their stay at the facility. Resident R99's clinical record also contained hospital discharge/admission orders which directed the facility to make an appointment with an orthopedic surgeon specializing in spinal care within one week of admission [DATE]). A nursing progress note dated 11/22/23, documented that an appointment for Resident R99 with the orthopedic surgeon specializing in spinal care was not made until 11/22/23, a period of 26 days after admission. During interview on 2/7/24, at 2:48 p.m., Registered Nurse Supervisor Employee R10 confirmed that the appointment for Resident R99 with the orthopedic surgeon was not made until 11/22/23, more than three weeks after admission to the facility. 28 Pa. Code 211.12(d)(3) Nursing services 395536 Page 13 of 14 395536 02/08/2024 Edison Manor Nursing & Rehabilitation Center 222 West Edison Avenue New Castle, PA 16101

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on review of facility policy, observations, and staff interviews, it was determined the facility failed to maintain infection control and prevention measures related to laundry services. Residents Affected - Many Findings include: Review of facility policy entitled, General Linen Handling Policy, dated 1/17/24, revealed The facility will handle all used linen as potentially contaminated and will employ standard precautions in handling such linen. Linen will be handled in a manner which reduces the likelihood of contamination. Contaminated laundry/linens will be bagged or contained at the point of use or collection. Leak resistant bags or containers will be used for any linens contaminated with blood or body substances. Observations in the laundry area on 2/07/24, at 10:20 a.m. revealed dirty linen and clothing covered with feces in a large laundry cart that was utilized for a collection device from bags delivered via the laundry chute. Soiled wash cloths and towels with large amounts of feces were observed in a garbage bag to be discarded related to the large amount of feces on them. An interview with the Laundry Manager on 2/07/24, at 10:20 a.m. revealed that staff send down soiled clothing, linen and even depends (incontinence products) that are covered with large amounts of feces and mixed in with all resident clothing and linen; clothing and linen are also delivered blood covered. The Laundry Manager indicated that when the laundry is observed with large of amounts of feces, the items are discarded due to it cannot be placed in a washer safely. The Laundry Manager further indicated the laundry at times is delivered in open bags allowing the soiled laundry to scatter easily at the bottom of the laundry chute, and that no resident clothing or linen is delivered in red bags to signify special precautions for infection control and prevention measures. The Laundry Manager indicated that numerous staff educations have been provided regarding the safe and proper way to deliver linen and resident clothing via the laundry chute to laundry services, however, no positive resolution has occurred. An interview with the Infection Control Registered Nurse on 2/07/24, at 10:30 a.m. revealed transmission-based precautions are maintained for five residents and that red bags should be utilized for their linen and clothing. He/She further indicated that the linen/clothing should be delivered to laundry services in closed bags without concern of large amount of feces and/or blood for proper infection control and prevention measures. An interview with the Director of Nursing on 2/07/24, at approximately 11:00 a.m. confirmed that resident linen/clothing should not be delivered to laundry services with large amounts of feces and/or blood. 28 Pa. Code 201.14(a) Responsibility of Licensee 28 Pa. Code 211.10(d) Resident care policies 28 Pa. Code 211.12(d)(5) Nursing Services 28 Pa. Code 205.26(c) Laundry 395536 Page 14 of 14