Health inspection·November 20, 2023

F 0577 Allow residents to easily view the nursing home's survey results and communicate with advocate agencies. Level of Harm - Potential for minimal harm Based on observation and interview, it was determined that the facility failed to ensure that the most recent Department of Health survey results were readily accessible to residents and visitors. Residents Affected - Many Findings include: Observation on November 20, 2023, at 12:05 p.m., revealed a sign that indicated that facility reports of past surveysn were available to review upon request and instructed readers to inquire with the center Administrator. In an interview at 12:27 p.m. on November 20, 2023, the Administrator confirmed that survey results were not kept in a readily accessible location; they were only available upon request and maintained in the Administrator's office. 28 Pa. Code 201.14(a) Responsibility of licensee. Page 1 of 5 395540 395540 11/20/2023 Easton Skilled Nursing and Rehabilitation Center 2600 Northampton Street Easton, PA 18045

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 review and staff interview, it was determined that the facility failed to ensure that physicians' orders were implemented for two of 35 sampled residents. (Residents 54, 394) Residents Affected - Few Findings include: Clinical record review revelaed that Resident 54 had diagnoses that included adult failure to thrive, protein-calorie malnutrition, and dementia. A physician's order dated October 24, 2023, directed staff to administer a medication (midodrine hydrochloride) three times a day for orthostatic hypotension (low blood pressure when standing, sitting, or lying down). Staff was not to administer the medication if the resident's systolic blood pressure (SBP) was 140 millimeters mercury (mm/Hg) or higher. Review of Resident 54's Medication Administration Record (MAR) revealed that staff administered the medication when the resident's SBP was above 140 mm/Hg on one occasion in October 2023 and two occasions in November 2023. Clinical record review revealed that Resident 394 had diagnoses that included end stage renal disease and diabetes. A physician's order dated November 3, 2023, directed staff to administer a medication (midodrine hydrochloride) two times a day every Monday, Wednesday, and Friday for hypotension (low blood pressure). Staff was not to administer the medication if the resident's SBP was 130 mm/Hg or higher. A review of Resident 394's MAR revealed that staff administered the medication when the resident's SBP was higher than 130 mm/Hg two times in November 2023. In an interview on November 20, 2023, at 10:26 a.m., the Director of Nursing confirmed that the medication was administered outside the established parameters for Residents 54 and 394. CFR 483.25 Quality of Care Previously Cited 05/03/2023 28 Pa. Code 211.12(d)(1)(5) Nursing services. 395540 Page 2 of 5 395540 11/20/2023 Easton Skilled Nursing and Rehabilitation Center 2600 Northampton Street Easton, PA 18045

F 0689 Level of Harm - Minimal harm or potential for actual harm Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Based on observation and staff interview, it was determined that the facility failed to ensure that the resident's environment was free of accident hazards for one of 35 sampled residents. (Resident 188) Residents Affected - Few Findings include: On November 18, 2023, at 10:35 a.m., 12:48 p.m., and 2:30 p.m., a blood draw needle was observed on resident 188's overbed table. At these times, Resident 188 was in bed and able to access the blood draw needle. In an interview on November 20, 2023, at 12:50 p.m., the Director of Nursing confirmed that a needle should not be left at bedside. CFR 483.25(d) Accidents. Previously cited 01/19/23 28 Pa. Code 211.12(d)(1)(5) Nursing services. 395540 Page 3 of 5 395540 11/20/2023 Easton Skilled Nursing and Rehabilitation Center 2600 Northampton Street Easton, PA 18045

F 0697 Provide safe, appropriate pain management for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm Based on facility policy review, clinical record review, and interview, it was determined that the facility failed to ensure non-pharmacological interventions were attempted to alleviate pain prior to the administration of pain medication prescribed on an as needed basis for one of 35 sampled residents. (Resident 89) Residents Affected - Few Findings include: Review of the facility policy entitled, Pain Management, last reviewed January 10, 2023, revealed that an individualized, person-centered care plan would be developed for pain and included non-pharmacological, and pharmacological approaches. Interventions for pain would be monitored for effectiveness. Documentation would include non-pharmacological interventions and effectiveness. Clinical record review revealed that Resident 89 had diagnoses that included fibromyalgia, anxiety, and chronic pain. A physicians order dated June 1, 2023, directed staff to administer oxycodone-acetaminophen every eight hours, as needed for pain rated at four through seven out of ten. Review of Resident 89's Medication Administration Records (MARs) for October and November of 2023, revealed that staff administered the medication on two occasions in October and two occasions in November. There was no evidence that staff attempted non-pharmacological interventions to alleviate pain prior to the administration of the as needed medication. In an interview on November 20, 2023, at 1:48 p.m., the Director of Nursing confirmed that there was no evidence that non-pharmacological interventions were attempted prior to the administration of Resident 89's as needed pain medication. 28 Pa. Code 211.9(a)(1) Pharmacy services. 28 Pa. Code 211.12(d)(1)(5) Nursing services. 395540 Page 4 of 5 395540 11/20/2023 Easton Skilled Nursing and Rehabilitation Center 2600 Northampton Street Easton, PA 18045

F 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. Based on facility policy review, clinical record review, and staff interview, it was determined that the facility failed to ensure that pharmacy recommendations were acted upon by the physician and maintained in the resident's clinical record per facility policy for three of 35 sampled residents. (Residents 7, 82, 144) Findings include: Review of the facility policy entitled, Medication Regimen Review, last reviewed January 10, 2023, revealed that the facility should maintain readily available copies of the consultant pharmacists' reports as part of the resident's permanent record. Clinical record review revealed that Resident 7 had diagnoses that included congestive heart failure and chronic obstructive pulmonary disease. Review of the monthly medication review revealed that the pharmacist made recommendations regarding Resident 7's medications on August 26 and September 20, 2023. There was no documented evidence of what the specific recommendations were or that they were addressed by the physician. On June 20, 2023, the pharmacist recommended an Abnormal Involuntary Movement Scale (AIMS) assessment. On July 26, 2023, the physican accepted the recommendation for an AIMS assessment. There was no documented evidence that an AIMS assessment was completed. Clinical record review revealed that Resident 82 had diagnoses that included acute kidney failure and chronic obstructive pulmonary disease. Review of the monthly medication review revealed that the pharmacist made recommendations regarding Resident 82's medications on October 18, 2023. There was no documented evidence of what the specific recommendations were or that they were addressed by the physician. Clinical record review revealed that Resident 144 had diagnoses that included dementia, anxiety, restlessness, and agitation. Review of the monthly medication review revealed that the pharmacist made recommendations regarding Resident 144's medications on September 25, 2023. There was no documented evidence of what the specific recommendations were or that they were addressed by the physician. In an interview on November 20, 2023, at 1:48 p.m., the Director of Nursing confirmed that there was no evidence of what the specific recommendations were or that the physician acknowledged the recommendations for Resident 7, 82, and 144. The Director of Nursing also confirmed that no AIMS assessment was completed for Resident 7 per the pharmacist's recommendation and physician's order. 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services. 395540 Page 5 of 5