Health inspection·February 21, 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 observation, review of grievances lodged with the facility, and staff interview, it was determined that the facility failed to provide care in a manner that promotes each resident's quality of life by failing to respond timely to residents' requests for assistance as evidenced by four out of 11 residents sampled (Residents 1, 8, 9, and 10). Findings include: A review of a grievance submitted by Resident 4's representative dated January 23, 2024, revealed that the resident's representative had to physically call facility herself and ask for someone to answer her mother's call bell since no staff had answered the call bell. Review of the facility's resolution revealed that on January 24, 2024, nursing staff were provided written and/or verbal education via telephone to please be attentive to answering call bells. A resident call bell should be answered within 5-10 minutes. It is everyone's job to answer call bells, not just CNAs (nurse aides). Please do not walk by a call bell without addressing the resident's needs. Observations performed on the second-floor resident care unit on February 21, 2024, at 6:30 AM revealed that there were 4 call lights sounding at that time, and one licensed practical nurse and two nurse aides present on the unit. At time of observation, Employee 1, LPN, was completing paperwork at the nurse's desk, Employee 2, a nurse aide, was performing resident care on her assignment, and Employee 3, nurse aide, was at the nurse's station also completing computer work for her assignment, as the four residents' requests for assistance via the nurse call bell system continued to sound. Review of staff assignment sheet revealed that Employee 3 had been assigned to the area of the unit on which the 4 residents' call lights were sounding but continued to do data entry instead of responding to residents requests for assistance. Continued observation revealed that at 6:55 AM, approximately 20 minutes later, Employee 2 responded to the residents' call bells. Interview with the Nursing Home Administrator on February 21, 2024, at approximately 2:30 p.m. revealed the expectation was for staff to answer call bells within 5-10 minutes and provide the requested assistance to residents. Page 1 of 8 395567 395567 02/21/2024 Dunmore Health Care Center 1000 Mill Street Dunmore, PA 18512

F 0550 Refer F677, F725 Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code 201.18 (e)(1)(4) Management 28 Pa. Code 211.10 (c)(d) Resident care policies Residents Affected - Some 28 Pa. Code 211.12 (c)(d)(1)(5) Nursing services 395567 Page 2 of 8 395567 02/21/2024 Dunmore Health Care Center 1000 Mill Street Dunmore, PA 18512

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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a review of select facility policy and clinical records and staff interviews it was determined that the facility failed to provide services necessary to maintain adequate personal hygiene and grooming of residents' dependent on staff for assistance with these activities of daily living for three out of 11 residents reviewed (Residents 2, CR1, and CR2). Residents Affected - Some Findings include: A review of a facility policy for Resident Bath/Showering/Scheduling Policy, dated as last revised September 9, 2022, indicated that residents will be bathed or showered according to their preferences in order to maintain healthy hygiene and skin condition. According to the policy, each resident will be asked about his/her bathing preferences upon admission (type of bath, preferred days and times). Each resident will be scheduled to receive bathing a minimum of two times per week, unless they prefer less frequent baths. The procedures were that If the bath/shower cannot be given or the resident refuses, the nursing assistant will promptly report this to the Charge nurse. The charge nurse will speak with the resident who refuses to ascertain why they are refusing and to determine if alternative arrangements that suit the resident can be made. If the resident continues to refuse the Charge nurse will document the resident's refusal in the medical record. Review of clinical record revealed that Resident 4 was admitted to the facility on [DATE]. A review of a grievance submitted by Resident 4's representative dated January 23, 2024, the resident's representative voiced concerns that staff provided the resident only one shower in the seven days the resident had resided in the facility. The resident asked for more showers and the resident's representative did not believe that the resident had been showered after she requested a shower. Review of facility resolution revealed that on January 24, 2024, nursing staff were education that, all residents get two showers a week and bed baths in between. If a resident wants a shower more often, then it should be provided. COVID positive residents still need showers. They should shower last after the negative residents are already showered. Shower room should be cleaned by housekeeping after all COVID positive showers are done. Review of Resident 2's clinical record revealed admission to the facility on February 2, 2024, with diagnoses which included hypertension, chronic kidney disease, and hyperlipidemia (high cholesterol). A review of Resident 2's admission MDS Assessment (Minimum Data Set-a federally mandated standardized assessment process completed periodically to plan resident care) dated February 9, 2024, revealed that the resident was cognitively intact, that it was very important to choose between a tub bath, shower, bed bath, and required substantial/maximal assistance (helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort) from staff for showers/ bathing. Review of Resident 2's Documentation Survey Report dated February 2024 revealed that the resident did not have a scheduled shower/bath day assigned on the aide's documentation survey report of tasks to be completed. Further review of the report revealed that there was no evidence that Resident 2 was provided a shower during the resident's stay. According to the report, Resident 2 had received 395567 Page 3 of 8 395567 02/21/2024 Dunmore Health Care Center 1000 Mill Street Dunmore, PA 18512

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some only bed baths from February 2, 2024, through February 20, 2024, when reviewed during the survey ending February 21, 2024. Review of Resident CR1's clinical record revealed admission to the facility on February 6, 2024, with diagnoses which included congestive heart failure, heart disease, and chronic obstructive pulmonary disease. Resident CR1 was discharged from the facility on February 12, 2024. A review of Resident CR1's admission MDS assessment dated [DATE], revealed that the resident was cognitively intact, that it was very important to choose between a tub bath, shower, bed bath, and required partial/moderate assistance (helper does less than half the effort. Helper lifts or holds trunk or limbs but provides less than half the effort) from staff for showers/ bathing. Review of Resident CR1's Documentation Survey Report dated February 2024 revealed that the resident received a bed bath on February 6, 2024. There was no documented evidence that the resident was offered or provided a shower during her stay at the facility from February 6, 2024, through February 12, 2024. Further review of the clinical record failed to provide evidence that the resident was provided the opportunity to choose the time of day she would like for showers to be provided. Review of Resident CR2's clinical record revealed admission to the facility on January 25, 2024, with diagnoses which included COVID-19, depression, and stroke. Resident CR2 was discharged from the facility to home on February 12, 2024. Review of Resident CR2's admission MDS assessment dated [DATE], revealed that the resident was cognitively intact, that it was very important to choose between a tub bath, shower, bed bath, and required partial/moderate assistance from staff for showers/ bathing. Review of Resident CR2's Documentation Survey Report dated February 2024 revealed that the resident did not have a scheduled shower/bath day assigned to the nurse aides on the task report. Further review of the report revealed that there was no evidence that Resident CR2 was provided a shower during the resident's stay. According to the report, Resident CR2 had only received bed baths from admission February 1, 2024, through February 12, 2024. During an interview February 21, 2024, at approximately 2 PM the Regional Clinical Nurse Consultant confirmed that residents are to receive two showers per week and confirmed that the facility was unable to demonstrate that the above residents had been showered at least twice a week. The consultant further confirmed that the staff education provided on January 24, 2024, regarding showering of residents. Refer F725 and F550 28 Pa Code 211.12 (c)(d)(4)(5) Nursing services 28 Pa. Code 211.10 (c)(d) Resident care policies 395567 Page 4 of 8 395567 02/21/2024 Dunmore Health Care Center 1000 Mill Street Dunmore, PA 18512

F 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, a review of clinical records, grievances lodged with the facility and nurse staffing levels and staff interviews it was determined that the facility failed to provide and/or efficiently deploy sufficient nursing staff to consistently provide timely care, including assistance with activities of daily living, to meet the physical needs and promote the psychosocial well-being of each resident including Resident 4, Resident 2, Resident CR1 and CR2). Findings include: A review of a grievance submitted by Resident 4's representative dated January 23, 2024, revealed that the resident's representative had to physically call facility herself and ask for someone to answer her mother's call bell since no staff had answered the call bell. Review of the facility's resolution revealed that on January 24, 2024, nursing staff were provided written and/or verbal education via telephone to please be attentive to answering call bells. A resident call bell should be answered within 5-10 minutes. It is everyone's job to answer call bells, not just CNAs (nurse aides). Please do not walk by a call bell without addressing the resident's needs. Education was also provided regarding resident showers, which noted that all residents get two showers a week and bed baths in between. If a resident wants a shower more often, then it should be provided. COVID positive residents still need showers. They should shower last after the negative residents are already showered. Shower room should be cleaned by housekeeping after all COVID positive showers are done. Observation of the first-floor nursing unit on February 21, 2024, at approximately 6:20 AM, 42 residents were residing on the unit. There was one LPN and 2 nurse aides assigned to the unit. At time of observation, the registered nurse supervisor was seated at the nurse's station taking care of medications for a resident no longer in the facility. Observation on the second-floor nursing unit on February 21, 2024, at approximately 6:30 AM, 44 residents were residing on the unit. There was one LPN (license practical nurse) on the unit and 2 nurse aides assigned to care for the residents. Upon arrival to the second-floor resident unit at 6:30 AM, there were 4 resident room call bells sounding on one side of the hall. At that time, Employee 1, LPN, was completing data entry while watching Resident 8, one nurse aide, Employee 2, was tending to residents on the other side of the hall, and the other nurse aide, Employee 3, was completing data entry for her shift. No one was observed responding to sounding call bells. Continued observation revealed that it took 20 minutes for the second-floor nursing staff to respond to the 4 call bells. Review of staff assignment sheet revealed that Employee 3 had been assigned to the area of the unit on which the 4 residents' call lights were sounding but continued to do data entry instead of responding to residents requests for assistance. Continued observation revealed that at 6:55 AM, approximately 20 minutes later, Employee 2 responded to the residents' call bells. Interview with the Nursing Home Administrator on February 21, 2024, at approximately 2:30 p.m. revealed the expectation was for staff to answer call bells within 5-10 minutes and provide the 395567 Page 5 of 8 395567 02/21/2024 Dunmore Health Care Center 1000 Mill Street Dunmore, PA 18512

F 0725 requested assistance to residents. Level of Harm - Minimal harm or potential for actual harm Interview with Employee 1, LPN, on February 21, 2024, at 7 AM revealed that Resident 8 had been admitted on [DATE], and due to behaviors, required 1:1 observation during the 11 PM to 7 AM shift. According to Employee 1, the night shift nursing supervisor assisted with sitting with resident during the night, but was not able to continue to watch the resident throughout the entire shift. This required each assigned staff member on the second floor to alternate watching Resident 8 while attempting to meet the care needs of the other 43 residents on the unit. Residents Affected - Some Observation of shift change from night shift to day shift on February 21, 2024, revealed that there was no staffing sheet available for the oncoming shift, which resulted in the on-coming staff be unaware of which unit to report for duty. The oncoming staff were unable to timely to timely report to the unit to which they were assigned due to the lack of a deployment sheet upon start of the shift. Review of Resident 2's clinical record revealed admission to the facility on February 2, 2024, with diagnoses, which included hypertension, chronic kidney disease, and hyperlipidemia (high cholesterol). A review of Resident 2's admission MDS Assessment (Minimum Data Set-a federally mandated standardized assessment process completed periodically to plan resident care) dated February 9, 2024, revealed that the resident was cognitively intact, that it was very important to choose between a tub bath, shower, bed bath, and required substantial/maximal assistance (helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort) from staff for showers/ bathing. Review of Resident 2's Documentation Survey Report dated February 2024 revealed that the facility did not identify the resident's scheduled shower or bath days on the nurse aide's assignment. Further review of the report revealed that there was no evidence that Resident 2 was provided a shower since admission. According to the report, the facility's nursing staff provided Resident 2 only bed baths from admission on [DATE], through February 20, 2024, when reviewed during the survey on February 21, 2024. Review of Resident CR1's clinical record revealed admission to the facility on February 6, 2024, with diagnoses which included congestive heart failure, heart disease, and chronic obstructive pulmonary disease. Resident CR1 was discharged from the facility on February 12, 2024. A review of Resident CR1's admission MDS assessment dated [DATE], revealed that the resident was cognitively intact, that it was very important to choose between a tub bath, shower, bed bath, and required partial/moderate assistance (helper does less than half the effort. Helper lifts or holds trunk or limbs but provides less than half the effort) from staff for showers/ bathing. Review of Resident CR1's Documentation Survey Report dated February 2024 revealed that the resident received a bed bath on February 6, 2024. There was no documented evidence that nursing staff provided or offered the resident a shower during her stay at the facility. Further review of the clinical record failed to provide evidence that the resident was provided the opportunity to choose the time of day she would prefer to be showered. Review of Resident CR2's clinical record revealed admission to the facility on January 25, 2024, 395567 Page 6 of 8 395567 02/21/2024 Dunmore Health Care Center 1000 Mill Street Dunmore, PA 18512

F 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some with diagnoses which included COVID-19, depression, and stroke. Resident CR2 was discharged from the facility to home on February 12, 2024. Review of Resident CR2's admission MDS assessment dated [DATE], revealed that the resident was cognitively intact, that it was very important to choose between a tub bath, shower, bed bath, and required partial/moderate assistance from staff for showers/ bathing. Review of Resident CR2's Documentation Survey Report dated February 2024 revealed that the facility did not schedule a shower/bath day for the resident and none was assigned to the nursing the staff. There was no evidence that nursing staff showered Resident CR2 during the resident's stay. Nursing provided Resident CR2 only bed baths from February 1, 2024, through February 12, 2024, when the resident was discharged home. During an interview February 21, 2024, at approximately 2 PM the Regional Clinical Nurse Consultant confirmed that residents are to receive two showers per week and confirmed that the facility was unable to demonstrate that the above residents had been showered at least twice a week. A review of nurse staffing and resident census and staff interview, it was determined that the facility failed to consistently provide minimum general nursing care hours to each resident daily as required by PA state licensure regulations. A review of the facility's weekly staffing records revealed that on the following dates the facility failed to provide the state minimum nurse staffing of 2.87 hours of general nursing care to each resident: A review of the facility's calculated total nursing care hours per resident day for February 18, 2024, was at 227.50 total hours for a maximum resident census of 84 and the facility required 241.08 total hours for a maximum resident census of 84. Further review of PPD for February 18, 2024, revealed that the facility provided only 2.71 hours of direct nursing care to each resident and failed to provide the minimum of 2.87 hours of direct nursing care daily to each resident daily. An interview with the Nursing Home Administrator (NHA) on February 21, 2024, at 2:35 PM, confirmed that the facility failed to provide the minimum of 2.87 hours of direct nursing care daily for each resident. Refer F550, F677 28 Pa. Code 201.18 (b)(1)(2)(3) Management 28 Pa. Code 211.10 (c)(d) Resident care policies 28 Pa. Code 211.12 (d)(1)(3)(4)(5)(i)(1) Nursing services 395567 Page 7 of 8 395567 02/21/2024 Dunmore Health Care Center 1000 Mill Street Dunmore, PA 18512

F 0732 Post nurse staffing information every day. Level of Harm - Potential for minimal harm Based on observation, review of posted daily nurse staffing data and staff interview, it was determined that the facility failed to ensure accurate and complete daily nursing time posting. Residents Affected - Many Findings include: During an observation on February 21, 2024, at approximately 6:15 AM the facility's posted nursing time was observed at the entrance to the first-floor nursing unit. A review of the posted nursing time revealed that the posting was not dated. Further review of the posted nursing time revealed that there was no time available for the 3p to 11p shift. The facility failed to post the daily nurse staffing data accordingly. 28 Pa. Code 211.12 (d)(1)(3)(5) Nursing services 28 Pa. Code 201.18 (b)(1)(3) Management 395567 Page 8 of 8