Health inspection·June 23, 2023

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 review of clinical records and staff interviews, it was determined that the facility failed to follow physician's orders for treatments for one of 20 residents reviewed (Resident R41). Residents Affected - Few Findings include: Review of Resident R41's clinical record revealed an admission date of 8/30/22, with diagnoses including scalp wound, liver cancer, stroke with left-sided weakness, adrenal gland cancer, seizures, and dementia. Further review of Resident R41's clinical record revealed: a physician's order dated 4/06/23, to consult the neurosurgeon on 4/12/23, for suture removal and wound check; a physician's order dated 4/07/23, identified to apply saline soaked gauze to sutures to soften prior to removal every day shift until 4/10/23; give five milligrams (mg) of Valium (medication used to treat anxiety) by mouth one hour prior to suture removal until 4/10/23. Further review of Resident R41's clinical record lacked evidence of a physician's order to remove his/her sutures. Review of Resident R41's medication and treatment records for April 2023, revealed Valium five mg was administered on 4/10/23, at 1:01 p.m., and saline soaked gauze was applied to his/her sutures one time on 4/10/23. Review of Resident R41's clinical record revealed: a departmental progress note dated 4/06/23, that indicated the facility received a call from the neurosurgeon's office to schedule an appointment on 4/12/23, for suture removal and wound check; a departmental progress note dated 4/10/23, revealed that the sutures were removed by facility staff; a physician's progress note dated 4/12/23, that Resident R41's physician had been notified of the suture removal at the facility and would look into the matter further. An office visit progress note dated 4/12/23, indicated that the neurosurgeon believed the suture removal at the facility to be unfortunate and that the mid-portion of the incision had dehisced (opened back up). During an interview on 6/21/23, at 2:00 p.m. the Director of Nursing confirmed that the orders to administer Valium and apply saline soaked gauze did not instruct facility staff to remove Resident R41's sutures. 28 Pa. Code 211.12(d)(5) Nursing services Page 1 of 2 395572 395572 06/23/2023 Fairview Manor 900 Manchester Road Fairview, PA 16415

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observations, review of facility policy, and staff interview it was determined that the facility failed to utilize proper hand hygiene during meal distribution in two of three resident kitchenette areas (B and D units). Findings include: Review of a facility policy dated 2/20/23, entitled Infection Control/Food Safety indicated that staff should complete thorough hand washing after handling soiled equipment and during food preparations to prevent cross contamination, and avoid direct contact with food by bare hands. Observation on 6/21/23, at approximately 11:30 a.m. revealed that Dietary Employee E1 was observed opening the refrigerator door on the D Unit kitchenette with gloved hands and grabbing a soda, then grabbed a pickle and placed it on a plate. After this exchange Dietary Employee E1 proceeded to grab a bun and start the next plate of food. Dietary Employee E1 did not remove gloves and perform hand hygiene during the entire exchange. Observation on 6/21/23, at 11:53 a.m. on the B Unit kitchenette revealed that Licensed Practical Nurse (LPN) Employee E2 touched a resident sandwich with bare hands to cut it with a knife. During an interview at that time LPN Employee E2 confirmed he/she believed that wearing gloves to touch resident food was a dignity issue. During an interview on 6/21/23, at 12:13 p.m. the Dietary Manager confirmed that hand hygiene should have been performed and gloves changed after opening the refrigerator to grab the soda, and that LPN Employee E2 should have worn gloves to touch the resident's sandwich. 28 Pa. Code 211.6(f) Dietary services 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 201.18(b)(1) Management 395572 Page 2 of 2