Health inspection·December 28, 2023

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review and staff interview, it was determined that the facility failed to develop a care plan and interventions to meet each resident's needs as identified in the comprehensive assessment for two of 13 sampled residents. (Residents 25, 154) Findings include: Clinical record review revealed that Resident 25 had diagnoses that included chronic obstructive pulmonary disease and congestive heart failure. Review of the Minimum Data Set (MDS) assessment dated [DATE], revealed that the Care Area Assessment (CAA) summary triggered urinary incontinence and dental care as problem areas to be care planned. Resident 25's current care plan did not include interventions to address urinary incontinence and dental care. Clinical record review revealed that Resident 154 had diagnoses that included displaced left femur fracture, muscle weakness, and chronic obstructive pulmonary disease. Review of the MDS assessment dated [DATE], revealed that the CAA summary triggered pain and urinary incontinence as problem areas to be care planned. Resident 154's current care plan did not include interventions to address pain or urinary incontinence. In an interview on December 28, 2023, at 12:33 p.m., the Registered Nurse Assessment Coordinator confirmed there was no documented evidence that the care areas were addressed in the residents' current care plans. 28 Pa. Code 211.12(d)(1)(5) Nursing services. Page 1 of 3 395574 395574 12/28/2023 Belle Terrace 1320 Mill Road Quakertown, PA 18951

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, policy review, and staff interview, it was determined that the facility failed to ensure that physicians' orders or care plan interventions were implemented for two of 13 sampled residents. (Residents 36, 42) Residents Affected - Few Findings include: Review of the facility policy entitled, Weight Assessment and Intervention, last reviewed January 1, 2023, revealed that staff was to weigh each resident monthly after the first two weeks following admission. Clinical record review revealed that Resident 36 had diagnoses that included depression, anxiety, and morbid obesity. A physician's order dated November 24, 2021, directed staff to observe the resident and document for side effects of antidepressants including weight gain. Review of the current care plan revealed, Resident 36 was at risk for altered nutrition with an intervention for staff to weigh and monitor the resident's weight per facility policy. There was no documentation that staff weighed Resident 36 in September, November, and December 2023. Clinical record review revealed that Resident 42 had diagnoses that included dysphagia and depression. Review of the current care plan revealed that Resident 42 was at risk for weight loss related to poor oral intake with an intervention for staff to weigh and monitor the resident's weight per facility policy. There was no documentation that staff weighed Resident 42 in November and December, 2023. In an interview on December 28, 2023, at 1:20 p.m., the Director of Nursing confirmed that staff did not weigh the residents in accordance with physician's orders and/or the facility policy. 28 Pa. Code 211.12(d)(1)(5) Nursing services. 395574 Page 2 of 3 395574 12/28/2023 Belle Terrace 1320 Mill Road Quakertown, PA 18951

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on policy review, observation, and staff interview, it was determined that the facility failed to administer medications in accordance with facility infection control policies on one of two nursing units. (A hall) Residents Affected - Few Findings include: Review of the facility policy entitled, Administering Medication, last reviewed January 1, 2023, revealed that staff was to follow established facility infection control procedures for the administration of medications including hand hygiene. On December 27, 2023, LPN 1 was observed administering medications to Resident 49. The nurse touched each pill with her ungloved hand prior to administering them to the resident. In an interview on December 28, 2023, at 10:00 a.m., the Director of Nursing stated that nurses may not touch medications with their hands unless they are wearing clean gloves. 28 Pa. Code 211.10(d) Resident care policies. 28 Pa. Code 211.12(d)(1)(5) Nursing services. 395574 Page 3 of 3