Health inspection·August 10, 2024

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 physician's orders were implemented for two of four sampled residents. (Residents 1, 2) Residents Affected - Few Findings include: Clinical record review revealed that Resident 1 had diagnoses that included intervertebral disc displacement (when a disc in the spinal column shifts and presses on against the spinal nerves) and morbid obesity. A physician's order dated July 2, 2024, directed staff to cleanse surgical incision to lower back with normal saline solution and pat dry, to keep incision clean and dry, to keep the incision open to air, and to apply folded abdominal pad dressing (ABD) on each side of the incision due to skin fold two times a day. A review of the July 2024 Treatment Administration Records (TARs) revealed that there was no evidence the treatment was done as ordered on July 3, 4, and 6, 2024. Clinical record review revealed that Resident 2 had diagnoses that included metabolic encephalopathy and cellulitis of bilateral lower extremities. A review of physician's orders dated August 1 through 10, 2024, the Medication Administration Record (MAR) for August 2024, and the Treatment Administration Record (TAR) for August 2024, revealed the following: Staff were to apply ammonium lactate external lotion 12% to bilateral lower extremities daily for venous stasis. There was no evidence that the lotion was applied as ordered on August 5, 2024. Staff were to administer doxycycline monohydrate (an antibiotic) oral capsule 100 milligrams (mg) two times a day. There was no evidence that the medication was administered as ordered on August 8, 2024. Staff were to administer Suboxone sublingual film (a narcotic) 2-0.5mg 1 film four times a day for narcotic dependence. There was no evidence that the medication was administered as ordered on August 5, 2024. A physician's order dated July 2, 2024, directed staff to apply moisturizing lotion to the entire left lower leg then cover with ACE bandage from bottom of foot and work up to below the knee every day shift to maintain skin integrity. A review of the August 2024 TAR revealed that there was no evidence the treatment was done as ordered on August 4 through 8, 2024. In an interview on August 10, 2024, at 2:05 p.m., the Manager on Duty confirmed that there was no documented evidence that Residents 1 and 2 received the treatments and/or medications as ordered by the physician. Page 1 of 2 395574 395574 08/10/2024 Belle Terrace 1320 Mill Road Quakertown, PA 18951

F 0684 28 Pa. Code 211.12(d)(1)(5) Nursing services. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 395574 Page 2 of 2