Health inspection·August 11, 2023

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations and a staff interview, it was determined that the facility failed to provide housekeeping and maintenance services to maintain a clean, orderly, and homelike environment in resident areas on one of two resident units (Unit 3). Findings include: An observation on August 8, 2023, at 10:45 a.m., of resident room [ROOM NUMBER] revealed black and gray scuff marks, areas of chipped paint, and dozens of scratches in the dry wall on the wall adjacent to the door-side bed and on the wall to the left of the restroom door. The heating and cooling unit in the room was observed to have black and gray scuff marks running along the bottom portion of the entire unit, approximately covering 4.0 feet x 0.5 feet of the unit. The window-side wall was observed to have two 1.5-inch holes penetrating through the drywall. An observation on August 10, 2023, at 11:30 a.m. of resident room [ROOM NUMBER] revealed black and gray scuff marks, areas of chipped paint, and scratches in the dry wall on the lower portion of the wall adjacent to the door-side bed and on the lower wall to the left of the restroom door. The heating and cooling unit in the room was observed to have black and gray scuff marks running along the bottom portion of the entire unit, approximately covering 4.0 feet x 0.25 feet of the unit. The bottom running board on the unit was bent in the middle section and disconnected from the unit. The top of the heating and cooling unit was observed to have tan and brown stains. The wall behind and to the left of the window-side bed was observed to have several scratches and areas of chipped paint in the drywall. An observation on August 10, 2023, at 11:35 a.m. of resident room [ROOM NUMBER] revealed black and gray scuff marks, areas of chipped paint, and multiple scratches in the dry wall on the lower portion of the wall adjacent to the door-side bed and on the lower portion of the wall to the right of the restroom. The wall behind the door-side resident bed had multiple 1.0 cm punctures in the drywall and several scratches. The heating and cooling unit in the room was observed to have black and gray scuff marks running along the bottom portion of the entire unit, approximately covering 4 feet x 0.25 feet of the unit, and areas of chipped paint. During an interview on August 10, 2023, at approximately 1:30 p.m., the Nursing Home Administrator confirmed that the facility's environment should be kept in good repair and maintained in a clean and homelike manner. 28 Pa Code 201.18(e)(2.1) Management Page 1 of 7 395587 395587 08/11/2023 Meadows Nursing and Rehabilitation Center 4 East Center Street Dallas, PA 18612

F 0623 Level of Harm - Potential for minimal harm Residents Affected - Some Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. Based on clinical record reviews and staff interviews, it was determined that the facility failed to provide written notice of facility-initiated resident transfer to the hospital identifying the reason for the transfer in a language and manner easily understand to the resident and the resident's representative for one resident out of 18 residents sampled. (Resident 37). Findings include: A review of Resident 37's clinical record revealed that the resident was transferred to the hospital on July 1, 2023, and returned to the facility on July 5, 2023. Review of the facility's notice of transfer or discharge revealed that Resident 37 was transferred to the hospital because her needs cannot be met at the current facility. Interview with the Nursing Home Administrator on August 11, 2023, at approximately 10:30 a.m. confirmed that Resident 37's reason for the transfer was not written in a language and manner easily understood. 28 Pa. Code 201.14(a) Responsibility of Licensee 395587 Page 2 of 7 395587 08/11/2023 Meadows Nursing and Rehabilitation Center 4 East Center Street Dallas, PA 18612

F 0641 Ensure each resident receives an accurate assessment. 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 clinical records, the Resident Assessment Instrument, and staff interviews, it was determined that the facility failed to ensure the Minimum Data Set Assessments (MDS, a federally mandated standardized assessment conducted at specific intervals to plan resident care) accurately reflected the status of four residents out of the 18 sampled (Residents 22, 31, 62, 142). Residents Affected - Some Findings include: A review of the clinical record revealed that Resident 22 was admitted to the facility on [DATE]. A review of Resident 22's annual MDS assessment dated [DATE], revealed in Section I. Active Diagnoses. I6000. Schizophrenia was coded Yes and indicate that the diagnosis was a primary reason for admission. Review of Resident 22's quarterly MDS dated [DATE], revealed that Identified that Resident 22's May 5, 2023, Quarterly MDS Section I. Active Diagnoses. I6000. Schizophrenia was coded No. Interview with the Nursing Home Administrator on August 10, 2023, at 12:20 PM, revealed that Resident 22 had a history of mental illness that included schizophrenia, and that the facility failed to accurately code the May 5, 2023, quarterly MDS to reflect schizophrenia as an active diagnosis. A review of Resident 31's quarterly MDS assessment dated [DATE], revealed in Section N0450, Antipsychotic Medication Review, that the resident had not received antipsychotic medications since admission, entry, or reentry. However, a clinical record review revealed Medication Administration Records (MAR) for April 2023 and May 2023 indicating that Resident 31 received Aripiprazole (an antipsychotic medication), making the MDS assessment inaccurate. A review of Resident 62's comprehensive admission MDS assessment dated [DATE], revealed in Section J1700 Health Conditions, that the resident did not have any fracture related to a fall in the 6 months prior to admission. However, a clinical record review revealed the resident was admitted to the facility from the hospital on May 31, 2023, with a diagnosis of a closed fracture of the right femur and right artificial hip joint due to a fall that occurred on May 27, 2023. During an interview with the nursing home administrator (NHA) on May 11, 2023, at approximately 9:30 a.m., the NHA confirmed the MDS errors for Residents 31 and 62. A review of Resident 142's admission MDS assessment dated [DATE], revealed in Section H0100 Appliances that the resident had an Ostomy (including urostomy, ileostomy, and colostomy). Section H0300, Urinary Continence indicated that the resident was always continent (coded 0), however the resident had an indwelling bladder catheter, condom catheter, ostomy, or no urine output for the entire 7 days, making the August 1, 2023, admission MDS Assessment inaccurate. An interview with the Administrator on August 9, 2023 at 10:00 a.m. confirmed that Resident 142's 395587 Page 3 of 7 395587 08/11/2023 Meadows Nursing and Rehabilitation Center 4 East Center Street Dallas, PA 18612

F 0641 admission MDS assessment dated [DATE], was inaccurate, with respect to completion of Section H0300 related to Urinary Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 395587 Page 4 of 7 395587 08/11/2023 Meadows Nursing and Rehabilitation Center 4 East Center Street Dallas, PA 18612

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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of clinical records and select facility policy, and staff interview it was determined that the facility failed to monitor bowel activity and implement physician's ordered bowel protocol to promote bowel activity for one resident (Resident 76) out of 18 sampled residents. Residents Affected - Few Findings include: According to the American Academy of Family Physicians {The American Academy of Family Physicians is one of the largest medical organizations in the US founded to promote the science and art of family medicine}the primary goal of constipation management should be symptom improvement, and the secondary goal should be the passage of soft, formed stool without straining at least three times per week. A review of Resident 76's clinical record revealed that the resident was admitted to the facility on [DATE], with diagnoses of compression fractures [are small breaks or cracks in the vertebrae (the bones that make up your spinal column] of the first lumbar [(L1) is the first of the series and are the lumbar vertebrae that are the largest movable bones of the backbone] and second lumbar vertebrae [(L2) vertebra is the second uppermost of the five (5) lumbar vertebrae toward the lower end of the spinal column, within the lower back., subsequent encounter for fracture with routine healing, abnormalities of gait[a person's manner of walking] and mobility, and constipation [Infrequent, irregular or difficult evacuation of the bowels]. A physician order dated July 10, 2023, at 7:05 PM, was noted for Milk of Magnesia Suspension 1200 MG/15 ML (Magnesium Hydroxide), give 2400 mg orally as needed for constipation, give 30 cc PO (orally) after lunch at 1 PM on day 3 without BM (bowel movement). If MOM was ineffective, administer Magnesium Citrate Solution [an oral laxative solution that can ease the occasional constipation that is available over the counter (OTC) and can help produce a bowel movement in 30 minutes to 6 hours], give 10 ounces by mouth as needed for constipation on day 4 without a BM by 1PM. On day four without a BM, administer a Dulcolax Suppository 10 mg (Bisacodyl) [stimulant laxatives made to relieve occasional constipation], insert 1 suppository rectally as needed for constipation and give at 8 pm on Day 4 with no BM. The physician orders also included a Fleet Enema 7-19 GM/118 ML (Sodium Phosphate), insert 1 application rectally as needed for constipation give 1 applicator at 6am (before getting OOB) {out of bed} on day 5 of no BM and if ineffective by 1 PM, notify the MD. A bowel and bladder note progress note dated July 14, 2023, at 3:06 PM, revealed that the resident had problems with constipation in the past and reported to staff that she took Metamucil at home regularly. The resident had complaints of being constipated It's been 3-days, I did have a small BM earlier today. A review of the nursing tasks performed for the resident according to the Survey Documentation Report dated July 2023, revealed that the resident had no BM from July 11, 2023, 3:00 PM-11:00 PM shift, through July 15, 2023, at 7:45 PM. The resident's July 2023 medication administration record (MAR) revealed no documented evidence that the physician's prescribed bowel protocol was administered as ordered to promote bowel activity during the period of inactivity. 395587 Page 5 of 7 395587 08/11/2023 Meadows Nursing and Rehabilitation Center 4 East Center Street Dallas, PA 18612

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Resident 76's current care plan failed to address the resident's diagnosis of constipation and the measures planned and prescribed to promote normal bowel activity. During an interview with the Director of Nursing (DON) on August 10, 2023, at 1:33 PM, confirmed that the physician ordered bowel protocol was not administered as ordered and the resident's care plan failed to address her diagnosis of constipation and interventions to promote bowel activity, and prevent and relieve constipation. 28 Pa Code 211.12 (c)(d)(3)(5) Nursing services. 395587 Page 6 of 7 395587 08/11/2023 Meadows Nursing and Rehabilitation Center 4 East Center Street Dallas, PA 18612

F 0757 Ensure each resident’s drug regimen must be free from unnecessary drugs. Level of Harm - Minimal harm or potential for actual harm Based on a review of clinical records and staff interviews it was determined that the facility failed to ensure that the resident's drug regimen was free of unnecessary antibiotic drugs for one out of 18 residents sampled (Resident 26). Residents Affected - Few Findings included: A review of Resident 26's clinical record revealed a Suspected UTI SBAR (Situation-Background-Assessment-Recommendation) dated July 18, 2023, indicating that Resident 26 had experienced increased urinary frequency. According to the document, the resident did not have an indwelling catheter, incontinence, or new/worsening symptoms, and that the resident did not need an immediate prescription for an antibiotic, but may need additional observation. The physician ordered a urinalysis and culture and sensitivity (report to indicate what antibiotic will treat the infection) to rule out a urinary tract infection. Nursing documentation dated July 19, 2023, at 3:45 p.m. indicated that the physician was aware of the urinalysis results and ordered Augmentin 500 mg orally twice a day for 5 days. The urine culture and sensitivity report, however, remained pending. Review of the urine culture and sensitivity report dated July 21, 2023, revealed that the bacteria were not susceptible to treatment with Augmentin that had been prescribed. Nursing documentation dated July 21, 2023, at 10:17 p.m. revealed that the physician was made aware of the urine culture and sensitivity results and the physician discontinued Augmentin and started Cefdinir 300 mg orally two times a day for 5 days for treatment of the resident's UTI. Review of the resident's July 2023 Medication Administration Record revealed that Resident 26 received 5 doses of Augmentin for treatment of the UTI prior to the results of the culture and sensitivity results. There was no physician documentation to indicate the clinical necessity of initiating antibiotic treatment with Augmentin to treat the resident's urinary frequency prior to receiving the results of the culture and sensitivity tests. Interview with the Director of Nursing on August 11, 2023, at 12:45 PM, confirmed that the administration of Augmentin was not clinically justified for treatment of Resident 26's urinary tract infection. 28 Pa. Code 211.2 (3) Medical Director 28 Pa. Code 211.9 (k) Pharmacy Services 28 Pa. Code 211.12 (d)(1)(3) Nursing Services 28 Pa. Code 211.5 (f) Clinical records 395587 Page 7 of 7