Health inspection·August 22, 2023

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm Based on review of select facility guidelines and clinical records, and staff interview, it was determined that the facility failed to provide supplemental oxygen administration care consistent with professional standards of practice for one of three residents reviewed (Resident A1). Residents Affected - Few Findings include: Review of the facility Non-Invasive Pulse Oximetry Testing guidelines last reviewed by the facility February 2023 revealed that the practice of the facility is to perform non-invasive pulse oximetry test (quick and non-invasive monitoring technique that measure the oxygen level in the blood by shining light at specific wavelengths through tissue, most commonly the fingernail bed) to evaluate conditions which are commonly associated with oxygen desaturation (drops in oxygen level). Indications for pulse oximetry testing include: the resident exhibits signs or symptoms of acute respiratory dysfunction such as : tachypnea (abnormally rapid breathing); cyanosis (bluish discoloration of the skin from inadequate oxygen in the blood); confusion; severe chest pain; dyspnea (difficult breathing); respiratory distress; hypoxia (low levels of oxygen in the blood); or the resident has chronic lung disease, chest trauma, severe cardiopulmonary disease, or neuro-muscular disease involving the muscles of respiration, and oximetry is needed for at least one of the following reasons: initial evaluation to determine the severity of respiratory impairment; evaluation of an acute change in condition; evaluation of exercise tolerance in a resident with respiratory disease; evaluation to establish medical necessity of an oxygen therapeutic regimen. Documentation of the pulse oximetry is maintained as part of the permanent medical record. As a matter of practice, pulse oximetry should be tested: prior to the initiation of oxygen, weekly with long term therapy, daily and possibly every shift with the exacerbation of symptoms. Clinical record review revealed that Resident A1 had diagnoses, which include dementia (a chronic or persistent disorder of the mental processes caused by brain disease or injury and marked by memory disorders, personality changes, and impaired reasoning) and hypertension. A physician order dated May 2, 2023, was noted to discontinue oxygen 2 liters/minute continuous at this time and to check oxygen saturation level every shift for three days, may apply oxygen 2 liters/minute via nasal cannula for saturations < 90%. An out of sequence late nurses note written by Employee 1 (LPN) dated July 3, 2023, for July 1, 2023 at 12:48 PM noted that after the resident's representative (second emergency contact) finished feeding resident at lunch time, he stopped this nurse in the hall to report her intake of food and ice cream. He mentioned that the resident looked as if she might need oxygen and that in the past she had experienced apnea (stop breathing while asleep or have almost no airflow). The resident was assessed by the LPN and no shortness of breath or difficulty breathing was seen. Page 1 of 2 395602 395602 08/22/2023 Wesley Village 209 Roberts Road Pittston, PA 18640

F 0695 There was no documented evidence that the resident was assessed by a registered nurse at that time. Level of Harm - Minimal harm or potential for actual harm There was also no documented evidence that a pulse oximetry test was completed as per facility guidelines, based on the resident's history of continuous oxygen use and the signs reported by the resident's representative that the resident may possibly need oxygen applied at that time. Residents Affected - Few A nurses note dated July 2, 2023 at 10:04 PM regarding July 2, 2023 at 7:30 PM noted while accompanied by resident's first responsible party, the resident began yelling and displayed agitation. Pulse ox obtained and read 84% RA (room air). Oxygen 2 liters/minute via nasal cannula applied at that time and effective with pulse ox reading 100% minutes later. Resident with no further signs or symptoms of agitation. Vital signs stable. No overt s/s distress. Will monitor further. A registered nurse nurses note dated July 2, 2023 at 9:15 PM noted that pulse ox decreased to 84% oxygen applied. Pulse ox increased to 100% on oxygen 2 liters/minute. Respirations 20, unlabored, dry. Resting comfortably in broda chair. First responsible party at bedside. CRNP (certified registered nurse practitioner) made aware. New order received for oxygen continuous at 2 liters /minute for shortness of breath. First responsible party made aware of new order. Interview with Nursing Home Administrator on August 22, 2023 at 2:15 PM failed to provide documented evidence that a registered nurse assessed Resident A1 and timely obtained a pulse oximetry test on July 1, 2023, to evaluate the resident's need for supplemental oxygen administration and care consistent with professional standards of practice and facility guidelines. 28 Pa. Code 211.12 (a)(d)(1)(5) Nursing services 28 Pa. Code 211.10(c) Resident Care Policies 395602 Page 2 of 2