Health inspection·February 16, 2024

F 0610 Respond appropriately to all alleged violations. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy, clinical records, facility documents, and staff interview, it was determined that the facility failed to fully investigate alleged allegation of abuse/neglect for one of three residents (Resident R10). Residents Affected - Few Findings include: Review of the facility policy J-5-O Prohibition and Prevention of Resident Abuse, Neglect, Exploitation, Mistreatment, or Misappropriation of Resident Property dated [DATE], indicated to assure a timely, thorough, and objective investigation of all allegations of abuse, neglect exploitation, mistreatment, or misappropriation of resident property. The Investigation Statement form should include a graphic description if physical abuse is suspected. Be sure to include a description of the scene, positioning of resident and staff, time, nature of injury, etc. Review of the admission record indicated Resident R10 was admitted to the facility on [DATE]. Review of Resident R10's Minimum Data Set (MDS- a periodic assessment of care needs) dated [DATE], indicated the diagnoses of high blood pressure, heart failure (the heart doesn't pump blood as well as it should), and Parkinson's Disease (disorder of the nervous system that results in tremors). Review of Resident R10's incident report dated [DATE], at 8:00 p.m. indicated resident noted with a skin tear to right lower leg as he was being readied for bed. A trickle of bright red blood present, stopped with slight pressure. Review of facility provided Risk Management Report dated [DATE], indicated Nurse Aides (NA) Employee E3 and Employee E4 reported to Registered Nurse (RN) Employee E5 that they noticed a skin tear on Resident R10's right lower leg when getting him ready for bed. Review of NA Employee E3's Investigation Statement dated [DATE], indicated right lower leg skin tear was noted when getting client ready for bed. Review of NA Employee E4's Investigation Statement dated [DATE], indicated Pulled down pants, skin tear left lower leg. Review of Resident R10's second incident report dated [DATE], at 8:00 p.m. indicated during evening care the staff observed a horizontal skin tear to resident's right great toe at the bottom of the toe. Page 1 of 7 395605 395605 02/16/2024 St Barnabas Nursing Home 5827 Meridian Road Gibsonia, PA 15044

F 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of facility provided Risk Management Report dated [DATE], indicated NA Employee E6 got RN Employee E7 to further assess Resident R10. Resident noted to have a cut to the bottom of the right great toe. Moderate amount of bleeding. Review of NA Employee E6's Investigation Statement dated [DATE], indicated I was getting resident ready for bed. I took his sock off. His toe started to bleed. Review of RN Employee E7's Investigation Statement dated [DATE], indicated NA Employee E6 got RN Employee E7 to further assess Resident R10. Resident noted to have a cut to the bottom of the right great toe. Moderate amount of bleeding. Interview with the Director of Nursing (DON) on [DATE], at 1:00 p.m. indicated that it was not noticed that both injuries occurred during undressing the resident and that normally the DON would interview employees until finding the employee who last observed the skin intact. The Director of Nursing further indicated that the facility failed to include a description of the scene or positioning of resident and staff at the time. Interview with the Director of Nursing on [DATE], at 2:10 p.m. indicated there was not a thorough investigation completed, and the only witness statements obtained were from staff involved at the time, that the facility failed to fully investigate (interviewing all potential witnesses and to interview other staff members who had contact with Resident R10), alleged allegation of abuse/neglect for one of three residents (Resident R10). 28 Pa. Code: 201.29(b)(d)(j) Resident rights. 28 Pa. Code: 201.14 (a) Responsibility of licensee. 28 Pa. Code: 211.12 (d) (1) Nursing services. 395605 Page 2 of 7 395605 02/16/2024 St Barnabas Nursing Home 5827 Meridian Road Gibsonia, PA 15044

F 0625 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy, clinical records, and resident and staff interview, it was determined that the facility failed to notify the resident or resident's representative of the facility bed-hold policy (an agreement for the facility to hold a bed for an agreed upon rate during a hospitalization) for two of four resident hospital transfers (Resident R11). Findings Include: The facility policy A-16: Bed Hold, dated 1/8/24, indicated the Bed Hold policy is given at the time of admission. When a resident is sent to the hospital or goes on therapeutic leave, a copy should be sent with the patient. All residents and/or resident representative should be contacted for a bed hold and they will be reminded of the 15 day bed hold for Medicaid. Review of the admission record indicated Resident R11 admitted to the facility on [DATE]. Review of Resident R11's Minimum Data Set (MDS - a periodic assessment of care needs) dated 2/3/24, indicated the diagnoses of high blood pressure, anemia (the blood doesn ' t have enough healthy red blood cells), and hemiparesis (paralysis of one side of the body). Review of Resident R11's physician order dated 12/26/23, indicated send resident to the hospital for evaluation after updating the mother of current status. Review of Resident R11's clinical record failed to include documented evidence that the resident or the resident's representative were provided with written information about the facility's bed hold policy at the time of the transfer to the hospital on [DATE]. Review of Resident R11's physician order dated 1/19/24, indicated to discharge to hospital for evaluation and treatment. Review of Resident R11's clinical record failed to include documented evidence that the resident or the resident's representative were provided with written information about the facility's bed hold policy at the time of the transfer to the hospital on 1/19/24. Interview on 2/15/24, at 10:17 a.m. Registered Nurse Assessment Coordinator (RNAC) Employee E2 confirmed the facility failed to notify Resident R11 or their representative of the facility bed-hold policy as required. 28 Pa. Code: 201.29(b)(d)(j) Resident rights. 395605 Page 3 of 7 395605 02/16/2024 St Barnabas Nursing Home 5827 Meridian Road Gibsonia, PA 15044

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 facility policy and clinical records and staff interviews it was determined that the facility failed to make certain that resident assessments were accurate for two of five hospice residents (Resident R10 and R25). Residents Affected - Few Findings include: Review of the Resident Assessment Instrument (RAI) Manual (provides instructions and guidelines for completing a Minimum Data Set Section (MDS-periodic assessment of care needs) dated October 2023, Section O: Special Treatments, Procedures, and Programs. The intent of the items in this section is to identify any special treatments, procedures, and programs that the resident received or performed during the specified time periods. Code residents identified as being in a hospice program for terminally ill persons. Review of the admission record indicated Resident R10 was admitted to the facility on [DATE]. Review of Resident R10's MDS dated [DATE], indicated the diagnoses of high blood pressure, heart failure (the heart doesn't pump blood as well as it should), and Parkinson's Disease (disorder of the nervous system that results in tremors). Review of Resident R10's physician order summary indicted an order dated 2/15/23, for hospice care. Review of Resident R10's care plan dated 2/15/23, indicated the resident has a terminal prognosis related to Parkinson's disease and is receiving hospice care. Further review of Resident R10's MDS dated [DATE], Section O failed to indicate hospice services as required. Interview on 2/15/24, at 11:15 a.m., Licensed Practical Nurse Assessment Coordinator (LPNAC) Employee E1 confirmed Resident R10's MDS dated [DATE], Section O failed to indicate hospice as required. Review of admission record indicated Resident R25 was admitted to the facility 10/4/22. Review of Resident R25's MDS dated [DATE], indicated the diagnoses of high blood pressure, cerebrovascular accident (Occurs when the supply of blood to the brain is reduced or blocked completely, which prevents brain tissue from getting oxygen and nutrients), and dementia (a group of symptoms that affects memory, thinking and interferes with daily life). Review of Resident R25's physician order summary indicated an order dated 11/2/22, for hospice care. Review of Resident R25's care plan dated 11/3/22, indicated the resident has a terminal prognosis and is receiving hospice care. Further review of Resident R25's MDS dated [DATE], Section O failed to indicate hospice services as required. 395605 Page 4 of 7 395605 02/16/2024 St Barnabas Nursing Home 5827 Meridian Road Gibsonia, PA 15044

F 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview on 2/14/24, at 2:44 p.m., LPNAC Employee E1 confirmed Resident R25's MDS dated [DATE]. Section O failed to indicate hospice as required. Interview on 2/16/24, at 1:30 p.m., Nursing Home Administrator (NHA) and Director of Nursing (DON) confirmed that the facility failed to make certain that resident assessments were accurate for two of five hospice residents (Resident R10 and R25) reviewed. 28 Pa. Code 211.5 (f)(g)(h) Clinical records 28 Pa. Code: 211.12 (d) (1) Nursing services. 395605 Page 5 of 7 395605 02/16/2024 St Barnabas Nursing Home 5827 Meridian Road Gibsonia, PA 15044

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review, observations, and staff interviews, it was determined that the facility failed to provide appropriate respiratory care for one of two residents (Resident R158). Residents Affected - Few Findings include: Review of federal guidance § 483.25(i) Respiratory care, including tracheostomy care and tracheal suctioning. The facility must ensure that a resident who needs respiratory care, including tracheostomy care and tracheal suctioning, is provided such care, consistent with professional standards of practice, the comprehensive person-centered care plan, the residents' goals and preferences. Review of facility policies failed to reveal a policy for oxygen therapy. Review of the clinical record indicated that Resident R158 was admitted to the facility on [DATE]. Review of Resident R158's Minimum Data Set (MDS - a periodic assessment of care needs) dated 2/5/24, indicated diagnoses aspiration pneumonia (inhalational acute lung injury that occurs from body fluids or matter leak into the lungs from the stomach or mouth), anemia (a deficiency of healthy red blood cells), and high blood pressure. Review of Section O - Special Treatments, Procedures, and Programs, Sub-section O0110C, Oxygen Therapy failed to indicate that oxygen therapy was performed within the last 14 days. During an observation on 2/13/24, at 9:15 a.m., Resident R158 was observed receiving 2 liters per minute of oxygen via a nasal cannula (lightweight tube placed in the nostrils to provide oxygen). Review of Resident R158's active physician orders failed to reveal an order for oxygen use or an order to change respiratory tubing. Review of Resident R158's current plan of care, initiated 2/6/24, updated 2/12/24, indicated resident has potential for behavioral problems; removing O2 (oxygen) cannula and dropping on floor. Interventions revised on 2/12/24, indicated to remind resident of need to keep oxygen on, and staff to attempt to reapply oxygen cannula when resident has been noted to remove. Review of Resident R158's Admission/readmission assessment dated [DATE], indicated oxygen use at 2 liters, and Comments: Resident on 2L (liters) of O2 with Sat of 100% Hospital reports if taken off quickly drops to upper 80's. Review of Resident R158's Skilled Days Charting, dated 2/13/24, indicated that on 2/13/24, at 6:39 p.m., Most Recent O2 sats: 97%; method: Oxygen via Nasal. Further review indicated that oxygen is being used, 2 liters via nasal cannula. Review of Resident R158's Skilled Night Charting, dated 2/14/24, indicated that oxygen is being used, 2 lpm (liter per minute) via nasal cannula, and Comments: Removes oxygen frequently as hs, applied as needed. 395605 Page 6 of 7 395605 02/16/2024 St Barnabas Nursing Home 5827 Meridian Road Gibsonia, PA 15044

F 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of Resident R158's Skilled Days Charting, dated 2/14/24, indicated that oxygen is being used, 2 lpm (liter per minute) via nasal cannula. Review of Resident R158's Skilled Night Charting, dated 2/15/24, indicated that oxygen is being used, 2 lpm (liter per minute) via nasal cannula, and Comments: Removes oxygen frequently as hs, applied as needed. Review of Resident R158's progress notes dated 2/13/24, at 4:44 a.m., indicated resident takes O2 off multiple times during the night. Review of Resident R158's progress notes dated 2/12/24, at 2:49 p.m., indicated Lung sounds clear but diminished on 2L via nasal cannula. During an interview on 2/15/24, at 2:00 p.m., the Director of Nursing (DON) confirmed that the facility does not have a policy for oxygen therapy. The DON also at this time confirmed that Resident R158 does not have a physicians order for oxygen therapy. During an interview on 2/15/24, at 2:05 p.m., the Director of Nursing confirmed that the facility failed to provide appropriate respiratory care for one of two residents (Resident R158). 28 Pa. Code: 201.14(a) Responsibility of licensee. 28 Pa. Code 211.12(d)(1)(2)(3)(5) Nursing services 395605 Page 7 of 7