Health inspection·May 1, 2025

F 0658 Ensure services provided by the nursing facility meet professional standards of quality. Level of Harm - Minimal harm or potential for actual harm Based on review of the Pennsylvania Code Title 49. Professional and Vocational Standards, facility job descriptions, clinical records, facility documents, and staff interviews, it was determined that the facility failed to follow nursing standards of practice to ensure the physician was contacted regarding an incomplete order prior to medication administration for one of eight residents reviewed (Resident R1). Residents Affected - Few Findings include: Review of Pennsylvania Code Title 49. Professional and Vocational Standards 21.11. General functions of the Registered Nurse (RN) (a)(4) stated, Carries out nursing care actions which promote, maintain and restore the well-being of individuals and (b) The RN is fully responsible for all actions as a licensed nurse and is accountable to clients for the quality of care delivered and (d) The Board recognizes standards of practice and professional codes of behavior, as developed by appropriate nursing associations, as the criteria for assuring safe and effective practice. Review of the facility's job description for RNs revealed The purpose of the RN is to deliver care to residents utilizing the nursing process of assessment, planning, intervention, implementation, and evaluation under the direction of the residents' attending physician. The RN will effectively interact with residents, family and other health team members while maintaining all standards of professional nursing. Review of Resident R1's clinical record revealed an admission date of 4/8/25, with diagnoses that included osteomyelitis (an infection in the bone), weakness, and type II diabetes (condition where the body does not use insulin properly). Resident R1's order summary revealed a physician's order for Piperacillin Sodium-Tazobactam Sodium Intravenous Solution Reconstituted 3.375 (3-0.375) grams (an antibiotic used to treat many different infections caused by bacteria), use 1 dose intravenously every 6 hours for 5 days. The physician's order lacked the amount the medication was to be reconstituted with and/or the rate the medication was to be administered. Resident R1's clinical record progress notes dated 4/8/25, documented that Resident R1 received his/her Piperacillin Sodium-Tazobactam Sodium Intravenous Solution Reconstituted 3.375 (3-0.375) grams at 8:08 p.m. and 11:36 p.m. and that the medication was reconstituted per instructions and on 4/9/25, that the Piperacillin Sodium-Tazobactam Sodium Intravenous Solution Reconstituted 3.375 (3-0.375) grams was administered at the wrong rate and route. Review of facility documents dated 4/10/25 and 4/15/25, revealed that the RN failed to ensure the Page 1 of 3 395607 395607 05/01/2025 Shippenville Nursing and Rehab 21158 Paint Boulevard Shippenville, PA 16254

F 0658 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few physician was contacted regarding an incomplete medication order prior to administering the medication for the first and second doses. During an interview on 4/30/25, at approximately 10:30 a.m. the Nursing Home Administrator confirmed that the RN failed to contact the physician regarding the incomplete medication order prior to the medication administrations that did not adhere to professional nursing standards. 28 Pa. Code 211.12(d)(1)(5) Nursing Services 395607 Page 2 of 3 395607 05/01/2025 Shippenville Nursing and Rehab 21158 Paint Boulevard Shippenville, PA 16254

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 review of clinical records and staff interview, it was determined that the facility failed to enter physician's orders timely resulting in a delay in treatment for one of eight residents reviewed (Resident R1). Residents Affected - Few Findings include: Review of Resident R1's clinical record revealed an admission date of 4/8/25, with diagnoses that included osteomyelitis (an infection in the bone), weakness, and type II diabetes (the body does not use insulin properly). Resident R1's clinical record revealed he/she arrived at the facility on 4/8/25, at approximately 10:00 a.m. His/her medication orders which included Piperacillin Sodium-Tazobactam Sodium Intravenous Solution Reconstituted 3.375 (3-0.375) grams (an antibiotic used to treat many different infections caused by bacteria) were not entered into the facility electronic health record system for the nurses to be alerted when the medication was due to be administered. This resulted in Resident R1 missing his/her noon dose of Piperacillin Sodium-Tazobactam Sodium Intravenous Solution Reconstituted 3.375 (3-0.375) grams and his/her 6:00 p.m. dose being administered late. During an interview on 4/30/25, at approximately 10:30 a.m. the Nursing Home Administrator confirmed that facility failed to enter the physician's orders timely which resulted in a missed and a late dose Resident R1's antibiotic medication. 28 Pa. Code 201.18(b)(1)(3) Management 28 Pa. Code 211.12(d)(1)(5) Nursing Services 395607 Page 3 of 3