Health inspection·October 22, 2024

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of clinical records and staff interview it was determined the facility failed to develop and implement a comprehensive person-centered care plan that included specific and individualized interventions to address the resident's needs for intravenous medication administration through a central venous line (PICC catheter) to ensure the safe delivery of antibiotic medications and the care of the line for one out 5 residents sampled. (Resident 1). Findings include: A review of Resident 1's clinical record revealed the resident was admitted to the facility on [DATE], with diagnosis to include, bacterial meningitis (a very serious type of infection that can cause the tissues around the brain to swell, leading to long-term complications and even death) and was admitted to the facility with a PICC line (a peripherally inserted central catheter a long catheter introduced through a vein in the arm and passed through to the larger veins into the heart). An admission Minimum Data Set Assessment (MDS - a federally mandated standardized assessment conducted at specific intervals to plan resident care) dated October 7, 2024, revealed. the resident was severely cognitively impaired with a BIMS score of 5 (Brief Interview for Mental Status a tool to assess the resident's attention, orientation, and ability to register and recall new information a score of 0 through 7 indicates severe, cognitive impairment) , requires extensive staff assistance for activities of daily living, and was admitted on intravenous antibiotic medication delivered through a central venous catheter (PICC line). A review of the resident's plan of care dated October 2, 2024, revealed a care plan for the potential for complications at the IV (intravenous) insertion site. The goal was for the IV site to remain free of signs and symptoms of infection. Interventions included, change the IV site dressing per physician order and as needed if soiled or wet and change IV tubing per physician order or per protocol. A review of physician's orders dated October 2, 2024, revealed the following: Monitor PICC site every shift for infection, line fracture, breakage, dislodgement, pain or swelling every shift and document findings in progress notes. Measure PICC line on admission and every day shift every seven day and record measurement in the progress notes. Page 1 of 6 395623 395623 10/22/2024 Grandview Nursing and Rehabilitation 78 Woodbine Lane Danville, PA 17821

F 0656 Change IV tubing every 72 hours. Level of Harm - Minimal harm or potential for actual harm Ensure emergency kit is at the bedside (hemostat{clamp to control bleeding}, tape & 4x4 gauze sponges). Change PICC dressing and clave caps(needleless connectors for IV access) every seven days. Residents Affected - Few Measure arm circumference on admission and every 72 hours. The above mentioned interventions were not on the resident's care plan at the time of the survey. During an interview October 22, 2024, at 2:00 PM the Director of Nursing confirmed the facility failed to ensure that comprehensive care plans were fully developed and implemented. 28 Pa Code 211.12 (d)(5) Nursing services 395623 Page 2 of 6 395623 10/22/2024 Grandview Nursing and Rehabilitation 78 Woodbine Lane Danville, PA 17821

F 0658 Ensure services provided by the nursing facility meet professional standards of quality. 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, facility policy review and staff interview, it was determined the facility failed to ensure that nursing services met professional standards of quality according to the Pennsylvania Code Title 49, Professional and Vocational Standards, by failing to implement nursing practices for the administration of an intravenous medication via central venous catheter for one of 5 residents reviewed (Resident 1). Residents Affected - Some Findings include: According to the Pennsylvania Code Title 49, Professional and Vocational Standards Department of State, Chapter 21 State Board of Nursing, Chapter 21.145 Functions of the LPN (Licensed Practical Nurse) requires the following: The LPN is prepared to function as a member of the health care team by exercising sound nursing judgement based on preparations, knowledge, skills, understandings, and past experiences in nursing situations. The LPN participates in the planning, implementation, and evaluation of nursing care in settings where nursing takes place. (b) The LPN administers medication and carries out the therapeutic treatment ordered for the patient in accordance with the following: (d) The Board recognizes codes of behavior as developed by appropriate practical nursing associations as the criteria for assuring safe and effective practice. Chapter 21.145b. IV therapy curriculum requirements. (f) An LPN may perform only the IV therapy functions for which the LPN possesses the knowledge, skill, and ability to perform in a safe manner, except as limited under § 21.145a (relating to prohibited acts), and only under supervision. as required under paragraph (1). (1) An LPN may initiate and maintain IV therapy only under the direction and supervision of a licensed professional nurse or health care provider authorized. to issue orders for medical therapeutic or corrective measures (such as CRNP, physician, physician assistant, podiatrist, or dentist). (g) An LPN who has met the education and training requirements of § 21.145b (relating to IV therapy curriculum requirements) may perform the following IV therapy functions, except as limited under § 21.145a and only under supervision as required under subsection (f): (1) Adjustment of the flow rate on IV infusions. (2) Observation and reporting of subjective and objective signs of adverse reactions to any IV administration and initiation of appropriate interventions. 395623 Page 3 of 6 395623 10/22/2024 Grandview Nursing and Rehabilitation 78 Woodbine Lane Danville, PA 17821

F 0658 (3) Administration of IV fluids and medications. Level of Harm - Minimal harm or potential for actual harm (4) Observation of the IV insertion site and performance of insertion site care. Residents Affected - Some (5) Performance of maintenance. Maintenance includes dressing changes, IV tubing changes, and saline or heparin flushes. (6) Discontinuance of a medication or fluid infusion, including infusion devices. (7) Conversion of a continuous infusion to an intermittent infusion. (8) Insertion or removal of a peripheral short catheter. (9) Maintenance, monitoring and discontinuance of blood, blood components and plasma volume expanders. (10) Administration of solutions to maintain patency of an IV access device via direct push or bolus route. (11) Maintenance and discontinuance of IV medications and fluids given via a patient-controlled administration system. (12) Administration, maintenance and discontinuance of parenteral nutrition and fat emulsion solutions. (13) Collection of blood specimens from an IV access device. The facility failed to have a policy available to the survey team regarding LPN's providing care to and administering medications through a central catheter line (a thin, flexible tube that's inserted into a large vein in the body to provide fluids, medication, or blood transfusions). Clinical record review revealed that Resident 1 was admitted to the facility on [DATE] with diagnosis to include, bacterial meningitis (a very serious type of infection which can cause the tissues around the brain to swell, leading to long-term complications and even death) and was admitted to the facility with a PICC line (a peripherally inserted central catheter a long catheter introduced through a vein in the arm and passed through to the larger veins into the heart). A physician's orders dated October 2, 2024, revealed, Penicillin G Potassium in Dextrose (an antibiotic medication) Intravenous Solution 40000 UNIT/ML, Use 100 ml intravenously every 4 hours for bacterial meningitis for 27 Days. A review of an October 2024 Medication Administration Record (MAR) revealed that between October 3, 2024, and October 20, 2024, Employee 1, LPN, Employee 2, LPN, and Employee 3 LPN signed the MAR as administering the IV antibiotic medication to Resident 1 through the PICC line. There was no evidence the LPNs received education or had supervision regarding the administration of IV antibiotics through a PICC line. During an interview on October 23, 2024, at approximately 2:00 PM the director of nursing (DON) 395623 Page 4 of 6 395623 10/22/2024 Grandview Nursing and Rehabilitation 78 Woodbine Lane Danville, PA 17821

F 0658 confirmed that LPNs in the facility did not receive education regarding the administration of medications through PICC lines. Level of Harm - Minimal harm or potential for actual harm Refer F755 Residents Affected - Some 28 Pa. Code 201.20(a) Staff Development. 28 Pa Code 211.12(5) Nursing services. 395623 Page 5 of 6 395623 10/22/2024 Grandview Nursing and Rehabilitation 78 Woodbine Lane Danville, PA 17821

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of clinical records and staff interview, it was determined the facility failed to implement pharmacy procedures for medication administration and documentation for one of five residents sampled (Resident 1 ). Finding include: Clinical record review revealed that Resident 1 was admitted to the facility on [DATE] with diagnosis to include, bacterial meningitis (a very serious type of infection which can cause the tissues around the brain to swell, leading to long-term complications and even death) and was admitted to the facility with a PICC line (a peripherally inserted central catheter a long catheter introduced through a vein in the arm and passed through to the larger veins into the heart). A review of physician's orders dated October 2, 2024, revealed, Penicillin G Potassium in Dextrose (an antibiotic medication) Intravenous Solution 40000 UNIT/ML, use 100 ml intravenously every 4 hours for bacterial meningitis for 27 Days. A review of Resident 1's Medication Administration Record for October 2024 revealed on October 8, 2024, at 5:00 PM, October 10, 2024, at 1:00 AM, October 10, 2024, at 5:00 AM, October 19, 2024, at 1:00 PM, and October 21, 2024, at 1:00 PM the antibiotic was not documented as administered. During an interview October 22, 2024, at 2:00 PM, the Director of Nursing confirmed that on the above noted dates, it could not be determined if the doses of the antibiotic medication were administered to the resident. Refer F658 28 Pa Code 211.12 (d)(3)(5) Nursing services. 28 Pa Code 211.9 (a)(1)(j.1)(4)(k) Pharmacy services. 395623 Page 6 of 6