Health inspection·November 10, 2022

F 0554 Allow residents to self-administer drugs if determined clinically appropriate. 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 and clinical record, observations and resident and staff interviews, it was determined that the facility failed to determine it was safe to self administer medications for one of eight residents (Resident R70). Residents Affected - Few Findings include: Review of facility policy Self Administration of Medications last updated 6/24/22, indicated if the resident does desire to self administer medications, the nurse will complete the medication self administration assessment, physician orders are obtained for self administration, the residents care plan will be initiated or updated to reflect self administration of medications. Review of Resident R70's Minimum Data Set (periodic review of care needs) dated 11/3/22, indicated she was admitted on [DATE], her Brief Interview of Mental Status (test of cognitive abilities) score was 15 (highest score possible) and her current diagnosis included seasonal allergies, high blood pressure and anxiety. Review of R70's physician order dated 7/27/22, indicated she was ordered Flonase (treats seasonal allergies) one spray in both nostrils one time a day, and did not include an order for self administration. Review of R70's clinical record did not include a self administration assessment, or care planning for self administration of medications. During an interview of Resident R70 on 11/7/22, at 11:21 a.m. the resident had her Flonase on her bedside table and indicated she used it to thin her phlegm. During a second interview of Resident R70 on 11/9/22, 10:28 a.m. the resident had her Flonase on her bedside table and indicated she used to thin her phlegm. During an interview of Resident R70's assigned nurse on 11/9/22, at 10:35 a.m. Licensed Practical Nurse Employee E6 confirmed that she left the Flonase in the residents room for her to self administer. During an interview on 11/10/22, at 10:35 a.m. the Director of Nursing confirmed that Resident R70 was self administering her Flonase and the facility failed to have a physician order for self administration, a self administration assessment, or care planning for self administration of medications. Page 1 of 10 395624 395624 11/10/2022 Wecare at Rolling Meadows Rehab and Nursing Ce 107 Curry Road Waynesburg, PA 15370

F 0554 28 Pa. Code 211.12(d)(1) Nursing Services. Level of Harm - Minimal harm or potential for actual harm Previously cited 6/27/22. 28 Pa. Code 211.12(d)(2)(3) Nursing Services. Residents Affected - Few 395624 Page 2 of 10 395624 11/10/2022 Wecare at Rolling Meadows Rehab and Nursing Ce 107 Curry Road Waynesburg, PA 15370

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 facility policy, clinical records, and staff interviews, it was determined that the facility failed to notify physicians of increased and decreased Capillary Blood Glucose (CBG) levels, and failed to assess residents for hyperglycemia (high blood glucose) and hypoglycemia (low blood glucose), for two of six Residents (Residents R22, and R32). Residents Affected - Few Findings include: The Centers for Disease Control defines diabetes as: Diabetes Mellitus is a chronic (long-lasting) health condition that affects how your body turns food into energy. Most of the food you eat is broken down into sugar (also called glucose) and released into your bloodstream. When your blood sugar goes up, it signals your pancreas to release insulin. Insulin acts like a key to let the blood sugar into your body's cells for use as energy. If you have diabetes, your body either doesn't make enough insulin or can't use the insulin it makes as well as it should. When there isn't enough insulin or cells stop responding to insulin, too much blood sugar stays in your bloodstream. Over time, that can cause serious health problems, such as heart disease, vision loss, and kidney disease. Hypoglycemia is a condition that occurs when blood glucose is lower than normal, usually below 70 milligrams per deciliter (mg/dl). If left untreated, hypoglycemia may lead to weakness, confusion, unconsciousness, arrhythmias and even death. People with Diabetes Mellitus may be prescribed injectable insulin to assist in maintaining acceptable levels of CBG's. Hyperglycemia, or high blood glucose, occurs when there is too much sugar in the blood. This happens when your body has too little insulin. Hyperglycemia is blood glucose greater than 125 mg/dL while fasting (not eating for at least eight hours, or a blood glucose greater than 180 mg/dL one to two hours after eating. If you have hyperglycemia and it's untreated for long periods of time, you can damage your nerves, blood vessels, tissues and organs. Damage to blood vessels can increase your risk of heart attack and stroke, and nerve damage may also lead to eye damage, kidney damage and non-healing wounds. Review of the facility policy Hypoglycemia - Diabetic Management last reviewed 6/24/22, indicated the charge nurse/unit manager will assess the resident's status, provide interventions, re-check the blood glucose in 15 minutes, notify the physician if indicated, and document the episode, assessment, and treatment in the nurse's progress notes. Review of the facility policy Hyperglycemia Management - Diabetes Management last reviewed 6/24/22, indicated the charge nurse/unit manager will assess the resident's status and notify the physician if blood glucose is over 350 or the prescribed parameters, re-check the blood glucose in one hour, and document the episode, assessment, and treatment in the nurse's progress notes. Review of the clinical record revealed Resident R22 was admitted to the facility on [DATE], with diagnoses that included diabetes, high blood pressure, and depression. Review of the Minimum Data Set (MDS - a mandated assessment of a resident's abilities and care needs) dated 11/4/22, indicated the diagnoses remain current. Review of a physician order dated 4/6/22, indicated to check CBG at bedtime, and Glucagon (a natural substance that raises blood sugar by causing the body to release sugar stored in the liver) Emergency kit 1 mg to be injected intramuscularly as needed for hypoglycemia below 70. 395624 Page 3 of 10 395624 11/10/2022 Wecare at Rolling Meadows Rehab and Nursing Ce 107 Curry Road Waynesburg, PA 15370

F 0684 Level of Harm - Minimal harm or potential for actual harm Further review of a physician order dated 5/6/22, indicated to check CBG before meals with sliding scale insulin coverage. Review of the clinical record electronic Medication Administration Record (eMAR) revealed that the resident's CBG's were as follows: Residents Affected - Few On 5/30/22, at 3:35 a.m., CBG was noted to be 53. On 5/30/22, at 4:11 p.m., CBG was noted to be 53. On 7/2/22, at 5:17 p.m., CBG was noted to be 65. On 7/9/22, at 9:09 p.m., CBG was noted to be 427. On 8/15/22, at 2:29 p.m., CBG was noted to be 63. On 8/24/22, at 6:13 p.m., CBG was noted to be 57. On 8/26/22, at 3:34 p.m., CBG was noted to be 54 On 9/24/22, at 4:39 p.m., CBG was noted to be 65. On 10/7/22, at 4:01 p.m., CBG was noted to be 59. On 10/8/22, at 3:39 p.m., CBG was noted to be 56. On 11/7/22, at 11:36 a.m., CBG was noted to be 68. Review of Resident R22's eMAR and clinical progress notes indicated the resident was not assessed for hypo/hyperglycemia, Glucagon was not administered as ordered, and the physician was not notified of abnormal results on the above listed dates. A review of the care plan dated 4/7/22, indicated to give diabetes medication as ordered and monitor/document side effects and effectiveness, and to monitor/document/report signs and symptoms of hyperglycemia and hypoglycemia to MD as needed. Review of a clinical record indicated Resident R32 was admitted to the facility on [DATE], with diagnoses that included diabetes, depression, anxiety, and high blood pressure. Review of the MDS dated [DATE], indicated the diagnoses remain current. Review of a physician order dated 2/11/22, indicated to check CBG before meals with sliding scale insulin coverage. Review of Resident R32's eMAR revealed that the resident's CBG's were as follows: On 5/10/22, at 4:33 p.m., CBG was noted to be 440. On 5/10/22, at 9:29 p.m., CBG was noted to be 440. 395624 Page 4 of 10 395624 11/10/2022 Wecare at Rolling Meadows Rehab and Nursing Ce 107 Curry Road Waynesburg, PA 15370

F 0684 On 5/11/22, at 4:53 p.m., CBG was noted to be 448. Level of Harm - Minimal harm or potential for actual harm On 5/12/22, at 10:20 p.m., CBG was noted to be 439. On 5/13/22, at 8:56 p.m., CBG was noted to be 458. Residents Affected - Few On 5/15/22, at 8:03 p.m., CBG was noted to be 435. On 5/18/22, at 8:45 p.m., CBG was noted to be 401. On 5/19/22, at 5:04 p.m., CBG was noted to be 433. On 5/19/22, at 9:36 p.m., CBG was noted to be 405. On 5/27/22, at 11:45 p.m., CBG was noted to be 408. On 5/28/22, at 8:13 p.m., CBG was noted to be 495. On 5/31/22, at 8:38 p.m., CBG was noted to be 416. On 6/1/22, at 10:35 a.m., CBG was noted to be 409. On 6/1/22, at 4:40 p.m., CBG was noted to be 414. On 6/1/22, at 8:05 p.m., CBG was noted to be 438. On 6/8/22, at 8:28 p.m., CBG was noted to be 439. On 6/16/22, at 7:59 a.m., CBG was noted to be 419. On 6/17/22, at 10:18 p.m., CBG was noted to be 439. Review of Resident R32's eMAR and clinical progress notes indicated the resident was not assessed for hyperglycemia, and the physician was not notified of abnormal results on the above listed dates. A review of Resident R32's care plan dated 10/1/21, indicated to give diabetes medication as ordered and monitor/document side effects and effectiveness, and to monitor/document/report signs and symptoms of hyperglycemia to MD as needed. During an interview on 11/10/22, at 10:30 a.m., the Director of Nursing confirmed the facility failed to document hypo/hyperglycemic episodes, failed to follow hypoglycemic protocols, and failed to notify the MD of changes in condition for Residents R22, and R32. 28 Pa. Code 201.18 (b)(1) Management 28 Pa. Code 201.29(d) Resident Rights 28 Pa. Code 211.10 (c) Resident Care policies 395624 Page 5 of 10 395624 11/10/2022 Wecare at Rolling Meadows Rehab and Nursing Ce 107 Curry Road Waynesburg, PA 15370

F 0684 28 Pa. Code 211.10(d) Resident Care Policies Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code 211.12 (d)(1)(2)(3) Nursing services 28 Pa. Code 211.12 (d)(5) Nursing Services Residents Affected - Few 395624 Page 6 of 10 395624 11/10/2022 Wecare at Rolling Meadows Rehab and Nursing Ce 107 Curry Road Waynesburg, PA 15370

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on review of facility policies, observations, and staff interviews it was determined that the facility failed to accurately label and date open medications, and secure medications in four of six medication carts and to store medications at the correct temperatures in one of two medication rooms (Medication carts Zone 1, 2/4, and 7, and Medication Room A). Findings include: Review of facility policy Medication Labels last reviewed 6/24/22, indicated labels are permanently affixed to the outside of the prescription containers. That each prescription label must include the residents name. Review of facility policy Medication Administration last reviewed 6/24/22, indicated when opening a multi-dose container, the date opened shall be recorded on the container, insulin pens will be clearly labeled with the resident's name. Review of facility policy Medication Storage - Med Cart last reviewed 6/24/22, indicated the medication carts must be securely locked at all times when out of the nurse's view, and when the medication cart is not being used, it must be locked and parked at the nurse's station or inside the medication room. During an observation of the Zone 7 medication cart on 11/8/22, at 8:05 a.m. the following was observed: - One Levemir flex pen (prefilled pen to inject long acting insulin under the skin) failed to contain a label with the residents name. - Five Novolog flex pens (prefilled pen to inject short acting insulin under the skin) failed to contain a label with the residents name. - One Lispro pen (prefilled pen to inject fast acting insulin under the skin) failed to contain a label with the residents name. During an interview of Licensed Practical Nurse (LPN) Employee E1 on 11/8/22, at 8:05 a.m. confirmed the above observation of the Zone 7 medication cart, and that the facility failed to label prefilled insulin pens with the residents name. During an observation of the Zone 2/4 medication cart on 11/8/22, at 8:20 a.m. the following OTC medications were observed open without a date of opening:: One bottle -magnesium oxide 400 milligrams (mg - supplement) One bottle -vitamin D3 25 micrograms (mcg - supplement) One bottle -docusate sodium 100 mg (stool softener) 395624 Page 7 of 10 395624 11/10/2022 Wecare at Rolling Meadows Rehab and Nursing Ce 107 Curry Road Waynesburg, PA 15370

F 0761 One bottle -omeprazole 20 mg (stomach acid reducer) Level of Harm - Minimal harm or potential for actual harm One bottle -ibuprofen 200 mg (fever/pain relief) One bottle -melatonin 5 mg (sleep aid) Residents Affected - Some Three bottles -multi-vitamin (supplement) One bottle - acetaminophen 500 mg (pain/fever relief) Two bottles -ferrous sulfate 324 mg (iron supplement) One bottle -senna 8.6 mg (stool softener) Two bottles -aspirin 81 mg (fever/pain relief) One bottle -folic acid 1mg (supplement) During an interview on 11/8/22, at 8:25 a.m. Licensed Practical Nurse Employee E3 confirmed the OTC medications were not dated when opened in Medication Cart Zone 2/4. During an observation on 11/9/22, at 10:39 a.m. Medication Cart Zone 2/4 was observed unattended and unlocked at the A side Nurse's Station. During an interview on 11/9/22, at 10:40 a.m. Licensed Practical Nurse Employee E4 confirmed she left the medication cart unattended and unlocked when not in use. During an interview on 11/10/22, at 10:35 a.m. the Director of Nursing confirmed that the facility failed ensure medications were accurately labeled with the residents and dated when opened, and medication carts were secured, and that medications were stored at the correct temperatures. 28 Pa. Code 211.9(a)(1) Pharmacy services. 28 Pa. Code 211.12(d)(1)(5) Nursing services. 395624 Page 8 of 10 395624 11/10/2022 Wecare at Rolling Meadows Rehab and Nursing Ce 107 Curry Road Waynesburg, PA 15370

F 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on review of facility policy, observations and staff interviews, it was determined that the facility failed to properly store food products in two of three storage areas in the main kitchen (dry storage, and freezer). Residents Affected - Many Findings included: A review of facility policy Dry Food Policy dated 6/24/22, indicated food will be stored six inches from the floor, away from direct contact with walls and a minimum of 18 inches from the ceiling. A review of facility policy Food Storage - Refridgerators and Freezers dated 6/24/22, indicated food must be kept six inches off of the floor on an enclosed shelf. During an observation in the Main Kitchen on 11/7/22, at 9:04 a.m. the following was observed: - in the dry food storage room was one box was directly on the floor containing disposable bowls. - in the walk-in freezer there were two boxes stacked directly on the floor containing food products. During an interview on 11/7/22, at 9:10 a.m. the Kitchen Employee E2 confirmed that the facility failed to properly store supplies. 28 Pa. Code: 211.6(c) Dietary Services. 395624 Page 9 of 10 395624 11/10/2022 Wecare at Rolling Meadows Rehab and Nursing Ce 107 Curry Road Waynesburg, PA 15370

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on review of facility policy, observation, and staff interview it was determined that the facility failed to prevent the potential for cross-contamination during glucometer usage for one of two residents (Resident R54), and medication administration for one of two residents (Resident R72). Residents Affected - Few Findings include: A review of the facility policy Blood Glucose Monitor Device Cleaning and Disinfecting last reviewed 6/24/22, indicated the blood glucose monitor equipment will be cleaned and disinfected between resident use, utilizing a disposable germicidal bleach wipe. A review of the facility policy Medication Administration last reviewed 6/24/22, indicated staff shall follow established infection control procedures (e.g. handwashing, antiseptic technique, gloves, etc.) for the administration of medications. During an observation 11/8/22, at 8:01 a.m. Licensed Practical Nurse (LPN) Employee E3 did not clean the glucometer prior to, or after using it to check Resident R54's blood sugar level. During an observation on 11/8/22, at 8:10 a.m. LPN Employee E3 broke a narcotic medication pill (Oxycodone) in half with her fingers and removed two acetaminophen (pain reliever) tablets from the medication bottle by tipping the bottle on its side and pulling them out, one at a time, with her one-inch-long fingernail when preparing medications for Resident R72. LPN Employee E3 was not wearing gloves and had failed to wash her hands between residents. During an interview on 11/8/22, at 8:25 a.m. LPN Employee E3 confirmed that she did not clean the glucometer, that she touched the medications with her hands, and failed to complete handwashing as required. During an interview on 11/10/22, at 10:30 a.m. the Director of Nursing confirmed that the facility failed to prevent the potential for cross-contamination during the use of the glucometer, and medication administration. 28 Pa. Code: §201.14 (a) Responsibility of licensee. 28 Pa. Code: §201.18 (b)(1)(e)(1) Management. 28 Pa. Code: §211.10 (d) Resident care policies. 28 Pa. Code: §211.12 (d)(1)(2)(3)(5) Nursing services. 395624 Page 10 of 10