Health inspection·May 8, 2025

F 0565 Honor the resident's right to organize and participate in resident/family groups in the facility. Level of Harm - Minimal harm or potential for actual harm Based on a review of facility policy, the minutes from facility Resident Council meetings, and grievances lodged with the facility, and resident and staff interviews, it was determined the facility failed to put forth sufficient efforts to promptly resolve continued resident complaints and grievances expressed during Resident Council meetings and verbal grievances, including those voiced by six of six residents attending a resident group meeting (Residents 16, 43, 62, 129, 32, and 71) and failed to keep the residents apprised of the status of the facility's decisions and efforts toward grievance resolution. Residents Affected - Few Findings include: A review of the facility's Grievance Policy last revised in December 2019 indicated the residents', families, and their representatives have the right to voice grievances concerning care and treatment, behavior of staff or other residents or any concerns regarding their stay. Further stating the grievance official or designee will meet with the resident to formally review the resolution to the grievance. A review of the Minutes from Resident Council meetings dated March 5, 2025, revealed concerns from residents that call bells were not answered timely. A grievance was filed on March 5, 2025, regarding this concern. Review of this grievance revealed no follow up was completed with the residents who raised this concern during resident council. There was no documented evidence of corrective actions taken to address this issue. A group meeting conducted on May 7, 2025, at 10:00 a.m. with six residents (Residents 16, 43, 62, 129, 32, and 71) revealed unanimous reports the facility failed to address their complaints regarding the timeliness of call bell response. The facility was unable to provide documented evidence that efforts had been made to resolve resident complaints concerning call bell timeliness as of the survey ending May 8, 2025, that had been brought up during resident council meeting. During an interview on May 8, 2025, at 9:10 a.m., the Nursing Home Administrator (NHA) and Director of Nursing (DON) confirmed the absence of documented actions addressing grievances raised during Resident Council meetings or verbal complaints. 28 Pa. Code 201.18 (e)(1)(4) Management 28 Pa. Code 201.29(a) Resident Rights Page 1 of 12 395625 395625 05/08/2025 Marywood Heights 2500 Adams Avenue Scranton, PA 18509

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 select facility policy, a review of clinical records and staff interviews it was determined the facility failed to provide nursing services consistent with professional standards of quality by failing to ensure that licensed nurses timely administered residents' medications for 2 of 18 residents reviewed. (Resident 9 and 41). Residents Affected - Some Findings included: According to the Pennsylvania Code, Title 49, Professional and Vocational Standards, State Board of Nursing, 21.11 (a)(1)(2)(4) indicates the registered nurse (RN) was to carry out nursing care actions that promote, maintain, and restore the well-being of individuals. The Pennsylvania Code, Title 49, Professional and Vocational Standards, State Board of Nursing, 21.145 Functions of the Licensed Practical Nurse (LPN) (a) The LPN is prepared to function as a member of the health-care team by exercising sound judgement based on preparation, 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. 21.148 Standards of nursing conduct (a) A licensed practical nurse shall: (5) Document and maintain accurate records. According to the American Nurses Association Principles for Nursing Documentation, nurses document their work and outcomes and provide an integrated, real-time method of informing the health care team about the patient status. Timely documentation of the following types of information should be made and maintained in a patient's EHR (electronic health record) to support the ability of the health care team to ensure informed decisions and high quality care in the continuity of patient care including Medication Records. A review of facility policy entitled: Medication Administration last reviewed by the facility on January 2, 2025, indicated that medications are administered within 60 minutes of their scheduled time. A review of the clinical record of Resident 9 revealed admission to the facility on June 7, 2024, with diagnoses which included unspecified dementia (a progressive loss of cognitive function) and muscle weakness. A review of Resident 9's Medication Administration Record for May 2025 revealed the resident was prescribed and scheduled to receive the following medications: Loratadine 10MG (antihistamine used to treat allergies) 1 tablet by mouth at 8:00 AM Duloxetine HCL 30MG (antidepressant) 1 capsule by mouth at 8:00 AM Lactobacillus Rhamnosus- (probiotic supplement used to treat digestive issues) 1 capsule by mouth at 08:00AM Glucosamine-Chondroitin 750/600 mg-(dietary supplement to treat joint disorders) 1 tablet by mouth at 08:00AM Triamterene-HCTZ 37.5-25MG (a water pill used to commonly treat high blood pressure)- 1 tablet by 395625 Page 2 of 12 395625 05/08/2025 Marywood Heights 2500 Adams Avenue Scranton, PA 18509

F 0684 mouth at 08:00AM Level of Harm - Minimal harm or potential for actual harm Allopurinol 100MG- (used to prevent gout and decrease uric acid levels)1 tablet by mouth at 08:00AM Metoprolol Succinate 50MG (used to treat high blood pressure)- 1 tablet by mouth at 08:00AM Residents Affected - Some Miralax Powder 17 GM- (used to treat constipation)1 scoop by mouth at 08:00AM Review of the resident's medication administration audit report for May 2025 indicated that on May 3, 2025, the medications scheduled for 8:00 AM were administered at 10:19 AM, 2 hours and 19 minutes after the scheduled time. On May 6, 2025, the scheduled 8:00 AM medications were administered at 10:23 AM, 2 hour and 23 minutes after the scheduled time. A review of the clinical record of Resident 41 revealed admission to the facility on July 16, 2024, with diagnoses, of Parkinson's disease (a progressive neurological disorder that affects movement causing tremors and stiffness of the muscles), and generalized muscle weakness. A review of Resident 41's Medication Administration Record for May 2025 revealed that the resident was prescribed and scheduled to receive the following medications: Carafate 1 GM/10ML (anti ulcer medication)- 10ML by mouth at 08:00AM Vitamin D 50mcg- 1 tablet by mouth at 08:00AM Sennosides 8. 6mg (used to treat constipation)- 2 tablets by mouth at 08:00AM Finasteride 5mg (used to treat difficult urination)-1 tablet by mouth at 08:00AM Carbidopa-Levodopa 25/100MG (used to treat Parkinson's disease)- 2 tablets by mouth at 08:00AM Protonix 40MG (used to treat stomach disease/ulcers)- 1 packet by mouth at 08:00AM Multivitamin- 1 tablet by mouth at 08:00AM Calcium Carb/Cholecalciferol 600 MG/10 MCG (calcium supplement)- 1 tablet by mouth at 08:00AM Liquacel Oral Solution (protein supplement)- 30 ml by mouth at 08:00AM Gabapentin 100MG (used to treat nerve pain)- 1 tablet by mouth at 08:00AM Folic Acid 1MG- 1 tablet by mouth at 08:00AM Lasix 20mg (diuretic or water pill)- 1 tablet by mouth at 08:00AM Toprol XL 25MG (used to treat high blood pressure)- 1 tablet by mouth at 08:00AM Klor-Con 20 mEq (potassium supplement)- 1 tablet by mouth at 08:00AM Review of the resident's medication administration audit report for May 2025 indicated that on May 395625 Page 3 of 12 395625 05/08/2025 Marywood Heights 2500 Adams Avenue Scranton, PA 18509

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 5, 2025, the medications scheduled for 8:00 AM were administered at 09:52 AM, 1 hour and 52 minutes after the scheduled time. On May 6, 2025, the medications scheduled at 08:00AM were administered at 10:54 AM, 2 hours and 54 minutes after the scheduled time. Interview with the Nursing Home Administrator on May 8, 2025, at approximately 2:45 PM confirmed that the late medication administration is not consistent with the professional standards and medications should be received in a timely manner. 28 Pa. Code 211.12 (c)(d)(1)(3)(5) Nursing Services 395625 Page 4 of 12 395625 05/08/2025 Marywood Heights 2500 Adams Avenue Scranton, PA 18509

F 0697 Provide safe, appropriate pain management for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record and select facility policy review and staff interview, it was determined the facility failed to provide effective pain management and administer pain medication as prescribed by the physician and failed to attempt non-pharmacological interventions to alleviate pain prior to the administration of a narcotic pain medication prescribed on an as needed basis for one resident out of 18 sampled residents (Resident 69). Residents Affected - Few Findings include: A review of the facility's policy entitled Pain Management with a policy review date of January 2, 2025, indicated that all residents are assessed for pain every shift by a nurse utilizing a 0 (zero) to 10 pain intensity scale (0 = no pain, 1,2, and 3 are classified as mild pain, 4, 5, 6, and 7 are classified as moderate pain, 8, 9, and 10 are classified severe pain). Non-pharmacological interventions may be effective for pain relief and might include ice packs, heat, (these require a physician's order) toileting, position changes, therapeutic touch, music, breathing exercise, distraction, and equipment such as a TENS (transcutaneous electrical nerve stimulation uses low voltage electrical current to relieve pain) unit (also requires a physician order). The nurse must assess for pain after utilizing these measures, which may be appropriate, and must note this in a progress note. A clinical record review revealed that Resident 69 was initially admitted to the facility on [DATE], and a more recent readmission to the facility on December 23, 2024, with diagnoses that included major depressive disorder (is a mood disorder that causes a persistent feeling of sadness and loss of interest that affects how one feels, thinks, and behaves and can lead to a variety of emotional and physical problems) with severe psychotic symptoms (is the term for a collection of symptoms that happen when a person has trouble telling the difference between what's real and what's not), lack of coordination, abnormal gait (walking patterns) and mobility, and history of fracture to the left pubis (left pelvis is the sturdy ring of bones located at the base of the spine). A review of the resident's physician's orders revealed an order dated September 28, 2024, at 6:18 PM, Acetaminophen Tablet 325 mg (milligrams), give 2 tablets by mouth every 4 hours PRN (as needed) for mild pain and Oxycodone HCl (an opioid analgesic used to treat moderate to severe pain) oral tablet 5 mg, give 5 mg by mouth every 5 hours PRN for pelvic pain. Additionally, the orders for Oxycodone HCl failed to specify a corresponding administration intensity scale. A review the resident's electronic Medication Administration Record (eMAR - is used to document medications taken by each resident) dated January 2025, revealed that the PRN Acetaminophen (non-opioid pain medication) ordered to manage mild pain and PRN Oxycodone HCl (opioid pain medication) were administered without any documented attempts of nonpharmacological interventions and administered outside of the prescribed physician orders/pain intensity scale on the following dates as follows. January 5, 2025, at 10:57 PM, administered PRN opioid pain medication for a reported pain level at 7 and without attempted nonpharmacological interventions. January 7, 2025, at 9:24 PM, administered PRN opioid pain medication for a reported pain level at 7 and without attempted nonpharmacological interventions. January 14, 2025, at 2:22 AM, administered PRN Acetaminophen for a reported pain level at 9 and 395625 Page 5 of 12 395625 05/08/2025 Marywood Heights 2500 Adams Avenue Scranton, PA 18509

F 0697 without attempted nonpharmacological interventions with pain level exceeding the mild pain intensity scale. Level of Harm - Minimal harm or potential for actual harm January 14, 2025, at 2:36 AM, administered PRN opioid pain medication for a reported pain level at 9 and without attempted nonpharmacological interventions. Residents Affected - Few January 14, 2025, at 9:45 AM, administered PRN opioid pain medication for a reported pain level at 7 and without attempted nonpharmacological interventions. January 15, 2025, at 3:04 AM, administered PRN Acetaminophen for a reported pain level at 3 and without attempted nonpharmacological interventions. January 15, 2025, at 5:22 PM, administered PRN opioid pain medication for a reported pain level at 7 and without attempted nonpharmacological interventions. January 15, 2025, at 10:00 PM, administered PRN opioid pain medication for a reported pain level at 7 and without attempted nonpharmacological interventions. January 16, 2025, at 7:26 PM, administered PRN opioid pain medication for a reported pain level at 8 and without attempted nonpharmacological interventions. January 17, 2025, at 7:25 PM, administered PRN opioid pain medication for a reported pain level at 7 and without attempted nonpharmacological interventions. January 18, 2025, at 2:48 AM, administered PRN opioid pain medication for a reported pain level at 8 and without attempted nonpharmacological interventions. January 18, 2025, at 5:23 AM, administered PRN opioid pain medication for a reported pain level at 7 and without attempted nonpharmacological interventions. January 18, 2025, at 11:26 PM, administered PRN opioid pain medication for a reported pain level at 8 and without attempted nonpharmacological interventions. January 20, 2025, at 3:29 PM, administered PRN opioid pain medication for a reported pain level at 8 and without attempted nonpharmacological interventions. January 21, 2025, at 10:00 PM, administered PRN opioid pain medication for a reported pain level at 6 and without attempted nonpharmacological interventions. January 22, 2025, at 9:01 AM, administered PRN opioid pain medication for a reported pain level at 5 and without attempted nonpharmacological interventions. January 23, 2025, at 3:18 PM, administered PRN opioid pain medication for a reported pain level at 7 and without attempted nonpharmacological interventions. January 24, 2025, at 5:17 AM, administered PRN opioid pain medication for a reported pain level at 8 and without attempted nonpharmacological interventions. January 24, 2025, at 4:14 PM, administered PRN opioid pain medication for a reported pain level at 395625 Page 6 of 12 395625 05/08/2025 Marywood Heights 2500 Adams Avenue Scranton, PA 18509

F 0697 7 and without attempted nonpharmacological interventions. Level of Harm - Minimal harm or potential for actual harm January 24, 2025, at 8:58 PM, administered PRN Acetaminophen for a reported pain level at 3 and without attempted nonpharmacological interventions. Residents Affected - Few January 26, 2025, at 3:00 AM, administered PRN opioid pain medication for a reported pain level at 10 and without attempted nonpharmacological interventions. January 26, 2025, at 3:12 AM, administered PRN Acetaminophen for a reported pain level at 10 and without attempted nonpharmacological interventions with pain level exceeding the mild pain intensity scale. January 26, 2025, at 8:58 PM, administered PRN Acetaminophen for a reported pain level at 3 and without attempted nonpharmacological interventions. January 29, 2025, at 3:32 PM, administered PRN opioid pain medication for a reported pain level at 8 and without attempted nonpharmacological interventions. January 30, 2025, at 9:31 AM, administered PRN Acetaminophen for a reported pain level at 3 and without attempted nonpharmacological interventions. Further review of Resident 69's clinical record failed to consistently reveal that licensed nursing staff attempted to notify the resident's attending physician of increased complaints and effectively alleviate her increased pain intensity levels. Additionally, the facility failed to assure that licensed nursing staff attempted non-pharmacological interventions prior to administering analgesic pain medication that included opioids. An interview with the Director of Nursing (DON) on May 8, 2025, at 2:30 PM, confirmed that licensed nursing staff failed to timely notify the resident's attending physician of increased complaints to develop an effective pain management regime to manage Resident 69's increased pain intensity levels. The DON also confirmed that the facility could not provide documented evidence that licensed nursing staff attempted non-pharmacological interventions prior to the administration of opioid pain medication. 28 Pa. Code 211.5(f) Medical records 28 Pa. Code 211.12 (c)(d)(1)(5) Nursing Services 395625 Page 7 of 12 395625 05/08/2025 Marywood Heights 2500 Adams Avenue Scranton, PA 18509

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. Based on a review of controlled drug shift count records, and staff interview, it was determined the facility failed to implement procedures to promote accurate controlled medication records on two of two medication carts observed. Findings include: A review of facility policy entitled Marywood Heights Count Records last reviewed January 2, 2025, revealed controlled drugs are inventoried and documented under proper conditions in regard to security and state/federal regulations. Further the policy indicated Scheduled II medications are counted by the oncoming nurse and outgoing nurse at the change of each shift and documented on the individual shift count sheet for narcotics. A review of the facility Master Control Substance Log from the 215 to 271 nursing unit medication cart revealed the following: April 13, 2025, the day shift on coming nurse failed to sign that the narcotic count was completed and correct. April 13, 2025, the evening shift off going nurse failed to sign that the narcotic count was completed and correct. April 15, 2025, the night shift off going nurse failed to sign that the narcotic count was completed and correct. April 16, 2025, the day shift oncoming nurse failed to sign that the narcotic count was completed and correct. April 16, 2025, the evening shift oncoming nurse failed to sign that the narcotic count was completed and correct. April 16, 2025, the day shift off going nurse failed to sign that the narcotic count was completed and correct. April 16, 2025, the night shift oncoming nurse failed to sign that the narcotic count was completed and correct. April 16, 2025 the evening shift off going nurse failed to sign that the narcotic count was completed and correct. April 19, 2025, the night shift on coming nurse failed to sign that the narcotic count was completed and correct, April 20, 2025, the night shift off going nurse failed to sign that the narcotic count was completed and correct. An interview with Employee 1 LPN (licensed practical nurse) on May 6, 2025, at 9:05 AM confirmed 395625 Page 8 of 12 395625 05/08/2025 Marywood Heights 2500 Adams Avenue Scranton, PA 18509

F 0755 the narcotic sheet was not signed off by the off going and oncoming nurses on the above dates. Level of Harm - Minimal harm or potential for actual harm A review of the facility Master Control Substance Log from the 202 to 262-unit medication cart revealed the following: Residents Affected - Some May 2, 2025, the day shift off going nurse failed to sign the narcotic count was completed and correct. May 2, 2025, the night shift on coming nurse failed to sign the narcotic count was completed and correct. May 2, 2025, the night shift off going nurse failed to sign the narcotic count was completed and correct. An interview with Employee 2 RN (registered nurse) on May 6,2025, at 9:25 AM, confirmed the narcotic sheet was not signed by the off by the off going and oncoming nurses on the above dates. An interview on May, 6 2025, at approximately 1:45 PM, the Nursing Home Administrator confirmed the facility failed to demonstrate consistent implementation of procedures for promoting accurate controlled drug records. 28 Pa Code 211.12 (c)(d)(1)(3)(5) Nursing service 28 Pa Code 211.9 (c)(k) Pharmacy services 28 Pa Code 211.5(f)(x) Clinical records 395625 Page 9 of 12 395625 05/08/2025 Marywood Heights 2500 Adams Avenue Scranton, PA 18509

F 0757 Ensure each resident’s drug regimen must be free from unnecessary drugs. 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 clinical records, and staff interviews, it was determined the facility failed to ensure that a resident's drug regimen was free of unnecessary antibiotics for one out of 18 residents sampled (Resident 56). Residents Affected - Few Findings included: A review of Resident 56's clinical record revealed the resident was admitted to the facility on [DATE], with diagnoses to include senile degeneration of the brain (a decline in cognitive function associated with aging) and chronic lymphocytic leukemia (a slow growing cancer of the white blood cells). A nursing progress note dated April 23, 2025, indicated the resident was noted to have yellow discharge from his penis. The physician was notified, and an order was obtained for a Urinalysis with Culture and Sensitivity (UA C&S a laboratory test used to detect and identify bacteria or fungi in urine, A urine culture is a method to grow and identify bacteria that may be in the urine. The sensitivity test helps select the best medicine to treat the infection) to assess for possible infection. A nursing progress note dated April 24, 2025, at 10:22 AM documented that a urine sample was obtained from the resident, the progress note further revealed the resident's urine appeared concentrated (dark in color, indicating potential infection or dehydration) A review of a nursing progress notes dated April 25, 2025, at 10:40 AM revealed the resident's urinalysis results were received, and faxed to the physician with no new orders at the time. A review of a nursing progress notes dated April 25, 2025, at 1:37PM revealed a new order for Ciprofloxacin 500mg by mouth twice daily for 7 days for a diagnosis of a urinary tract infection. A review of the resident's laboratory report dated April 25, 2025, 10:10AM revealed the urine culture identified Morganella morganii (a rare infection of urinary tract, commonly associated with antibiotic resistance. These enzymes break down certain antibiotics making the bacteria resistant to these medications) with bacterial growth of 50,000- 100,000 CFU/ml. The report further indicated the prescribed antibiotic (Ciprofloxacin) was resistant to the bacteria found in the resident's urine, rendering the treatment ineffective. A review of Resident 56's Medication Administration Record (MAR) for April 2025 revealed the resident received eight (8) doses of Ciprofloxacin, an unnecessary antibiotic, even though the culture and sensitivity results confirmed the prescribed medication was ineffective. During an interview with the Director of Nursing (DON) on May 8, 2025, at approximately 1:15 PM, the DON confirmed the administration of Ciprofloxacin was not clinically justified, as the prescribed antibiotic was ineffective against the identified organism. The DON acknowledged the resident received an unnecessary medication, which did not align with evidence-based infection control and antimicrobial stewardship practices. 28 Pa. Code 211.2(d)(3)(5) Medical Director 28 Pa. Code 211.12(d)(3)(5) Nursing services 395625 Page 10 of 12 395625 05/08/2025 Marywood Heights 2500 Adams Avenue Scranton, PA 18509

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 observation, select facility policy review and staff interview, it was determined the facility failed to implement procedures to ensure acceptable storage for medications on one of two nursing units observed. Findings include: A review of facility policy titled Disposal of Medications and Medication Related Supplies, last reviewed by the facility in January 2, 2025, revealed that discontinued medications and mediations left in the facility after a resident's discharge, which do not qualify for return to the pharmacy for credit, are destroyed. Observation of the medication storage room on May 6,2025, at 8:44 AM revealed an unsecured, opened white paper bag located on the counter of the medication room. The bag contained the following: Two separate rolls of medication packets, one roll containing 46 packets of medications, the second roll contained 29 packets of medications. One box containing two tabletss of Cefdinir (antibiotic). A clear plastic envelope containing two capsules of tizanidine (a muscle relaxant). One clear plastic envelope containing two tablets of Furosemide (a diuretic). A clear plastic envelope contained seven tablets of Potassium Chloride (a mineral supplement). 11 tabs of Torsemide (a diuretic). 14 tablets of Cefuroxime Axetil (an antibiotic). One box of Enalapril- HCTZ (blood pressure medication). One box containing four capsules of Doxycycline(antibiotic). One box containing 14 tabs of Olanzapine (an antipsychotic medication). One clear plastic envelope containing 20 tablets of Escitalopram(an antidepressant). A clear plastic envelope containing four tablets of Metoprolol Tartrate (blood pressure medication). A clear plastic envelope containing Metoprolol Succinate (blood pressure medication). One clear plastic envelope containing 12 tablets of Vitamin D3. A clear plastic envelope containing three tablets of Vitamin C. 395625 Page 11 of 12 395625 05/08/2025 Marywood Heights 2500 Adams Avenue Scranton, PA 18509

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Interview with Employee 1 a licensed practical nurse (LPN) during the time of the observation, confirmed the medications were all discontinued resident medications that were removed from the medication carts and brought into the medication storage room to be destroyed or returned to the pharmacy. Employee 1 indicated the medications are destroyed when the nurses have time. Employee 1 further stated she was a new employee to the facility and was unsure if she was allowed to destroy the medications without another nurse present. Employee 1 was uncertain of the timeframe which the pharmacy picks up discontinued medication. Interview the Director of Nursing (DON) and the Nursing Home Administrator on May 6,2025 at 1:45 PM confirmed the expectation was that discontinued resident medications would be removed from the medication cart by a licensed nurse and destroyed or returned to pharmacy per facility policy. 28 Pa. Code 211.9 (a)(1)(k) Pharmacy Services 28 Pa. Code 211.12 (d)(3)(5) Nursing services 395625 Page 12 of 12