Health inspection·May 10, 2023

F 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of clinical records, observation, and resident and staff interviews, it was determined that the facility failed to allow residents the right to make choices about aspects of his or her life in the facility that are significant to the resident for four of 19 residents reviewed (Residents R38, R44, R47, and R49). Findings include: During an interview on 5/07/23, at 2:00 p.m. Resident R38 indicated he/she is unaware of any alternatives available and only eats what is delivered to him/her daily. Resident R38 indicated that if he/she does not like what is provided to her for a meal, the staff are reluctant to ask the kitchen for something different due to negative feedback from the kitchen for the added meal request. Resident R38 indicated he/she would request something different, if he/she knew there were other choices/alternatives for a meal. Resident R38 indicated there is a menu posted at the front of the facility, however, he/she does not go out of her room often and staff do not have time to go look at the menu for him/her, and sometimes when staff do attempt to look at the menu, it is incorrectly posted with prior day menu or no menu at all. A quarterly Minimum Data Set (MDS- periodic assessment of resident care needs) dated 3/31/23, identified that Resident R38 had a Brief Interview for Mental Status (BIMS-tool used to assess cognitive status) score of 15 (a score from 15 to 15 indicating intact cognition, or mental status). During an interview on 5/07/23, at 2:15 p.m. Resident R49 indicated he/she is unaware of any alternatives available and only eats what is delivered to him/her daily. Resident R49 indicated that if he/she does not like what is provided to him/her for a meal, the staff are reluctant to ask the kitchen for something different due to negative feedback from the kitchen for the added meal request. A quarterly MDS dated [DATE], identified that Resident R49 had a BIMS score of 15 indicating intact cognition, or mental status. During an interview on 5/07/23, at 3:10 p.m. Resident R44 indicated he/she is unaware of any food choice alternatives available, and he/she only eats what is delivered to him/her daily for breakfast, lunch, and dinner. Resident R44 indicated he/she would definitely request something different occasionally, if he/she knew there were other choices/alternatives for a meal. A quarterly MDS dated [DATE], identified that Resident R44 had a BIMS score of 14, indicating intact cognition, or mental status. Page 1 of 6 395650 395650 05/10/2023 Warren Manor 682 Pleasant Drive Warren, PA 16365

F 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During an interview on 5/08/23, at 10:45 a.m. Resident R47 indicated he/she is unaware of any menu choice alternatives available for residents and eats what is under the tray due to not being aware that he/she had a choice of other food options. A quarterly MDS dated [DATE], identified that Resident R47 had a BIMS score of of 15, indicating intact cognition, or mental status. Observations on 5/07/23, through 5/08/23, of Resident R38, R44, R47, and R49's rooms revealed no menu and/or alternative menu choices in their rooms and no alternative menu choices at the front of the facility with the regular posted menu. During an interview on 5/09/23, at approximately 11:15 a.m. the Nursing Home Administrator (NHA) confirmed that some residents do not come out of their room and/or need assistance to come out of their room, furthermore, resulting in residents not having an opportunity to know what is being served for breakfast, lunch, and/or dinner. The NHA also confirmed that no menus and/or alternatives were provided to each resident in their rooms. 28 Pa. Code 201.29 (j) Resident rights 28 Pa. Code 201.18 (b)(1)(3) Management 28 Pa. Code 211.12(d)(1)(5) Nursing services 395650 Page 2 of 6 395650 05/10/2023 Warren Manor 682 Pleasant Drive Warren, PA 16365

F 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. Based on observations, review of facility records, and resident and staff interviews, it was determined that the facility failed to ensure sufficient nursing staff to assure residents attain or maintain the highest practicable physical, mental, and psychosocial well-being for five of 19 residents interviewed (Residents R28, R38, R44, R47, and R49). Findings include: During resident interviews on 5/07/23, from 1:30 p.m. to 3:30 p.m., 5/08/23, from 11:00 a.m. through 2:30 p.m., and 5/09/23, from 10:30 a.m. to 1:00 p.m., revealed that Resident R28, R38, R44, R47, and R49 verbalized that call bell response times were a concern with wait times of half hour or more. Residents verbalized it was common to wait for long periods of time related to insufficient staff on all shifts. During observations on 5/09/23, at approximately 11:00 a.m. Resident R28 was observed covered resting in bed with no clothes on from waist up and was requesting assistance to put a bra on. He/She indicated his/her call bell was on for over 15 minutes. Further observations at 11:15 a.m. revealed Resident R28 still resting in bed covered with no clothing on from waist up and call bell was still on. Further observations at 11:30 a.m. revealed Resident R28 laying in bed with a meal tray in front of him/her with no clothing on from waist up. Resident R28's call bell was off. Resident R28 verbalized, They turned my call bell off, sat the tray in front of me and left. There is just not enough of them, oh well. A review of a call log provided and confirmed by the Nursing Home Administrator (NHA) on 5/09/23, at approximately 1:00 p.m. revealed Resident R28's call bell was on for 42 minutes from 10:40 a.m. to 11:23 a.m. on 5/09/23. A review of Resident R28's Minimum Data Set (MDS-periodic assessment of resident care needs) Section G Activities of Daily Living (ADL) Assistance dated 2/03/23, revealed Resident R28 needs two + persons for assistance for bed mobility and one person assistance with dressing. Resident R28's Brief Interview of Mental Status (BIMS-tool used to assess cognitive status) dated 4/27/23, revealed a score of 12/15 which indicated moderately impaired cognitive status or mental status. During an interview on 5/07/23, Resident R38 verbalized that he/she needs assistance with meals. Resident R38 further indicated that staff will deliver his/her meal tray and start feeding him/her, but will need to step away to pass meal trays to other residents. When the staff return, Resident R38 indicated his/her food is always cold and unappealing. Resident R38 is noted to be followed by the dietitian for a weight loss. During observations on 5/09/23, at approximately 10:55 a.m. Resident R38 was observed resting in bed with his/her call bell on. Resident R38 indicated he/she needed to be changed related to being incontinent. Further observations at 11:20 a.m. revealed Resident R38's call bell still on with Resident R38 indicating no staff have been in room yet to check on resident's need. Further observations at 11:35 a.m. revealed that Resident R38's call bell was off, and he/she was not changed. Resident R38 indicated that he/she would wait to be changed until staff fed her, so his/her food would be warm. Resident R38 indicated that this happens on a daily basis due to not enough staff available to meet all the residents' needs, but he/she has been fed with no interruptions since Department of Health has been here for the past couple days. A review of a call log provided and confirmed by the Nursing Home Administrator (NHA) on 5/09/23, at approximately 1:00 p.m. revealed Resident R38's call bell 395650 Page 3 of 6 395650 05/10/2023 Warren Manor 682 Pleasant Drive Warren, PA 16365

F 0725 was on for 32 minutes from 10:53 a.m. to 11:25 a.m. on 5/09/23. Level of Harm - Minimal harm or potential for actual harm A review of Resident R38's MDS Section G ADL Assistance dated 4/06/23, revealed Resident R38 needs two + persons for assistance for bed mobility and dressing, two-person for assistance for transfers, and one-person assist with eating. Resident R38 had a BIMS score dated 3/31/23, of 15/15 which indicated intact cognition, or mental status. Resident R38's care plan dated 4/17/23, revealed interventions related to bladder incontinence and physical limitations requiring toileting assistance to check resident and assist to toilet every two hours and as required for incontinence. Residents Affected - Some A review of Grievances for the past three months revealed Resident R38's family member filed a grievance, dated 4/09/23, that Resident R38's call light was on and ignored. During an interview on 5/07/23, Resident R44 verbalized that he/she was left on the toilet for two hours recently. Resident R44 verbalized, The staff really try, but there is just not enough of them. A review of Resident R44's MDS Section G ADL Assistance dated 2/06/23, revealed Resident R44 needs one person for assistance for toileting. Resident R44's BIMS score dated 5/09/23, revealed a score of 14/15 which indicated intact cognition, or mental status. Resident R44's care plan dated 11/17/21, revealed interventions related to Parkinson's, weakness, immobility, impaired balance as assist required for toileting and extensive assist of one for transfers. During an interview on 5/8/23, Resident R47 verbalized he/she could wait an hour or more for staff to answer his/her call bell. Resident R47 indicated he/she could be incontinent of bowel and bladder and has to wait for long periods of time for staff to change him/her. Resident R47's BIMS score dated 3/24/23, revealed a score of 15/15 which indicated intact cognition, or mental status. A review of Resident R47's MDS Section G ADL Assistance dated 3/24/23, revealed Resident R47 needs one person for assistance for toileting. Resident R47's care plan dated 3/06/20, revealed interventions related to physical limitations requiring toileting assist and cognitive deficit as check resident/assist to toilet every two hours as required for incontinence. During an interview on 5/7/23, Resident R49 indicated he/she is used to waiting over 30 minutes when he/she presses the call bell for staff assistance. Resident R49's BIMS score dated 3/31/23, revealed a score of 15/15 which indicated intact cognition, or mental status. A review of Resident R49's MDS Section G ADL Assistance dated 4/04/23, revealed Resident R49 needs one person for assistance for transfers. Resident R49's care plan dated 3/30/23, revealed interventions related to a self care deficit, weakness, immobility, impaired balance as one assist needed for transfers and toileting. 28 Pa. Code 211.12(d)(4) Nursing services 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 201.18(a)(3) Management 395650 Page 4 of 6 395650 05/10/2023 Warren Manor 682 Pleasant Drive Warren, PA 16365

F 0732 Post nurse staffing information every day. Level of Harm - Potential for minimal harm Based on observations and staff interview, it was determined that the facility failed to ensure that the required nursing staffing information was posted on a daily basis. Residents Affected - Many Findings include: Observations on 5/7/23, at 3:20 p.m. revealed that the daily staffing posting was not publicly posted in the facility. During interview at the time of the observation, the lack of the posting was confirmed by the Director of Nursing. 28 Pa. Code 211.12 (c) Nursing services 395650 Page 5 of 6 395650 05/10/2023 Warren Manor 682 Pleasant Drive Warren, PA 16365

F 0842 Level of Harm - Minimal harm or potential for actual harm Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Based on review of facility policy and clinical records, and staff interview, it was determined that the facility failed to maintain complete and accurate clinical records for one of five residents reviewed (Resident R53). Residents Affected - Few Findings include: Review of facility policy entitled Documentation Policy dated 12/6/22, revealed that The Manor will provide a complete account of the resident's care, treatment, response to the care, signs, symptoms, etc., as well as the progress of the resident's care, (i.e., nursing progress notes, episodic charting, and plan of care.) Appropriate information to assist the physician in ordering medications, treatments, and diet. The purpose of the clinical record is to provide ongoing, individualized information regarding the status of the resident. Review of Resident R53's clinical record documented an admission date of 9/25/20, with diagnoses that included Type II Diabetes, Hyperlipidemia (High Cholesterol), Major Depressive Disorder, Insomnia (Difficulty Sleeping), and Muscle Weakness. Resident R53's clinical record documented that on 1/12/23, Resident R53 complained of pain with urination and disclosed that three days later on 1/15/23 he/she fell causing injuries which required transport to the ER, this transport resulted in an admission to the hospital. The clinical record documented Resident R53 returned from the hospital on 1/18/23 and was on an antibiotic to treat a urinary tract infection. There was no documented evidence in Resident R53's clinical record that the physician was updated regarding Residents R53's complaint of pain with urination. During an interview on 5/09/23, at approximately 12:00 p.m. the Director of Nursing confirmed that clinical record lacked evidence that the physician was contacted regarding Resident R53's complaint of painful urination. 28 Pa. Code 211.5(f) Clinical records 395650 Page 6 of 6