Health inspection·January 2, 2025

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record reviews and staff interviews, it was determined the facility failed to ensure that a dependent resident was provided with the necessary services to maintain personal hygiene by failing to provide showers as scheduled for one of six residents sampled (Resident CR1). Residents Affected - Few Findings include: A review of the clinical record revealed that Resident CR1 was admitted to the facility on [DATE], and had diagnoses, which included dementia (the loss of thinking, remembering, and reasoning to such an extent that it interferes with a person's daily life and activities) and a fracture of the right foot. The resident was discharged from the facility to home on December 16, 2024. A review of the resident's shower record revealed the resident was to be showered on Tuesdays and Fridays on the 3:00 PM to 11:00 PM shift. A review of the resident's shower schedule for the dates of November 26, 2024, through December 16, 2024, revealed the resident received a bed bath on November 26, November 29, December 3, December 6, December 10, and December 13, 2024. There was no documented evidence in the resident's clinical record or care plan of any resident refusals or reasons for providing a bed bath and not showering this resident as scheduled and as requested. Interview with the Nursing Home Administrator on January 2, 2025, at approximately 12:00 PM confirmed the facility failed to provide adequate services for personal hygiene to meet the residents' needs and preferences. 28 Pa Code 211.12 (d)(5) Nursing services. Page 1 of 3 395651 395651 01/02/2025 Birchwood Rehabilitation & Healthcare Center 395 Middle Road Nanticoke, PA 18634

F 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm Based on review of select facility policy and clinical records, and staff interview it was determined the facility failed to timely monitor the nutritional parameters of a resident with an identified significant weight loss for one of six residents sampled (Resident CR1). Residents Affected - Few Findings include: Review of the facility Weight Assessment and Intervention Policy last reviewed March 4, 2024, indicated that residents are monitored for undesirable or unintended weight loss or weight gain. Residents are weighed upon admission and at intervals established by the interdisciplinary team. Weights are recorded in each unit's weight record chart and in the individual's medical record. Any weight change of 5% or more since the last weight assessment is retaken the next day for confirmation. If the weight is verified, nursing will immediately notify the dietitian in writing. Unless notified of significant weight change, the dietitian will review the unit weight record monthly to follow individual weight trends over time. The threshold for significant unplanned and undesired weight loss will be based on the following criteria: 1 month- 5% weight loss is significant; greater than 5% is severe; 3 months- 7.5% weight loss is significant, greater than 7.5% is severe; 6 months- 10% weight loss is significant, greater than 10% is severe. If the weight change is desirable, this is documented. A review of Resident CR1's clinical record revealed admission to the facility on November 25, 2024, with diagnoses to include dementia (the loss of thinking, remembering, and reasoning to such an extent that it interferes with a person's daily life and activities) and fracture of the right foot. A review of the resident's weights noted the following: November 25, 2024- 165 pounds November 26, 2024- 165 pounds December 2, 2024- 152.2 pounds December 3, 3024- 152.2 pounds indicating a 12.8 pound weight loss or 7.8 % loss of body weight within eight days. Review of a dietary note dated December 12, 2024 (nine days after the weight loss occurred), noted the resident was at the facility for short-term rehabilitation. The note indicate the resident had a significant weight loss for one month which was unplanned and unfavorable. However, the note questioned the validity of the resident's initial weight. The note further indicated weight loss may be related to adjustment to facility and recent hospitalization. Physician, interdisciplinary team, and resident representative aware of weight change. The note recommended to continue weekly weights to monitor trend and add fortified foods to optimize PO (by mouth) intakes. Further review of the clinical record revealed no documented evidence that a weekly weight was obtained following the weight obtained on December 3, 2024. The resident was discharged from the facility to home on December 16, 2024. Interview with the Registered Dietitian on January 2, 2025, at approximately 11:30 AM confirmed the resident's weight loss was not timely addressed, a weekly weight was not obtained following the 395651 Page 2 of 3 395651 01/02/2025 Birchwood Rehabilitation & Healthcare Center 395 Middle Road Nanticoke, PA 18634

F 0692 weight loss on December 3, 2024, and failed to provide documented evidence the resident's physician and resident representative were timely notified of the significant weight loss. Level of Harm - Minimal harm or potential for actual harm 28 Pa Code 211.5(f)(ix) Medical records Residents Affected - Few 28 Pa. Code 211.12 (c)(d)(3)(5) Nursing services 395651 Page 3 of 3