Health inspection·October 26, 2023

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 clinical record review and staff interview, it was determined that the facility failed to ensure that a physician's order was implemented for three of 12 sampled residents. (Residents 22, 23, 30) Residents Affected - Few Findings include: Clinical record review revealed that the physician directed staff to administer the following bowel protocol for Residents 22, 23, and 30: staff was to administer prune juice on day shift (7:00 a.m. to 3:00 p.m.) if the resident had no bowel movement (BM) in 72 hours. If prune juice was ineffective, staff was to administer milk of magnesia 24 hours later on evening shift (3:00 p.m. to 11:00 p.m.). If milk of magnesia was ineffective, a bisacodyl suppository was to be administered on night shift (11:00 p.m. to 7:00 a.m.). If the suppository was ineffective, an enema was to be administered on night shift, 24 hours later. Clinical record review revealed that Resident 22 was admitted to the facility on [DATE], with diagnoses that included dementia and constipation. On August 17, 2023, the physician directed staff to follow the bowel protocol as needed. The Minimum Data Set (MDS) assessment dated [DATE], indicated that the resident had memory impairment and was dependent on staff for toileting. Record review revealed that from October 7 through 11, 2023, the bowel protocol was not followed as ordered by the physician and the resident did not have a BM until October 11, 2023, at 10:39 p.m. Further review of the clinical record revealed that from October 11 through 15, 2023, the bowel protocol was not followed as ordered by the physician and the resident did not have a BM until October 15, 2023, at 1:29 p.m. Clinical record review revealed that Resident 23 was admitted to the facility on [DATE], with diagnoses that included dementia, stroke, and constipation. On November 24, 2020, the physician directed staff to follow the bowel protocol as needed. The MDS assessment dated [DATE], indicated that the resident had memory impairment and was dependent on staff for toileting. Review of nurse aide documentation revealed that the resident had a BM on October 18, 2023, at 9:15 p.m. Record review revealed that from October 18 through 24, 2023, the bowel protocol was not followed as ordered by the physician and the resident did not have a bowel movement until October 24, 2023, at 7:40 p.m. Clinical record review revealed that Resident 30 was admitted to the facility on [DATE], with diagnoses that included dementia and constipation. On April 27, 2022, the physician directed staff to follow the bowel protocol as needed. The MDS assessment dated [DATE], indicated that the resident had memory impairment and was dependent on staff for toileting. Review of Resident 30's medication administration record for September 2023, revealed that the resident had a BM after administration of prune juice on September 23, 2023, at 10:39 a.m. Further review revealed that from September 23, 2023, through October 1, 2023, the bowel protocol was not followed as ordered by the physician and the (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 2 Event ID: 395656 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 395656 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Frederick Living - Cedarwood 2849 Big Road Frederick, PA 19435 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)