Inspection·April 18, 2024

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 review of facility policy, review clinical records and interview with staff, it was determined that the facility failed to ensure that resident received medication in accordance with physician orders for one of 35 residents reviewed. (Resident R49) Residents Affected - Few Findings include: Review Facility Policy on Administering Medications dated April 1, 2022, revealed that under section Policy: Medications shall be administered in a safe and timely manner and as prescribed. Under section Protocol #2. The Director of Nursing Services will supervise and direct all nursing personnel who administer medications and or have related functions. #3 Medications must be administered in accordance with orders, including any required time frame. #4 If a dosage is believed to be inappropriate or excessive for a resident or a medication, has been identified as having potential adverse consequences for the resident, or is suspected of being associated with adverse consequences, the person preparing or administering the medication shall contact the resident's attending physician or medical director to discuss concerns. #8 Medications may not be prepared in advance and must be administered within one hour of their prescribed time unless otherwise specified, for example, before and after meals. #15 If a drug is withheld, refused, or given at a time other than the scheduled time, the individual administering the medication shall document in the electronic health record, per protocol. Review of Resident R49's clinical record revealed that Resident 49 had diagnoses of hypertension (high blood pressure), and Lymphedema (swelling of the legs or arms). Review of Resident R49's physician orders revealed, an order dated April 26, 2022, for Amlodipine Besylate Tablet 10 milligrams give 1 tablet by mouth one time a day for HTN (Hypertension-High blood pressure). Review of Resident R49's April 2024 Medication Administration Record (MAR) revealed an entry for Amlodipine Besylate Tablet 10 milligrams (mg) give 1 tablet by mouth one time a day for HTN -Start Date of April 27, 2022. Further the Amlodipine was signed and coded 9 for April 17, 2024, at 9:00 a.m. Review of MAR chart code revealed that 9 was the code for other/see progress note. Review of nurses notes revealed that the medication Amlodipine 10 mg was not available for administration to Resident R49. Medication administration observation conducted on April 17, 2024, at 8:49 a.m. with Licensed Nurse, Employee E9 revealed that during the medication administration of Resident R49's morning medications, Employee E9 could not find Resident R49's blister pack for Amlodipine Besylate Tablet 10 mg. Interview with Licensed Nurse, Employee E9 at the time of the observation confirmed that 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 4 Event ID: 395687 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 395687 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE York Nursing and Rehabilitation Center 7101 Old York Road Philadelphia, PA 19126 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)