Health inspection·September 22, 2023

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, it was determined that the facility failed to provide a safe, clean, and comfortable environment for residents on three of three nursing units. (Nursing Units One, Two, Three) Findings include: Observations during the environmental tour of Unit One on September 20, 2023, at various times, revealed a bottom dresser drawer without a handle in room [ROOM NUMBER]-2, a broken nightstand top drawer in room [ROOM NUMBER]-1, and a broken bottom dresser drawer handle in room [ROOM NUMBER]-1. Observations during the environmental tour of Unit Two on September 19, 20, and 21, 2023, at various times throughout the day, revealed that the arm and base of the overbed tables in resident rooms 203, 204, 210, 211, 215, and 217 were covered in a dark dried substance. In room [ROOM NUMBER]-1, there was a celing tile with a large water stain with black spots and white residue surrounding the tile. In room [ROOM NUMBER]-2, the wall paper was off the wall. In room [ROOM NUMBER]-2, the outlet cover was broken behind the head of the bed. In room [ROOM NUMBER]-2, the baseboard cover was broken off the heating unit. Observations during the environmental tour of Unit Three on September 19 and 20, 2023, at various times throughout the day, revealed room [ROOM NUMBER] had a marred walledand a piece of wall molding was missing. On the side of 306-1, there was a piece of wall trim that was dangling by the headboard and on the side of 306-2, there were several holes in the wall where the wall trim had been. The arm and base of the overbed tables were covered in a dark, dried substance. The wall paper behind bed 1 and 2 in room [ROOM NUMBER] was off the wall. In room [ROOM NUMBER]-2, the baseboard cover was broken off the heating unit and the dresser was missing handles. In room [ROOM NUMBER], the bottom dresser drawer was broken. In room [ROOM NUMBER], the wall trim behind bed 2 was missing. In room [ROOM NUMBER], the wall paper was off the wall. In room [ROOM NUMBER], the headboard was detached from the bed frame and there were large water stained ceiling tiles above the bed. In room [ROOM NUMBER], the armoire closet was missing a bottom drawer and there were large water stained ceiling tiles above the bed. 28 Pa. Code 201.18(b)(1) Management. Page 1 of 4 395711 395711 09/22/2023 Elkins Crest Health & Rehabilitation Center 265 E. Township Line Road Elkins Park, PA 19027

F 0641 Ensure each resident receives an accurate assessment. 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, observation and staff interview, it was determined that the facility failed to complete an accurate Minimum Data Set (MDS) assessment for three of 29 sampled residents. (Residents 22, 80, 105) Residents Affected - Few Findings include: Clinical record review revealed that Resident 22 had diagnoses that included dementia and heart disease. Review of Resident 22's MDS assessment dated [DATE], indicated Resident 22 was on hospice. There was no documentation in the clinical record that indicated Resident 22 was on hospice services. In an interview on September 22, 2023, at 10:45 a.m., the Director of Nursing confirmed that MDS assessment had been inaccurately coded and that Resident 22 was not on hospice at that time. Clinical record review revealed that Resident 80 had diagnoses that included diabetes and dependence of renal dialysis. Section B of the MDS assessment dated [DATE], indicated that the resident had the ability to see in adequate light. In an interview on September 19, 2023, at 10:00 a.m., Resident 80 stated she is blind and can only see shadows. In an interview on September 21, 2023, at 2:00 p.m., the Director of Nursing confirmed the resident had severely impaired vision and that the MDS assessment had been inaccurately coded. Clinical record review revealed that Resident 105 had diagnoses that included traumatic hemorrhage of the cerebrum (stroke), tracheostomy (surgical airway), and seizures. Review of Resident 105's MDS assessment dated [DATE], indicated that Resident 105 did not utilize any type of restraint. On September 27, 2022, a physician ordered for staff to apply a left hand mitt restraint. Observations on September 19, 20, and 21, 2023 at various times, revealed Resident 105 wearing the a left hand mitt restraint, which was not identified on the MDS assessment. 395711 Page 2 of 4 395711 09/22/2023 Elkins Crest Health & Rehabilitation Center 265 E. Township Line Road Elkins Park, PA 19027

F 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. **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 develop a care plan and provide specialized services in accordance with the Pre-admission Screening and Resident Review (PASARR) evaluation for two of 29 sampled residents. (Residents 67, 77) Findings include: Clinical record review revealed that Resident 67 was admitted on [DATE], with diagnoses that included anxiety, mood disorder, major depressive disorder, violent behavior, and psychosis (a severe mental condition in which thought and emotions are affected that contact is lost with external reality). Review of the Minimum Data Set (MDS) assessment dated [DATE], identified the resident was oriented and required extensive assistance from staff. Review of the record revealed that Resident 67 had a PASARR Level 1 (federally required assessment to help ensure that all individuals with serious mental disorders and/or intellectual disabilities are not inappropriately placed in nursing homes for long term care) completed on August 5, 2020. According to that assessment, Resident 67 had a positive screen for serious mental illness that identified a need for specialized services such as training, service coordination, advocacy services, peer counseling, support groups, community integration activities, equipment, assessments, and transportation to help people function as independently as possible. Review of the clinical record revealed a lack of documentation to support that specialized services were included in the care plan or provided to Resident 67. Clinical record review revealed that Resident 77 was admitted on [DATE], with diagnoses that included schizophrenia, major depressive disorder, and schizoaffective disorder (a person who experience psychotic symptoms such as, hallucinations and delusions). Review of the MDS assessment dated [DATE], identified the resident was oriented and required assistance from staff. Review of the record revealed that Resident 77 had a PASARR Level 1 completed on August 3, 2018. According to that assessment, Resident 77 had a positive screen for serious mental illness that identified a need for specialized services. Review of the clinical record revealed a lack of documentation to support that specialized services were included in the care plan or provided to Resident 77. In an interview on September 21, 2023, at 2:00 p.m., the Administrator confirmed that no specialized services were provided for Residents 67 and 77. 395711 Page 3 of 4 395711 09/22/2023 Elkins Crest Health & Rehabilitation Center 265 E. Township Line Road Elkins Park, PA 19027

F 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on policy review and observation, it was determined that the facility failed to properly store food and maintain sanitary conditions in the dietary department. Residents Affected - Many Findings include: Review of the facility's policy entitled, Storage of Dry Food Policy, last reviewed March 2, 2023, revealed food was to be stored in a manner to avoid contamination, optimize food safety, and protect food quality and that foods were to be marked with a date when they were opened. Review of the facility's policy entitled, Use-By Guide-Quick Reference, last reviewed March 2, 2023, revealed foods should not be kept longer than seven days from the date marked on the product and the use-by date marked on the container. Observation during the tour of the kitchen on September 19, 2023, at 10:03 a.m., revealed the following: In the walk-in cooler, there was a container of diced tomatoes, an opened bag of lettuce, and a bag of tortillas that were not dated. There were two opened large jars of french dressing and mayonnaise with food debris on the outside of both containers. There were two large containers of sour cream with a use-by date of August 31, 2023, and one container of ricotta cheese with a use-by date of September 10, 2023. There was a cooked pork loin dated September 11, 2023. There were two vents with an accumulation of dust. In the freezer, there was a bag of opened sausage patties and a bag of tortillas that were not dated. In the bulk food storage area there were three large bins of flour, sugar, and thickener that were not dated. The top of the lid to the flour bin was covered with food debris. The bottom of the scoop holder had a accumulation of food debris. CFR 483.60(i) Food Safety Requirement Previously cited 10/04/22. 28 Pa. Code 201.14(a) Responsibility of licensee. 395711 Page 4 of 4