Health inspection·September 18, 2023

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. Based on clinical record reviews and staff interviews, it was determined that the facility failed to ensure that the resident's physician was notified timely about the unavailability of a medication for three of five residents reviewed (Residents 2, 3, 5). This deficiency was cited as past non-compliance. Findings include: An admission Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) for Resident 2, dated July 17, 2023, revealed that the resident was cognitively intact, required extensive assistance from staff for his daily care tasks, and had a diagnosis which included diabetes, high blood pressure, GERD (gastro-esophageal reflux disease), hyperlipidemia (high lipids), and schizophrenia (disorder that affects a person's ability to think, feel, and behave clearly). Physician's orders for Resident 2, dated June 29, 2023, included orders for the resident to receive 10 milligrams (mg) of aripiprazole (antipsychotic) once a day, 200 micrograms (mcg) aerosol inhaler of Asmanex (used to treat breathing problems) two puffs twice a day, 20 mg of atorvastatin (used to lower cholesterol and triglycerides) at bedtime, 0.2 mg of clonidine HCl (used to treat high blood pressure) twice a day, 180 mg of diltiazem HCl (used to treat high blood pressure) once a day, 20 mg of famotidine (used to prevent heart burn) once a day, 25 mg of hydralazine (used to treat high blood pressure) four times a day, 8 units of insulin glargine (used to treat diabetes) twice a day, 50 mg of metoprolol (used to treat high blood pressure) twice a day, 90 mcg of Pulmicort flexhaler (used to treat breathing problems) one puff twice a day, and 15 mg of Xarelto (blood thinner) daily. Review of the Medication Administration Records (MAR) for Resident 2, dated July 2023, revealed no documented evidence that the resident was administered aripiprazole at 9:00 a.m. on July 11 and 14; Asmanex the morning on July 11; atorvastatin at bedtime on July 10; clonidine the morning of July 11 and 14 and the evening of July 10; diltiazem daily on July 11; hydralazine at 8:00 a.m. on July 11 and 12, at 12:00 p.m. on July 11, at 4:00 p.m. on July 11 and 12, and at 8:00 p.m. on July 10 and 11; insulin glargine the evening of July 10; and Pulmicort the evening of July 10. There was no documented evidence that the physician was notified that the medications were not available or administered on theses dates and times. An annual MDS assessment for Resident 3, dated August 12, 2023, revealed that the resident was cognitively impaired, required supervision to limited assistance from staff for her daily care tasks, and had a diagnosis which included high blood pressure, depression, and dementia. Page 1 of 6 395726 395726 09/18/2023 Harmon House Health & Rehab Center 601 South Church Street Mount Pleasant, PA 15666

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Physician's orders for Resident 3, dated June 21, 2023, included orders for the resident to receive 50 mg of losartan (used to treat high blood pressure) once a day, 5 mg of nebivolol (used to treat high blood pressure) once a day, 20 mg of paroxetine HCl (used to treat depression) once a day, and 20 milliequivalents (mEq) of potassium chloride once day. Review of the MAR's for Resident 3, dated July 2023, revealed no documented evidence that the resident was administered losartan daily on July 9, 15, 16, and 25; nebivolol daily on July 8, 9, 10, 11, 12, 15, 16, 22, 23, and 25; paroxetine daily on July 9, 10, 22, 23, and 25; and potassium chloride daily on July 8, 9, 10, 11, 12, 15, 16, 22, 23 and 25, 2023. There was no documented evidence that the physician was notified that the medications were not available or administered on theses dates and times. An annual MDS assessment for Resident 5, dated August 12, 2023, revealed that the resident was cognitively impaired, required supervision to limited assistance from staff for her daily care tasks, and had a diagnosis which included high blood pressure, depression, and dementia. A nursing note, dated July 7, 2023, at 6:49 p.m. revealed that the resident's urinalysis was reviewed by the Certified Registered Nurse Practitioner and new orders were received for 150 mg of Diflucan (used to treat a fungal infection) now and then give 150 mg of Diflucan in three days. Review of the MAR's for Resident 5, dated July 2023, revealed that Diflucan was not administered on July 7 or 8, 2023, as ordered. There was no documented evidence that the physician was notified that the Diflucan was not available or administered on July 7 or 8, 2023. Interview with the Nursing Home Administrator on September 18, 2023, at 4:10 p.m. confirmed that there was no documented evidence that the physician was notified that Resident 2, 3, and 5's medication were not available or administered as ordered on the mentioned dates and times. Following the facility's identified concern of adjusting to the new over-the-counter medication supplies, the new pharmacy, and new charting system on July 1, 2023, the facility's corrective actions included: The pharmacy is supplying over-the-counter medications, medication carts were re-organized, central supply has been following up with nursing for appropriate ordering, new resident orders are now faxed directly to the pharmacy, medication times were adjusted to be compliant with the medication pass, and nursing staff was instructed to notify the physician of any medications that were not available from the pharmacy. Education was provided on August 10 and 29, 2023, with facility care staff regarding looking for medications in the cart, re-ordering medications five to seven days prior to medications running out from the new system, and that compliance reports would be pulled three times a day. The results of the audits were to be discussed during the QA meetings. The date of compliance was August 29, 2023, and the facility has ongoing audits to monitor compliance. 28 Pa. Code 211.12(d)(1)(5) Nursing services. 395726 Page 2 of 6 395726 09/18/2023 Harmon House Health & Rehab Center 601 South Church Street Mount Pleasant, PA 15666

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 policies and clinical records, as well as staff interviews, it was determined that the facility failed to ensure that physician's orders for medications were followed for three of five residents reviewed (Residents 2, 3, 5). This deficiency was cited as past non-compliance. Residents Affected - Some Findings include: The facility's policy regarding medication administration, dated May 12, 2023, indicated that the facility would ensure that authorized personnel, as determined by applicable law, administer medications according to times of administration as determined by the facility's pharmacy committee and/or physician/prescriber. An admission Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) for Resident 2, dated July 17, 2023, revealed that the resident was cognitively intact, required extensive assistance from staff for his daily care tasks, and had a diagnosis which included diabetes, high blood pressure, GERD (gastro-esophageal reflux disease), hyperlipidemia (high lipids), and schizophrenia (disorder that affects a person's ability to think, feel, and behave clearly). Physician's orders for Resident 2, dated June 29, 2023, included orders for the resident to receive 10 milligrams (mg) of aripiprazole (antipsychotic) once a day, 200 micrograms (mcg) aerosol inhaler of Asmanex (used to treat breathing problems) two puffs twice a day, 20 mg of atorvastatin (used to lower cholesterol and triglycerides) at bedtime, 0.2 mg of clonidine HCl (used to treat high blood pressure) twice a day, 180 mg of diltiazem HCl (used to treat high blood pressure) once a day, 20 mg of famotidine (used to prevent heart burn) once a day, 25 mg of hydralazine (used to treat high blood pressure) four times a day, 8 units of insulin glargine (used to treat diabetes) twice a day, 50 mg of metoprolol (used to treat high blood pressure) twice a day, 90 mcg of Pulmicort flexhaler (used to treat breathing problems) one puff twice a day, and 15 mg of Xarelto (blood thinner) daily. Review of the Medication Administration Records (MAR) for Resident 2, dated July 2023, revealed no documented evidence that the resident was administered aripiprazole at 9:00 a.m. on July 11, 13, and 14; Asmanex the morning on July 11 and the morning and evening on July 13; atorvastatin at bedtime on July 10, 11 and 13; clonidine the morning of July 11, 13, and 14 and the eveing of July 10; diltiazem daily on July 11 and 13; famotidine daily on July 13; hydralazine at 8:00 a.m. on July 11 and 12, at 12:00 p.m. on July 11 and 13, at 4:00 p.m. on July 11, 12 and 13, and at 8:00 p.m. on July 10, 11 and 13; insulin glargine the evening of July 10 and 13; Pulmicort the evening of July 10, 13 and 14; and Xarelto daily on July 13, 2023. An annual MDS assessment for Resident 3, dated August 12, 2023, revealed that the resident was cognitively impaired, required supervision to limited assistance from staff for her daily care tasks, and had a diagnosis which included high blood pressure, depression, and dementia. Physician's orders for Resident 3, dated June 21, 2023, included orders for the resident to receive 50 mg of losartan (used to treat high blood pressure) once a day, 5 mg of nebivolol (used to treat high blood pressure) once a day, 20 mg of paroxetine HCl (used to treat depression) once a day, and 20 milliequivalents (mEq) of potassium chloride once day. Review of the MAR's for Resident 3, dated July 2023, revealed no documented evidence that the 395726 Page 3 of 6 395726 09/18/2023 Harmon House Health & Rehab Center 601 South Church Street Mount Pleasant, PA 15666

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some resident was administered losartan daily on July 9, 13, 15, 16, 24, and 25; nebivolol daily on July 8, 9, 10, 11, 12, 13, 15, 16, 22, 23, 24, and 25; paroxetine daily on July 8, 9, 10, 22, 23, 24 and 25; and potassium chloride daily on July 8, 9, 10, 11, 12, 13, 15, 16, 22, 23, and 25, 2023. An annual MDS assessment for Resident 5, dated August 12, 2023, revealed that the resident was cognitively impaired, required supervision to limited assistance from staff for her daily care tasks, and had a diagnosis which included high blood pressure, depression, and dementia. A nursing note, dated July 7, 2023, at 6:49 p.m. revealed that the resident's urinalysis was reviewed by the Certified Registered Nurse Practitioner and new orders were received for 150 mg of Diflucan (used to treat a fungal infection) now and then give 150 mg of Diflucan in three days. Review of the MAR's for Resident 5, dated July 2023, revealed that Diflucan was not administered on July 7 or 8, 2023, as ordered. Interview with the Nursing Home Administrator on September 18, 2023, at 4:10 p.m. confirmed that Residents 2, 3, and 5 did not receive their medications as ordered. Following the facility's identified concern of adjusting to the new over-the-counter medication supplies, the new pharmacy, and new charting system on July 1, 2023, the facility's corrective actions included: The pharmacy is supplying over-the-counter medications, medication carts were re-organized, central supply has been following up with nursing for appropriate ordering, new resident orders are now faxed directly to the pharmacy, medication times were adjusted to be compliant with the medication pass, and nursing staff was instructed to notify the physician of any medications that were not available from the pharmacy. Education was provided on August 10 and 29, 2023, with facility care staff regarding looking for medications in the cart, re-ordering medications five to seven days prior to medications running out from the new system, and that compliance reports would be pulled three times a day. The results of the audits were to be discussed during the QA meetings. The date of compliance was August 29, 2023, and the facility has ongoing audits to monitor compliance. 28 Pa. Code 211.12(d)(1)(5) Nursing services. 395726 Page 4 of 6 395726 09/18/2023 Harmon House Health & Rehab Center 601 South Church Street Mount Pleasant, PA 15666

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on review of policies and clinical records, as well as observations and staff interviews, it was determined that the facility failed to ensure that medication was obtained and provided as ordered by the physician for three of five residents reviewed (Residents 2, 3, 5). This deficiency was cited as past non-compliance. Findings include: The facility's policy regarding medication administration, dated May 12, 2023, indicated that the facility would ensure that authorized personnel, as determined by applicable law, administer medications according to times of administration as determined by the facility's pharmacy committee and/or physician/ prescriber. An admission Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) for Resident 2, dated July 17, 2023, revealed that the resident was cognitively intact, required extensive assistance from staff for his daily care tasks, and had a diagnosis which included diabetes, high blood pressure, GERD (gastro-esophageal reflux disease), hyperlipidemia (high lipids), and schizophrenia (disorder that affects a person's ability to think, feel, and behave clearly). Physician's orders for Resident 2, dated June 29, 2023, included orders for the resident to receive 10 milligrams (mg) of aripiprazole (antipsychotic) once a day, 200 micrograms (mcg) aerosol inhaler of Asmanex (used to treat breathing problems) two puffs twice a day, 20 mg of atorvastatin (used to lower cholesterol and triglycerides) at bedtime, 0.2 mg of clonidine HCl (used to treat high blood pressure) twice a day, 180 mg of diltiazem HCl (used to treat high blood pressure) once a day, 20 mg of famotidine (used to prevent heart burn) once a day, 25 mg of hydralazine (used to treat high blood pressure) four times a day, 8 units of insulin glargine (used to treat diabetes) twice a day, 50 mg of metoprolol (used to treat high blood pressure) twice a day, 90 mcg of Pulmicort flexhaler (used to treat breathing problems) one puff twice a day, and 15 mg of Xarelto (blood thinner) daily. Review of the Medication Administration Records (MAR) for Resident 2, dated July 2023, revealed no documented evidence that the resident was administered aripiprazole at 9:00 a.m. on July 11 and 14; Asmanex the morning on July 11; atorvastatin at bedtime on July 10; clonidine the morning of July 11 and 14 and the evening of July 10; diltiazem daily on July 11; hydralazine at 8:00 a.m. on July 11 and 12, at 12:00 p.m. on July 11, at 4:00 p.m. on July 11 and 12, and at 8:00 p.m. on July 10 and 11; insulin glargine the evening of July 10; and Pulmicort the evening of July 10. The MAR indicated that the medications were unavailable. An annual MDS assessment for Resident 3, dated August 12, 2023, revealed that the resident was cognitively impaired, required supervision to limited assistance from staff for her daily care tasks, and had a diagnosis which included high blood pressure, depression, and dementia. Physician's orders for Resident 3, dated June 21, 2023, included orders for the resident to receive 50 mg of losartan (used to treat high blood pressure) once a day, 5 mg of nebivolol (used to treat high blood pressure) once a day, 20 mg of paroxetine HCl (used to treat depression) once a day, and 20 milliequivalents (mEq) of potassium chloride once day. 395726 Page 5 of 6 395726 09/18/2023 Harmon House Health & Rehab Center 601 South Church Street Mount Pleasant, PA 15666

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Review of the MAR's for Resident 3, dated July 2023, revealed no documented evidence that the resident was administered losartan daily on July 9, 15, 16, and 25; nebivolol daily on July 8, 9, 10, 11, 12, 15, 16, 22, 23, and 25; paroxetine daily on July 9, 10, 22, 23, and 25; and potassium chloride daily on July 8, 9, 10, 11, 12, 15, 16, 22, 23 and 25, 2023. There was no documented evidence that the physician was notified that the medications were not available or administered on theses dates and times. The MAR indicated that the medications were unavailable, awaiting pharmacy, or waiting for medications to be delivered by pharmacy. An annual MDS assessment for Resident 5, dated August 12, 2023, revealed that the resident was cognitively impaired, required supervision to limited assistance from staff for her daily care tasks, and had a diagnosis which included high blood pressure, depression, and dementia. A nursing note, dated July 7, 2023, at 6:49 p.m. revealed that the resident's urinalysis was reviewed by the Certified Registered Nurse Practitioner and new orders were received for 150 mg of Diflucan (used to treat a fungal infection) now and then give 150 mg of Diflucan in three days. Review of the MAR's for Resident 5, dated July 2023, revealed that Diflucan was not administered on July 7 or 8, 2023, as ordered. There was no documented evidence that the physician was notified that the Diflucan was not available or administered on July 7 or 8, 2023. The MAR indicated that they were awaiting pharmacy delivery. Interview with the Nursing Home Administrator on September 18, 2023, at 4:10 p.m. confirmed that the medications for Resident 2, 3, and 5's we not available for administration as ordered on the mentioned dates and times. Following the facility's identified concern of adjusting to the new over-the-counter medication supplies, the new pharmacy, and new charting system on July 1, 2023, the facility's corrective actions included: The pharmacy is supplying over-the-counter medications, medication carts were re-organized, central supply has been following up with nursing for appropriate ordering, new resident orders are now faxed directly to the pharmacy, medication times were adjusted to be compliant with the medication pass, and nursing staff was instructed to notify the physician of any medications that were not available from the pharmacy. Education was provided on August 10 and 29, 2023, with facility care staff regarding looking for medications in the cart, re-ordering medications five to seven days prior to medications running out from the new system, and that compliance reports would be pulled three times a day. The results of the audits were to be discussed during the QA meetings. The date of compliance was August 29, 2023, and the facility has ongoing audits to monitor compliance. 28 Pa. Code 211.12(d)(1)(5) Nursing services. 395726 Page 6 of 6