Health inspection·July 6, 2023

F 0563 Honor the resident's right to receive visitors of his or her choosing, at the time of his or her choosing. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a review of clinical records and concerns lodged with the facility and resident and staff interviews, it was determined that the facility to develop written policies and procedures regarding residents' visitation rights and failed to afford residents the rights to receive visitors of their choosing for three residents out of 10 sampled (Residents 19, 26 and CR1). Residents Affected - Some Findings include: Review of a concern lodged with the facility by a resident's interested family member revealed that this family member brought Resident 26 (her sister) back to the facility on June 23, 2023, after an outing. Following the resident's return, and as Resident 26's sister was leaving the building, she exchanged words with the Nursing Home Administrator. There was no evidence of a physical altercation, but a negative interaction between Resident 26's sister and the NHA. As a result of this interaction, the NHA banned Resident 26's sister from the facility. Resident 19, was also a sister of Resident 26, and the two sisters reside in the same room in the facility. The residents' other sister, was supposed to pick up both residents at the facility to attend a birthday party in the community on June 24, 2023, but the residents' nephew picked them up because the NHA had banned the other sister from the facility on June 23, 2023. Interview with Resident 26, who was cognitively intact with a BIMS score of 15, conducted on July 6, 2023, revealed that the resident stated that she couldn't understand why her sister could not visit the facility. Resident 26 stated that she didn't think it was fair to her, or her sister, Resident 19. Resident 19 was unable to be interviewed because she was hospitalized at the time of the survey on July 6, 2023. At the time of the survey ending July 6, 2023, there was no evidence that the facility had made efforts to resolve the difficulties/incident that led to the residents' sister being banned from the facility or that the facility had formulated a plan for any type of visitation with Residents 19 and 26 and their sister. A review of the resident's clinical record and concern forms revealed that Resident CR1's significant other raised a concern that the facility was limiting her visitation. Resident CR1's significant other believed her visitation was limited because she had expressed concerns about the resident's care and staff treatment of the resident to the facility on May 23, 2023. Page 1 of 5 395730 395730 07/06/2023 Kadima Rehabilitation & Nursing at Lakeside 245 Old Lake Road Dallas, PA 18612

F 0563 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some A review of the resident's clinical record revealed progress notes dated between May 24, 2023, and May 29, 2023, indicating Resident CR 1 was refusing care and refusing to eat because of issues between the facility and her significant other. The resident was hospitalized on [DATE], and did not return to facility. However, prior to the resident's hospitalization there was no evidence of the facility's efforts to resolve the concerns with the resident's significant other to assure that Resident CR1 was allowed visitation with her signifcant other as desired. At the time of the survey ending July 6, 2023, the facility was unable to provide a written policy and procedure regarding the visitation rights of residents, including those setting forth any clinically necessary or reasonable restriction or limitation or safety restriction or limitation, when such limitations may apply consistent with the requirements of this subpart, that the facility may need to place on such rights and the reasons for the clinical or safety restriction or limitation. During interview with the NHA on July 6, 2023 at 1:30 p.m. she confirmed Resident 19 and Resident 26's sister was banned from the facility on June 23, 2023 and has not been able to visit since then. The NHA also confirmed that the facility did not have a written visitation policy as required by regulation. 28 Pa. Code 201.29(a) Resident Rights 28 Pa Code 201.18 (e)(1) Management 395730 Page 2 of 5 395730 07/06/2023 Kadima Rehabilitation & Nursing at Lakeside 245 Old Lake Road Dallas, PA 18612

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a review of clinical records, and staff interview, it was determined that the facility failed to timely consult with the physician regarding the potential need to commence new treatment of one resident out of 10 sampled (Resident 19). Findings include: A review of the clinical record revealed that Resident 19 was admitted to the facility on [DATE], with diagnoses to include diabetes, and end stage renal disease. Nurse's notes dated June 30, 2023, at 6:30 p.m. indicated that Resident 19 complained of a sore throat. Nursing noted on July 2, 2023, at 9:09 p.m. that Resident 19 complained of feeling achy all over and had clogged ears and a temperature of 99.1 degrees farenheit. Nurses notes on July 3, 2023, at 7:35 a.m. revealed that Resident 19 complained of general malaise with a sore throat, clogged ears, chest discomfort, and achy all over. The resident's Spo2 (blood oxygen level) was 90% (typically between 95 and 100 percent) on room air. Resident 19 was refusing to go to Dialysis. There was no documented evidence that the physician was notified of the resident's complaints and symptoms and refusal to attend dialysis. Interview with the Director of Nursing on July 7, 2023 at 9:30 a.m. confirmed that the facility failed to timely consult with Resident 19's attending physician regarding the resident's change in condition. 28 Pa Code 211.12 (d)(3)(5) Nursing services 395730 Page 3 of 5 395730 07/06/2023 Kadima Rehabilitation & Nursing at Lakeside 245 Old Lake Road Dallas, PA 18612

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 review and staff and resident interview it was determined that the facility failed to provide services necessary to maintain adequate personal hygiene of residents' who need assistance with activities of daily living for two residents out of 10 sampled (Resident 26 and Resident 19). Residents Affected - Few Findings include: A review of the clinical record revealed that Resident 26 was admitted to the facility on [DATE], with diagnoses to include hypertension and seizures. The resident was cognitively intact with a BIMS score of 15. Review of Resident 26's Documentation Survey Report (direct care nursing tasks completed for the resident) indicated that the resident was to be showered on Tuesdays and Fridays on 3 PM to 11 PM shift. According to the Documentation Survey Report for the month of June 2023 indicated the resident did not receive a shower on Tuesday June 20, 2023, as scheduled. Interview with Resident 26 on July 6, 2023, the resident confirmed that staff did not provide her with a shower on June 20, 2023, as scheduled. The resident stated that she said something to staff about not receiving a shower as planned. The resident further stated that her sister also called the facility on June 22, 2023, asking why the resident was not showered. , According to to the resident, a male staff member who answered the phone at the nurses station, told the resident's sister that she wold be showered that day, but the facility again did not provide the resident a shower on June 22, 2023. The resident stated that her sister called the facility again on June 23, 2023, to ask about he resident's shower. Resident 26 stated that Friday, June 23, 2023, was her scheduled shower day. The resident stated that she did not receive a shower since the previous Friday June 16, 2023. A review of the clinical record revealed that Resident 19 was admitted to the facility on [DATE], with diagnoses to include diabetes, and end stage renal disease. A physician order dated May 26, 2023, was noted for the resident to receive a bed bath only at this time every Tuesday and Friday. The Documentation Survey Report indicated that the resident was to receive bathing (bed bath) on Tuesdays and Fridays on the evening shift. Review of Resident 19's Documentation Survey Report for June 2023 indicated that the resident did not receive a bed bath on June 20, 2023. Resident 19 was unable to be interviewed because she was hospitalized at the time of the survey. Interview with the Administrator on July 6, 2023 at 1:45 p.m. confirmed Resident 19 and 26 did not receive bathing on June 20, 2023. 28 Pa Code 211.12 (d)(5) Nursing services. 395730 Page 4 of 5 395730 07/06/2023 Kadima Rehabilitation & Nursing at Lakeside 245 Old Lake Road Dallas, PA 18612

F 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a review of clinical records, the facility's diet manual and menu extensions, and staff interviews, it was determined that the facility failed to pre-plan menus to meet the nutritional adequacy and specialized nutritional needs of one resident out of 10 residents reviewed (Resident 7). Findings include: Review of clinical record revealed Resident 7 was admitted on [DATE], with diagnoses to include morbid obesity. A physician order dated January 21, 2022, and revised on February 22, 2023, for the resident to receive a Heart Healthy diet with special instructions for double protein portions, bariatric diet (related to the medical treatment of obesity), and reduced portions. Review of the facility's dietary manual conducted at the time of the survey ending July 7, 2023, revealed that the manual did not include a Bariatric Diet. Review of the facility's menu extensions conducted during the survey ending July 7, 2023, revealed no planned menu extensions to be followed for Resident 7's Heart Healthy Diet with double protein portions bariatric diet. Interview with the Dietary Manager on June 7, 2023, at 11:51 AM, revealed that the facility did not have a Bariatric Diet planned in their dietary manual and did not have a planned written menu and extension for Resident 7's specific diet order and instructions. The NHA also confirmed via email on June 7, 2023, at 3:26 PM that the facility's diet manual and diet extension do not include a bariatric diet and Resident 7's diet is not specifically pre-planned. 28 Pa. Code 211.6(a) Dietary Services 395730 Page 5 of 5