Health inspection·April 20, 2023

F 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. 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, staff interview, and resident interview, it was determined that the facility failed to implement interventions to prevent pressure ulcers for one of three sampled residents with pressure sores. (Resident 9) Residents Affected - Few Findings include: Clinical record review revealed that Resident 9 had diagnoses that included generalized muscle weakness, arthritis of the right knee, and a pressure ulcer of the left heel. The Minimum Data Set assessment dated [DATE], indicated that the resident was oriented and required staff assistance with activities of daily living, including dressing. The care plan identified that the resident had the potential for skin breakdown related to immobility. Review of the consulting wound physician's report dated April 13, 2023, revealed that orders included that Resident 9 keep wearing Prevalon boots (boots with a cushioned bottom to prevent pressure) on both feet. Nursing documentation dated April 14, 2023, also noted that the resident was to wear Prevalon boots on both feet. Resident 9 was observed on April 19, 2023, at 2:11 p.m., and April 20, 2023, at 1:40 p.m. seated in the wheelchair wearing a pressure relieving boot on the left foot and only a sock on the right foot. Both feet were placed on and in contact with a wheelchair foot rest. In an interview on April 20, 2023, at 1:40 p.m., Resident 9 reported that staff do not always apply the boot for the right foot and that it was available in the closet. The resident denied refusing to wear the right boot. During an interview on April 20, 2023, at 1:47 p.m., the nurse aide (NA 1) reported that the resident had an order to wear a pressure relieving boot on the left foot only and stated that the resident had only one boot available. Observation on April 20, 2023, at 1:50 p.m., revealed that a second pressure relieving boot was in Resident 9's closet. 28 Pa. Code 211.12(d)(1)(5) Nursing services. Page 1 of 3 395752 395752 04/20/2023 Moravian Hall Square Health and Wellness Center 175 West North Street Nazareth, PA 18064

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **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 provide services to restore bladder function as much as possible for one of 15 sampled residents. (Resident 2) Findings include: Clinical record review revealed that Resident 2 was admitted to the facility on [DATE], with diagnoses that included urinary tract infection and anxiety. The Minimum Data Set assessment dated [DATE], indicated that she was incontinent of urine and required extensive assistance from staff to use the toilet. According to a Continence Assessment, dated February 7, 2023, the resident was considered a candidate for a toileting program. The care plan identified that the resident had a problem with incontinence, however there was no documented intervention to restore bladder function such as a toileting program. In an interview on April 20, 2023, at 10:30 a.m., the Quality Assurance Coordinator stated that a toileting program was never initiated for Resident 2. 28 PA Code 211.12(d)(1)(5) Nursing services. 395752 Page 2 of 3 395752 04/20/2023 Moravian Hall Square Health and Wellness Center 175 West North Street Nazareth, PA 18064

F 0804 Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. 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, policy review, and review of incident/accident reports, it was determined that the facility failed to ensure that hot liquids were served to residents at a safe temperature for one of 15 sampled residents. (Resident 2) Residents Affected - Few Findings include: Review of the facility policy entitled, Hot Beverage Policy, implemented May 27, 2021, revealed that the temperature of hot beverages would be recorded by a designated staff member at the start of meal service. The temperature of hot liquids would not exceed 155 degrees Fahrenheit to prevent burns and scalding. Clinical record review revealed that Resident 2 had diagnoses that included spinal stenosis and anxiety. A Minimum Data Set assessment dated [DATE], identified that the resident needed only staff setup assistance to eat meals. A nurse noted on March 26, 2023, at 2:38 p.m. that Resident 2 spilt hot chocolate on herself during lunch. Follow-up documentation revealed that the resident's skin was assessed after the incident and had reddened areas to her chest and abdomen. Review of the facility's investigation into the incident revealed that the temperature of the hot chocolate was not taken by dietary staff prior to service to ensure a safe temperature. 28 Pa. Code: 201:18(b)(1) Management. 395752 Page 3 of 3