Health inspection·October 6, 2023

F 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policies, clinical records,facility submitted documents, facility investigation information and staff interviews, it was determined that the facility failed to implement the facility abuse policy for two out of seven abuse allegations (Residents R14 and R62). Residents Affected - Some Findings include: Review of the facility policy Abuse Prevention Policy and Procedure last reviewed on 8/17/23, with a previous review date of 3/1/22, indicated that the facility will assure that every resident is free from verbal, sexual and mental abuse, etc. by developing and implementing policies. Every precaution will be taken to protect residents from neglect and abuse and every allegation will be thoroughly investigated. The employee under investigation will be suspended from employment during he investigation period. Review of the clinical record indicated that Resident R14 was admitted to the facility on [DATE], with diagnoses which included anxiety, back pain, inappropriate secretion of antidiuretic hormone. A MDS (Minimum Data Set- a periodic assessment of resident care needs) dated 10/14/23, indicated the diagnoses remained current. Review of the facility submitted documents dated 7/14/23, indicated that Resident R14 reported to the Activity director that staff was mean to her when the night nurse pulled on her arm when she was getting into bed and that the nurse made her go to bed. The report indicated that Licensed Practical Nurse (LPN) Employee E1 was the perpetrator. Review of the facility deployment staffing sheets dated 7/15/23, and 7/17/23, indicated LPN Employee E 1 continued to work while the investigation was ongoing. The investigation was completed as of 7/21/23. Review of the clinical record indicated that Resident R62 was admitted to the facility on [DATE], with diagnoses which included anxiety disorder, back pain, repeated falls. A MDS dated [DATE], indicated the diagnoses remained current. Review of the facility submitted documents dated 7/22/23, indicated that Resident R62 told the Assistant Director of Nursing(ADON) that Nurse Aide (NA) Employee E2 yelled in Resident R62's ear after Resident R62 asked her not to place her water pitcher on her tray table. Documentation indicated that Resident R62 told the ADON with tears in her eyes as she became fearful of the scared. Review of the staffing reviewed that NA Employee E2 worked on 3-11 and 11-7 shift on 7/23/23, with Page 1 of 7 395795 395795 10/06/2023 Lafayette Manor, Inc 147 Lafayette Manor Road Uniontown, PA 15401

F 0607 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some no suspension identified allowing potential abuse to continue. The investigation was not completed until 7/27/23. During an interview on 10/4/23, at 2:50 p.m., the Nursing Home Administrator confirmed that the employees identified had not been suspended and the facility failed to protect the residents from the potential for the abuse to continue. The facility failed to implement their abuse policy. 28 Pa. Code: 201.18(b)(1)(2) Management. 28 Pa. Code:201.29(a)(c)(d)(j)(m) Resident rights. 395795 Page 2 of 7 395795 10/06/2023 Lafayette Manor, Inc 147 Lafayette Manor Road Uniontown, PA 15401

F 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of the facility policy, clinical record and staff interview, it was determined that the facility failed to develop a baseline care plan that included risk for skin tears and interventions needed to provide effective and person-centered care for one of twelve residents (Resident R6). Findings include: Review of the facility policy Comprehensive Person-Centered Plan of Care last reviewed on 8/17/23, with previous review date of 3/1/22, indicated that a baseline plan of care will be developed within 48 hours of admission to include appropriate interventions to provide an initial set of instructions to provide effective and person centered care of the resident to meet the professional standards of quality care. Review of the clinical record indicated that Resident R6 was admitted to the facility on [DATE], with diagnoses which included cellulitis of right lower leg, vitamin B12 deficiency, eosinophilia(having too many eosinophils(white blood cells) which may contribute to inflammatory conditions) and peripheral vascular disease. A MDS(Minimum Data Set- a periodic assessment of resident care needs) dated 9/22/23, indicated the diagnoses remained current. Review of the admission assessment dated [DATE], indicated Resident R6 was admitted with a large skin tear over her right calf with 10 sutures and several steri strips. Review of Resident R6's plan of care did not include the care of the skin tear or that Resident R6 had fragile skin as indicated as the cause for the skin tear from the hospital. During an interview on 10/4/23, at 2:15 p.m. the Nursing Home Administrator confirmed that the facility failed to develop a baseline plan of care for fragile skin care and interventions to prevent the potential and actual development of skin tears for Resident R6. 28 Pa. Code: 211.11(a) Resident care plan. 395795 Page 3 of 7 395795 10/06/2023 Lafayette Manor, Inc 147 Lafayette Manor Road Uniontown, PA 15401

F 0742 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide the appropriate treatment and services to a resident who displays or is diagnosed with mental disorder or psychosocial adjustment difficulty, or who has a history of trauma and/or post-traumatic stress disorder. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical records and facility policy review, and staff interview, it was determined that the facility failed to ensure that a resident who displayed mental or psychosocial adjustment difficulties received appropriate treatment and services to correct the problem for one of three residents (Resident R15). Findings include: Review of the facility policy Behavioral Management dated 8/17/23, indicated all residents receive care and services to assist in reaching and maintaining the highest level of mental and psychosocial functioning. The interdisciplinary team will review the behaviors and develop and individualized care plan to address the resident's needs. Review of the clinical record indicated Resident R15 was admitted to the facility on [DATE], with diagnoses that included encephalopathy (disease in which the functioning of the brain is affected) kidney failure, heart disease, and depression. Review of Resident R15's Minimum Data Set (MDS- assessment of a resident's abilities and care needs) dated 8/8/23, indicated that the resident had severely impaired cognition, rarely understood and understands others, has physical behaviors towards others, and resists care. The diagnoses remained current. Review of the nursing progress notes indicated on 8/1/23, the resident became restless and needed to be at the nurses station, 8/4/23 was hitting the nurses hands away during medication administration, 8/5/23 tried to hit and scratch staff and refused meals and restorative (walking to maintain strength) care, 8/12/23 became combative with care and refused wound care, 8/12/23 refused medications on three attempts, 8/16/23 refused restorative care, 8/29/23 was resistive to care, 9/5/23 was combative, hitting an spitting on staff. Review of Resident R15's Behavior/Intervention sheets dated August and September 2023, revealed no behaviors documented for review. Review of Resident R15's care plan revised 5/23/23, did not include care and services for behaviors. During an interview on 10/4/23 at 4:30 p.m., Registered Nurse (RN) Employee E3 confirmed Resident R15 has the above behaviors and should be care planned for treatment and services. During an interview on 10/4/23 at 4:45 p.m., Licensed Practical Nurse (LPN) Employee E4 confirmed Resident R15 has the above behaviors and had no care plan. During an interview on 10/4/23 at 3:15 p.m., the Nursing Home Administrator (NHA) confirmed the above findings and the facility failed to ensure Resident R15 received appropriate treatment and services for mental or psychosocial adjustment difficulties during care. 28 Pa. Code 201.18(b)(1) Management. 395795 Page 4 of 7 395795 10/06/2023 Lafayette Manor, Inc 147 Lafayette Manor Road Uniontown, PA 15401

F 0742 28 Pa. Code 211.12(d)(3)(5) Nursing services. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 395795 Page 5 of 7 395795 10/06/2023 Lafayette Manor, Inc 147 Lafayette Manor Road Uniontown, PA 15401

F 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. **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 ensure a medication regime was free from potentially unnecessary medication for one of five residents (Resident R15). Findings include: Review of the facility policy Psychotropic Medication Use dated 8/17/23, indicated residents will not receive PRN (as needed) doses of psychotropic medications unless that medication is necessary to treat a specific condition that is documented in the clinical record and non-pharmacologic interventions must be attempted and documented. Review of the clinical record indicated Resident R15 was admitted to the facility on [DATE] with diagnoses that included encephalopathy (disease in which the functioning of the brain is affected) kidney failure, heart disease, and depression. Review of Resident R15's Minimum Data Set (MDS) (assessment of a resident's abilities and care needs) dated 8/8/23, indicated that the resident had severely impaired cognition, rarely understood and understands others, has physical behaviors towards others, and resists care. The diagnoses remained current. Review of a physician order dated 9/6/23, indicated to give Ativan (an anti-anxiety medication) 0.5 mg (milligrams) every 8 hours as needed for agitation/restlessness. Review of the medication administration record (MAR) dated September 2023, indicated that Resident R15 received Ativan on 9/1, 9/5, 9/8, 9/11, 9/12, 9/16, and 9/17/23, with effective results. The clinical record did not include a symptom or non-pharmacological intervention attempted. During an interview on 10/4/23 at 3:15 p.m., the Nursing Home Administrator (NHA) confirmed that there was no indication for use, or non-pharmacological intervention attempted for Ativan on the above dates for Resident R15. 28 Pa. Code 211.9(a)(1) Pharmacy services. 28 Pa. Code 211.12(d)(1)(5) Nursing services. 395795 Page 6 of 7 395795 10/06/2023 Lafayette Manor, Inc 147 Lafayette Manor Road Uniontown, PA 15401

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on the review of facility policy, clinical records and staff interviews, it was determined that the facility failed to maintain and complete accurate documentation for one of three residents with behaviors (Resident R15). Findings include: Review of the facility policy Behavior Management dated 8/17/23, indicated when a behavior is identified the licensed nurse will document in the clinical record and behavior records will be used. Review of the clinical record indicated Resident R15 was admitted to the facility on [DATE] with diagnoses that included kidney failure, heart disease, and depression. Review of Resident R15's Minimum Data Set (MDS) (assessment of a resident's abilities and care needs) dated 8/8/23, indicated that the resident had severely impaired cognition, rarely understood and understands others, has physical behaviors towards others, and resists care. The diagnoses remained current. Review of the nursing progress notes for Resident R15 indicated on 8/1/23, the resident became restless and needed to be at the nurses station, 8/4/23 was hitting the nurses hands away during medication administration, 8/5/23 tried to hit and scratch staff and refused meals and restorative (walking to maintain strength) care, 8/12/23 became combative with care and refused wound care, 8/12/23 refused medications on three attempts, 8/16/23 refused restorative care, 8/29/23 resistive to care, 9/5/23 was combative, hitting an spitting on staff. Review of Resident R15's Behavior/Intervention sheets dated August and September 2023, revealed no behaviors documented. During an interview on 10/4/23 at 3:15 p.m., the Nursing Home Administrator (NHA) confirmed that the facility failed to complete accurate documentation for Resident R15. 28 Pa. Code: 211.5(f)(g)(h) Clinical records. 395795 Page 7 of 7