Health inspection·February 22, 2024

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review, observation and resident and staff interview, it was determined that the facility failed to ensure that a resident had the call bell accessible for one of 33 sampled residents. (Resident 139) Findings include: Clinical record review revealed that Resident 139 had diagnoses of Parkinson's disease, dysphagia, (difficulty swallowing) and history of mild protein and calorie malnutrition. The Minimum Data Set assessment dated [DATE], indicated that the resident was alert and oriented, was frequently incontinent of bowel and bladder and had limitations in his upper and lower extremities on both sides. The care plan identified that the resident was at risk for falls due to Parkinson's disease. There was an intervention for staff to ensure that the resident had his call bell within reach. On February 20, 2024, at 10:29 a.m., 11:00 a.m., and 12:18 p.m., the resident was observed in bed. His touch pad call bell had been placed near the top of his pillow, completely out of his reach. At 10:29 a.m., the resident stated that he was thirsty and that he needed fresh water in his cup that was on his over the bed table. The cup of water was on the table and was out of his reach. On February 21, 2024, at 9:55 a.m., the resident was observed in bed. The call bell had been placed on his upper right shoulder, but it was upside down. At that time, the resident stated that he could not reach the call bell and that the cord needed to be about four to five inches longer so that he could utilize it to call for assistance from staff. In an interview on February 22, 2024, at 9:56 a.m., the Registered Nurse (RN 2 ) stated that the cord had not been long enough for the resident to reach the call bell and that he was capable of utilizing the call bell to call for assistance from staff. 28 Pa. Code 211.12(d)(1)(5) Nursing services. Page 1 of 7 395817 395817 02/22/2024 Yardley Rehabilitation and Healthcare Center 1480 Oxford Valley Road Yardley, PA 19067

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **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 comprehensive care plan to meet each resident's needs identified in the comprehensive assessment for two of 33 sampled residents. (Resident 39, 42) Findings include: Clinical record review revealed that Resident 39 was admitted to the facility on [DATE], and had diagnoses that included muscle weakness and history of a traumatic brain injury. The Minimum Data Set (MDS) assessment dated [DATE], identified that Resident 39 was frequently incontinent of urine and the Care Area Assessment (CAA) summary indicated that it was to be addressed in the care plan. There was no evidence that interventions to address Resident 39's urinary incontinence were included in the current care plan. Clinical record review revealed that Resident 42 was admitted to the facility on [DATE], and had diagnoses that included Parkinson's disease and dementia. The MDS assessment dated [DATE], indicated that Resident 42 was always incontinent of urine and the CAA summary indicated that it was to be addressed in the care plan. There was no evidence that interventions to address Resident 42's urinary incontinence were included in the current care plan. In an interview on February 22, 2024, at 11:35 a.m., the Director of Nursing confirmed that the identified care areas were not addressed in the residents' care plans. 28 Pa. Code 211.12(d)(1)(5) Nursing services. 395817 Page 2 of 7 395817 02/22/2024 Yardley Rehabilitation and Healthcare Center 1480 Oxford Valley Road Yardley, PA 19067

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, observation, and resident interview, it was determined that the facility failed to ensure that appropriate assistance with eating was provided to one of four sampled residents who required assistance with activities of daily living, including eating. (Resident 139) Residents Affected - Few Findings include: Clinical record review revealed that Resident 139 had diagnoses that included Parkinson's disease, cognitive communication deficit, and history of mild protein malnutrition. The Minimum Data Set assesment dated February 5, 2024, indicated that the resident was alert and oriented and had limitations in range of motion of his upper and lower extremities on both sides. The care plan identified that the resident had a self-care deficit in activities of daily living, including eating. There was an intervention that indicated he required hands-on assistance for eating and drinking. Review of a speech language pathology Discharge summary dated [DATE], revealed a therapist documented that the resident was totally dependent for feeding assistance. Further review of the summary revealed that the therapist recommended close supervision and feeding assistance as he was totally dependent for eating. Review of a nutrition note dated February 16, 2024, revealed that the resident needed to be fed by staff because of tremors that he had from Parkinson's disease. Observation on February 21, 2024, at 12:20 p.m., revealed that the resident was in his room in bed and a staff member brought in his food tray and placed it on his over the bed table. At 12:40 p.m., the resident was still not eating and had not touched any of the food or drinks on his food tray. He stated that staff usually assisted him with eating his meals; however, today no one had assisted him with eating his meal. He further stated that he was hungry and thirsty. It was not until 12:45 p.m., 25 minutes after receiving his meal, that a staff member went in to the room and sat down to assist him with eating his meal. CFR 483.254(a)(2) ADL Care Provided for Dependent Residents. Previously cited 3/10/23 28 Pa. Code 211.12(d)(1)(5) Nursing services. 395817 Page 3 of 7 395817 02/22/2024 Yardley Rehabilitation and Healthcare Center 1480 Oxford Valley Road Yardley, PA 19067

F 0697 Provide safe, appropriate pain management for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm Based on facility policy review, clinical record review, and staff interview, it was determined that the facility failed to attempt non-pharmacological interventions to alleviate pain prior to the administration of pain medication prescribed on an as needed basis for four of 33 sampled residents. (Resident 22, 64, 116, 121) Residents Affected - Few Findings include: Review of the facility policy entitled, Pain Management, last reviewed February 1, 2024, revealed that the facility was to provide adequate pain control for the residents. Pain was to be managed through non-pharmacological and pharmacological interventions. Clinical record review revealed that Resident 22 had diagnoses that included neuropathy (nerve pain). A physician's order dated November 2, 2023 directed staff to administer the narcotic pain medication, oxycodone, every four hours as needed for moderate to severe pain. Review of the care plan revealed the resident had pain and interventions included that staff offer relaxation therapy, heat and cold application, muscle simulation, or positioning to assist with pain control. Review of the Medication Administration Records (MARs), revealed that the resident received the oxycodone six times in January and twice in February, 2024, without evidence to support that non-pharmacological interventions were offered prior to the administration of the as needed pain medication. Clinical record review revealed that Resident 64 had diagnoses that included fibromyalgia and muscle wasting and atrophy (shrinking of muscles). A physician's order dated November 17, 2023, directed staff to administer the narcotic pain medication, oxycodone, every six hours as needed for pain. Review of the care plan revealed the resident had chronic pain and interventions included that staff offer relaxation therapy, bathing, heat and cold application, or muscle stimulation to assist with pain control. Review of the MARs, revealed that the resident received the oxycodone 65 times in January and 36 times in February, 2024, without evidence to support that non-pharmacological interventions were offered prior to the administration of the as needed pain medication. Clinical record review revealed that Resident 116 had diagnoses that included lumbago with sciatica (low back pain) and muscle weakness. A physician's order dated July 14, 2023, directed staff to administer the narcotic pain medication, oxycodone, every six hours as needed for pain. Review of the care plan revealed the resident had chronic pain and interventions included that staff offer relaxation therapy, heat and cold application, muscle stimulation, or positioning to assist with pain control. Review of the MARs, revealed that the resident received the oxycodone 54 times in January and 37 times in February, 2024, without evidence to support that non-pharmacological interventions were offered prior to the administration of the as needed pain medication. Clinical record review revealed that Resident 121 had diagnoses that included hemiparesis (weakness one one side of the body), neuropathy, and depression. A physician's order dated August 3, 2022, directed staff to administer the narcotic pain medication, oxycodone, every four hours as needed for severe pain. Review of the care plan revealed the resident had pain and interventions included that staff offer relaxation therapy, heat and cold application, muscle stimulation, or positioning to assist with pain control. Review of the MARs, revealed that the resident received the oxycodone 25 times in January and 20 times in February, 2024, without evidence to support that non-pharmacological interventions were offered prior to the administration of the as needed pain medication. 395817 Page 4 of 7 395817 02/22/2024 Yardley Rehabilitation and Healthcare Center 1480 Oxford Valley Road Yardley, PA 19067

F 0697 Level of Harm - Minimal harm or potential for actual harm In an interview on February 22, 2024, at 10:42 a.m., the Director of Nursing confirmed that there was no documented evidence that staff offered non-pharmacological interventions prior to the administration of the as needed pain medication. 28 Pa. Code 211.12(d)(1)(5) Nursing services. Residents Affected - Few 395817 Page 5 of 7 395817 02/22/2024 Yardley Rehabilitation and Healthcare Center 1480 Oxford Valley Road Yardley, PA 19067

F 0698 Provide safe, appropriate dialysis care/services for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm Based on policy review, clinical record review, observation, and interview, it was determined that the facility failed to ensure that staff provided services consistent with professional standards of practice for one of three sampled dialysis residents. (Resident 147) Residents Affected - Few Findings include: Review of the facility policy entitled, Hemodialysis Access Emergency Care Policy, dated February 1, 2024, revealed that a smooth clamp should be kept at the bedside of residents with a dialysis catheter in place. Clinical record review revealed that Resident 147 had diagnoses that included end stage renal disease, permacath (tunneled catheter inserted into the blood vessel in the neck or upper chest under the collarbone and into the right side of the heart for dialysis), and dependence on renal dialysis (a process of removing waste products and excess fluid from the body when the kidneys are not able to adequately filter the blood). Review of current physician's orders revealed that there was an order since January 24, 2024, for staff to keep a clamp at bedside at all times and to check for placement every shift. Observation on February 20, 2024, at 11:23 a.m., and February 21, 2024, at 10:00 a.m., revealed there was no clamp available in Resident 147's room as ordered. On February 21, 2024, at 11:00 a.m., LPN 1 confirmed that there was no clamp at the bedside. In an interview on February 22, 2024, at 9:40 a.m., The Director of Nursing confirmed that the facility failed to ensure the availability of necessary emergency supplies at the resident's bedside. 28 Pa. Code 211.12(c)(d)(1)(2)(5) Nursing Services. 395817 Page 6 of 7 395817 02/22/2024 Yardley Rehabilitation and Healthcare Center 1480 Oxford Valley Road Yardley, PA 19067

F 0732 Post nurse staffing information every day. Level of Harm - Potential for minimal harm Based on observation and interview, it was determined that the facility failed to post accurate and current nurse staffing information. Residents Affected - Many Findings include: Observation on February 20, 2024, at 10:05 a.m., and February 21, 2024, at 9:25 a.m., revealed that nurse staffing information was posted in the lobby and had not been updated since February 16, 2024. In an interview on February 21, 2024, at 1:00 p.m., the Nursing Home Administrator confirmed that incorrect staffing data was posted. 28 Pa Code 201.18(b)(3) Management. 395817 Page 7 of 7