Health inspection·January 9, 2025

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 review of clinical records, facility policy, and staff interviews, it was determined that the facility failed to develop a person-centered comprehensive care plan for one of 18 residents reviewed (Resident R70). Findings include: A review of the facility policy Care Plan, revised May 2023, revealed the facility will develop and implement a comprehensive person-centered care plan for each resident. The care plan will include measurable objectives and time frames to meet a resident's medical, nursing, and psychosocial needs that are identified in the comprehensive assessment. The care plan will describe the services that are to be furnished to attain or maintain the resident's highest practicable physical, mental and psychosocial well-being. Clinical record review revealed Resident R70 was admitted to the facility on [DATE], with diagnoses of Rhabdomyolysis (serious condition where your muscles break down and release toxins into your blood and kidneys), Hypertension (high blood pressure), and Malignant neoplasm of prostate (prostate cancer). Review of Resident R70's nursing notes from October 1, 2024 to January 8, 2024 revealed Resident R70 has been refusing various treatments several times weekly, such as Activities of Daily Living, medication, physical therapy, and occupational therapy. Review of Resident R70's care plan revealed no care plan related to Resident R70's refusal to treatments. Interview conducted on January 09, 2025 at 9:40 a.m. with Licensed nurse, Employee E3, confirmed Resident R70 did not have a care plan in place relating to the resident refusals to treatments. 28 Pa. Code: 211.12 (d) (1) (5) Nursing services. 28 Pa. Code 211.10 (c) Resident care policies. Page 1 of 2 395821 395821 01/09/2025 Little Flower Manor 1201 Springfield Road Darby, PA 19023

F 0757 Ensure each resident’s drug regimen must be free from unnecessary drugs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of clinical records and staff interview, it was determined that the facility failed to ensure that a resident's drug regimen was free of unnecessary drugs for one of 18 residents reviewed (Resident R30). Residents Affected - Few Findings included: Review of facility policy tilted Medication Regiment Review, revised June 2024, revealed if an irregularity is not time-sensitive but should be addressed before the consultant pharmacists' next monthly MRR, the facility staff and the consultant pharmacist will confer on the timeliness of attending physician/prescriber responses to identified irregularities based on the specific resident's clinical condition. Further review of facility policy revealed the physician/ prescriber should address the consultant pharmacist's recommendation no later than their next scheduled visit to the facility to assess the resident per policy, or applicable state and federal regulations. Clinical record review revealed Resident R30 was admitted to the facility on [DATE] with a diagnosis that included Anxiety, Hypertension (high blood pressure), and acute respiratory failure. Review of Resident R30's monthly pharmacy review dated October 29, 2024 revealed Resident R30 received a nonsedating antihistamine, Loratadine 10 milligrams (mg) daily for seasonal allergic rhinitis. Pharmacist comments revealed administration should be limited to the allergy season to avoid adverse events attributed to daily long-term use. Pharmacist recommended physician to reevaluate the continued need for Loratadine perhaps a trail discontinuation/PRN (as needed) period. Further review of Resident R30's monthly pharmacy review revealed the physician agreed and accepted the recommendation on October 31, 2024. Review of Resident R30's clinical record revealed Resident R30 had a standing order for Loratadine 10 mg started on February 13, 2024. The order continued to be a standing order and did not have a stop date that was recommended by pharmacist on October 29, 2024. Interview conducted on January 08, 2024 with Employee E2, Director of Nursing, confirmed Resident R30 continued to have a standing order for Loratadine 10 mg and should have been discontinued per pharmacy recommendation and physician response. 28 Pa. Code 211.2 (d)(3) Medical Director 28 Pa. Code 211.9 (k) Pharmacy Services 395821 Page 2 of 2