Health inspection·December 2, 2022

F 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. Based on clinical record review, review of select facility policies and procedures, and staff interview, it was determined that the facility failed to ensure that the resident's attending physician addressed pharmacy recommendations for four of five residents reviewed (Residents 3, 10, 21, and 30). Findings include: Review of the policy entitled Pharmacy Monthly Drug Regimen Review, last reviewed on March 22, 2022, indicates that the Director of Nursing or designee will assure that recommendations associated with drug irregularities are communicated to the attending physician within three days from the receipt of the report. Review of Resident 3's clinical record revealed that the facility's pharmacist made recommendations to his physician on April 28, 2022, for the consideration of a gradual dose reduction for the use of his Risperdal (an antipsychotic used to treat certain mood or mental disorders). The pharmacy recommendation was not addressed by Resident 3's physician until December 1, 2022, after questioning from this surveyor. Review of Resident 10's clinical record revealed that the facility's pharmacist made recommendations to her physician on March 23, 2022, for the consideration of a gradual dose reduction for the use of her Seroquel (an antipsychotic used to treat certain mood or mental disorders). There was no documented evidence in Resident 10's clinical record to indicate that her physician addressed the pharmacist's recommendation. Interview with the Administrator on December 1, 2022, at 1:23 PM confirmed the above findings for Resident 10. Review of Resident 21's clinical record revealed that the facility's pharmacist made recommendations to her physician on July 21, 2022, for the consideration of a gradual dose reduction for the use of her Lexapro (a medication used to treat depression or anxiety). There was no documented evidence in Resident 21's clinical record to indicate that her physician addressed the pharmacist's recommendation. Review of Resident 30's clinical record revealed that the facility's pharmacist made recommendations to her physician on March 24, 2022, for the consideration of a gradual dose reduction for the use of her Buspar (a medication used to treat anxiety). The pharmacy recommendation was not addressed by Resident 30's physician until December 1, 2022, after questioning from the surveyor. Interview with the Administrator and Director of Nursing on December 1, 2022, at 2:00 PM, acknowledged the above findings for Residents 3, 10, 21, and 30. (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 2 Event ID: 395838 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 395838 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/02/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Foxdale Village 500 E. Marylyn Avenue State College, PA 16801 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)