Health inspection·October 5, 2023

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. Based on review of facility policy, observation, clinical record review and interview with staff, it was determined that the facility did not ensure that the comprehensive care plan was updated in a timely manner related to contracture care for one of 15 records reviewed (Resident R14). Findings include: Review of facility policy titled Care Plans, Comprehensive Person-Centered, dated March 2022, revealed that, Assessments of residents are ongoing and care plans are revised as information about the residents and the residents' conditions change. Observations conducted on October 2, 2023, at 1:24 p.m. revealed that Resident R14's head was laying to the right in an exaggerated way. No collar or other device was noted at the time. Review of Resident R14's clinical record, revealed that the resident's care plan stated that she was to have Passive ROM (range of motion exercises) for both Upper and Lower extremities. Apply Kentucky neck collar/Aspen collar, (a form of neck brace which is used to correct head and neck misalignment) L (left) resting hand splint and R (right) palm cushion as recommended. This care plan item had been created on November 11, 2019. Interview with Nursing staff, Employee E4 on October 4, 2023, at 11:50 a.m. revealed that the resident no longer uses a collar, hand splint, or resting cushion, and instead utilizes passive ROM and a specialized pillow for her neck, a hand roll with finger separators for her left hand, and a towel roll for her right hand. Interview with Employee E2, the director of nursing on October 4, 2023, at 12:15 p.m. confirmed that the above care plan was not, but should have been revised as the resident's needs changed. 28 Pa. Code 211.12(d)(1) Nursing services 28 Pa. Code 211.12(d)(3) Nursing services 28 Pa. Code 211.12(d)(5) Nursing services Page 1 of 2 395847 395847 10/05/2023 Montgomery Subacute and Respiratory Center 251 Stenton Avenue Plymouth Meeting, PA 19462

F 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm Based on facility policies, clinical record review, and interview with staff it was determined that the facility failed to assess, develop, and implement interventions to address a significant weight loss in a timely manner for one of 7 residents (Resident R33). Residents Affected - Few Findings include: Review of Facility Policy titled Weight Assessment and Intervention revised March 2022, states that any weight change of 5% of more since the last weight assessment, is retaken the next day for confirmation. Further review of the policy states that a one-month weight loss of 5 % is significant and greater then a 5% weight loss in the time of one month is considered severe. Review of Resident R33's clinical record revealed Resident R33 was admitted into the facility on September 12, 2023 with a history of ALS (Amyotrophic Lateral Sclerosis, also know as Lou Gehrigsdisease, a nervous system disease that affects nerve cells in the brain and spinal cord. ALS causes loss of muscle control, and dysphagia (a condition with difficulty in swallowing food or liquid). Resident R33 required enteral feedings provided by a feeding tube for nutrition needs. Review of Resident R33's September 2023 physician orders revealed an order for Jevity 1.5 (a calorically dense, fiber-fortified therapeutic nutrition that provides complete balanced nutrition for tube feeding). Review of Resident R33's recent weights indicate a severe weight loss of 11 pounds and 4 ounces, a 7% weight loss in one week. On September 13, 2023, Resident R33's weight was 160 pounds and 8 ounces. On September 19, 2023, Resident R33's weight was 161 pounds and 2 ounces. On September 25, 2023, Resident R33's weight was 149 pounds and 8 ounces. Review of Resident R33's physician orders dated September 26, 2023, reveal an order to reweigh the resident by September 27, 2023 for further assessment of weight change. Review of Resident's September 2023 Medication Administration Record and September 2023 Treatment Administration Record) revealed that the resident was not weighted after the physician order was obtained. Review of Resident R33's nutrition note written by a Registered Dietician dated September 28, 2023 noted the significant weight loss and to continue tube feeding regimen with no additional interventions developed. 28 Pa. Code 211.10(c) Resident care policies 28 Pa. Code 211.12(d)(3) Nursing services 28 Pa Code 211.12 (d)(5) Nursing services 395847 Page 2 of 2