Health inspection·September 8, 2023

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. Based on review of facility policy, resident records, observation, and staff interview it was determined that the facility failed to uphold the privacy and dignity of one of five residents utilizing catheter care (Residents R51). Findings include: Review of the facility policy Indwelling Urinary Catheter last reviewed 5/30/23, indicated the catheter bag should have a privacy cover applied at all times unless it has one built in by the manufacturer. During an observation on 9/5/23, at 10:30 a.m. Resident R51 was observed utilizing a foley catheter without a privacy cover on the urine collection bag. During an observation on 9/6/23, at 12:12 p.m. the Director of Nursing confirmed Resident R51 did not have a dignity bag covering the urine collection bag. During an interview on 9/6/21, at 12:20 p.m. the Director of Nursing confirmed that the facility failed to uphold the privacy and dignity of one resident utilizing catheter care for Resident R51. 28 Pa Code: 201.29 (i) Resident rights. Page 1 of 3 395870 395870 09/08/2023 Quality Life Services - Markleysburg 252 Main Street Markleysburg, PA 15459

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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of clinical records and staff interviews, it was determined that facility staff failed to maintain ongoing communication with the dialysis (a machine filters wastes, salts and fluid from your blood when your kidneys are no longer healthy enough to do this work adequately) center for one of two residents reviewed (Resident R38). Residents Affected - Few Findings include: A review of the clinical record indicated that Resident R48 was admitted to the facility on [DATE], with diagnoses that included Stage 4 chronic kidney disease (kidneys are severely damaged and are not working as well as they should to filter waste from blood), diabetes, and high blood pressure. A review of the Minimum Data Set (MDS - periodic assessment of care needs) date 6/14/23, indicated the diagnoses remain current. A review of a physician's order dated 6/14/23, indicated Resident R48 was to receive dialysis three days a week on Monday, Wednesday, and Friday. Review of a care plan dated 2/17/23, indicated to check left upper arm AV fistula every shift and document. Further review of a care plan dated 6/14/23, indicated the resident is transported to dialysis via the transport bus. A review of the clinical record failed to reveal dialysis communications sheets for treatment dates from 6/14/23 through 9/5/23, missing 37 of 37 communication sheets. During an interview on 9/7/23, at 10:43 a.m. Registered Nurse Employee E1 confirmed the facility does not receive the communication sheets back from the dialysis center following treatment for Resident R48. During an interview on 9/7/23, at 11:55 a.m. the Director of Nursing confirmed the facility failed to ensure the dialysis communication forms for Resident R48 were completed for each dialysis treatment day and returned to the facility following each treatment. 28 Pa. Code: 211.12(d)(1)(3)(5) Nursing services. 395870 Page 2 of 3 395870 09/08/2023 Quality Life Services - Markleysburg 252 Main Street Markleysburg, PA 15459

F 0912 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide rooms that are at least 80 square feet per resident in multiple rooms and 100 square feet for single resident rooms. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interview, the facility failed to provide the required 80 square feet of space per resident for 16 of 25 rooms. Findings: During an observation of the facility floor plan on 9/5/23, at 2:15 p.m. the above room findings were as follows: room [ROOM NUMBER] (2 beds) 72.69 square feet per resident bed. room [ROOM NUMBER] (2 beds) 73.40 square feet per resident bed. room [ROOM NUMBER] (2 beds) 71.37 square feet per resident bed. room [ROOM NUMBER] (4 beds) 69.52 square feet per resident bed. room [ROOM NUMBER] (3 beds) 70.67 square feet per resident bed. room [ROOM NUMBER] (2 beds) 73.70 square feet per resident bed. room [ROOM NUMBER] (2 beds) 74.61 square feet per resident bed. room [ROOM NUMBER] (2 beds) 71.61 square feet per resident bed. room [ROOM NUMBER] (3 beds) 76.52 square feet per resident bed. room [ROOM NUMBER] (4 beds) 77.06 square feet per resident bed. room [ROOM NUMBER] (3 beds) 70.91 square feet per resident bed. room [ROOM NUMBER] (2 beds) 71.90 square feet per resident bed. room [ROOM NUMBER] (2 beds) 66.12 square feet per resident bed. room [ROOM NUMBER] (2 beds) 64.92 square feet per resident bed. room [ROOM NUMBER] (3 beds) 78.40 square feet per resident bed. room [ROOM NUMBER] (3 beds) 71.56 square feet per resident bed. During an interview on 09/8/23 at 12:02 p.m. the Nursing Home Administrator confirmed that the room sizes were less than 80 square feet as required. 28 Pa. Code: 205.20(f) Resident bedrooms. 395870 Page 3 of 3