Health inspection·January 2, 2025

F 0553 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Allow resident to participate in the development and implementation of his or her person-centered plan of care. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a review of select facility policy, clinical record review, and staff interviews, it was determined the facility failed to afford a resident and their designated representative the right to participate in the development of the resident's plan of care for one resident out of seven residents sampled (Resident 3). Findings include: A review of the facility policy titled, Resident Participation- Assessment/Care Plans, last revised February 2021, revealed the resident and his or her representative are encouraged to participate in the resident's assessment and in the development and implementation of the resident's care plan. Furthermore, the policy indicated facility staff support and encourage resident and resident representative participation in the care planning process by providing sufficient notice in advance of the care plan meeting and planning for enough time for exchange of information and decision-making. The social services director or designee is responsible for notifying the resident and representative and for maintaining records of such notices. A clinical record review revealed Resident 3 was admitted to the facility on [DATE], with diagnoses that included pneumonia (a lung infection) and chronic obstructive pulmonary disease (COPD is a condition caused by damage to the airways or other parts of the lung that blocks airflow and makes it hard to breathe). A multidisciplinary care conference form dated August 30, 2024, revealed Resident 3's family member is involved in resident care and visits with resident at the facility. Resident 3's admission record form indicated the resident has identified a family member as his resident representative. A review of an admission Minimum Data Set assessment (MDS-a federally mandated standardized assessment process conducted periodically to plan resident care) dated September 4, 2024, revealed that Resident 3 is severely cognitively impaired with a BIMS score of 06 (Brief Interview for Mental Status- a tool within the Cognitive Section of the MDS that is used to assess the resident's attention, orientation, and ability to register and recall new information; a score of 00-07 indicates severe cognitive impairment). A clinical record review revealed no documented evidence that Resident 3 or Resident 3's representative were invited to participate in or attended his November 2024 quarterly interdisciplinary care plan meeting. Page 1 of 2 395875 395875 01/02/2025 Greenwood Center for Nursing and Rehab 149 Lafayette Avenue Tamaqua, PA 18252

F 0553 Level of Harm - Minimal harm or potential for actual harm During an interview on January 2, 2025, at approximately 11:00 AM, the Director of Nursing (DON) confirmed there was no documented evidence that Resident 3 or Resident 3's representative participated in or were invited to participate in the resident's care plan development. The DON confirmed it is the facility's responsibility to afford residents and their designated representatives the right to participate in the development of the resident's plan of care. Residents Affected - Few 28 Pa. Code 201.29(a) Resident rights. 28 Pa. Code 211.12(d)(3) Nursing services. 395875 Page 2 of 2