Health inspection·August 4, 2023

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm Based on clinical record review and staff interview, it was determined that the facility failed to ensure that physician's orders were implemented for one of 23 sampled residents. (Resident 3) Residents Affected - Few Findings include: Clinical record review revealed that Resident 3 had diagnoses that included paraplegia (loss of feeling or movement in part of the body), anxiety, depression, and chronic pain. A physician's order dated June 21, 2023, directed staff to administer Percocet (a pain medication) every four hours as needed for severe pain of eight to 10 on the pain scale. Review of the June, July, and August 2023, medication administration records revealed that staff administered the medication when the resident's pain was rated below eight on the pain scale eight times in June, 19 times in July, and one time in August. In an interview on August 4, 2023, at 9:45 a.m., Quality Regulatory Consultant 1 confirmed that staff had administered the Percocet when the resident's pain was below the established parameters. CFR 483.25 Quality of Care Previously cited 10/6/22 28 Pa. Code 211.12(d)(1)(5) Nursing services. Page 1 of 2 395878 395878 08/04/2023 Orwigsburg Nursing and Rehabilitation Center 1000 Orwigsburg Manor Dr Orwigsburg, PA 17961

F 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review and staff interview, it was determined that the facility failed to implement treatment and services to prevent a further decrease in range of motion for one of six sampled residents with limited range of motion. (Resident 46) Findings include: Clinical record review revealed that Resident 46 had diagnoses that included quadriplegia (the inability to be able to move any muscles from the neck down), muscle spasm, and traumatic brain injury. The Minimum Data Set assessment dated [DATE], indicated that the resident was cognitively impaired, dependent on staff for activities of daily living, and had a limitation in range of motion on both sides of the upper extremities. On March 8, 2022, the occupational therapist (OT) recommended a restorative nursing program (RNP) for range of motion for both shoulders and the right elbow. A physician's order dated March 9, 2022, directed staff to provide the RNP and provide a prolonged stretch for both shoulders and also to extend the right elbow five times and hold it for 30 seconds. There was no evidence that staff had implemented the RNP. In an interview conducted on August 3, 2023, at 10:12 a.m., Quality Regulatory Consultant 1 confirmed there was no evidence that the RNP was provided and that it was not on the task list for nursing care duties. In an interview conducted on August 3, 2023, at 11:00 a.m., The Director of Therapy stated that Resident 46 required the RNP as recommended for both shoulders and right elbow for muscle contractures. In an interview conducted on August 3, 2023, at 12:09 p.m., Nurse Aide 1 (NA1) stated that nurse aides viewed the required daily care duties and RNPs on the task list. 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services. 395878 Page 2 of 2