Health inspection·April 16, 2025

F 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm Based on review of the Resident Assessment Instrument User's Manual and clinical records, as well as staff interviews, it was determined that the facility failed to complete accurate Minimum Data Set assessments for four of 29 residents reviewed (Residents 15, 23, 28, 38). Residents Affected - Few Findings include: The Long-Term Care Facility Resident Assessment Instrument (RAI) User's Manual, which provides guidance and instructions for the completion of MDS assessments, dated October 2024, indicated that the intent of Section N was to record the number of days, during the seven-day assessment period, that any type of injection, insulin, and/or select medications were received by the resident. Section N0415B1 was to be coded if the resident received an antianxiety medication during the seven-day assessment period, Section N0415F1 was to be coded if the resident received an antibiotic medication during the seven-day assessment period, Section N0415G1 Diuretic Medications (medications that promote the excretion of urine by the kidneys) was to be coded if the resident took the medication during the seven-day assessment period, and Section N0451K1 was to be coded if the resident received an anticonvulsant (medication used to prevent seizures) medication during the seven-day assessment period. Physician's orders for Resident 15, dated February 5, 2024, included an order for the resident to receive 320-12.5 mg of Valsartan-hydrochlorothiazide (antihypertensive - diuretic medication) daily for hypertension (high blood pressure). Medication Administration Records (MAR's) for Resident 15, dated January 2025, revealed that staff administered 320-12.5 mg of valsartan-hydrochlorothiazide daily from January 1 through 31, 2025. However, Section N0415G1 of Resident 15's quarterly MDS assessment, dated January 16, 2025, was coded to indicate that the resident did not receive a diuretic medication during the seven-day assessment. Physician's orders for Resident 23, dated July 23, 2024, included an order for the resident to receive 0.5 mg of lorazepam (an antianxiety medication) four times a day for post traumatic stress disorder. MAR's for Resident 23, dated January 2025, revealed that staff administered 0.5 mg of lorazepam four times a day from January 1 through 31, 2025. However, Section N0415B1 of Resident 23's quarterly MDS assessment, dated January 25, 2025, was coded to indicate that the resident did not receive an antianxiety medication during the seven-day assessment. Physician's orders for Resident 28, dated January 27, 2025, included an order for staff to apply 1 percent Silver Sulfadiazine cream (topical antibiotic cream used to prevent infections) to open areas on the resident's coccyx and right buttocks every evening. Treatment Administration Records (TAR's) for Resident 28 for February 2025 revealed that staff applied 1 percent Silver Sulfadiazine to the resident's coccyx and right buttocks every evening from February 1 through 9, 2025. However, Section N0415F1 of Resident 28's annual MDS assessment, dated February 15, 2025, was coded to indicate Page 1 of 12 395891 395891 04/16/2025 Laurel View Village 2000 Cambridge Drive Davidsville, PA 15928

F 0641 that the resident did not receive an antibiotic medication during the seven-day assessment. Level of Harm - Minimal harm or potential for actual harm Physician's orders for Resident 38, dated September 25, 2024, included an order for the resident to receive 100 mg of carbamazepine (anti-convulsant medication used to treat neuralgia) at bedtime for neuralgia (nerve pain). MAR's for Resident 38, dated December 2024, revealed that staff administered 100 mg of carbamazepine at bedtime from December 1 through 31, 2024. However, Section N0415K1 of Resident 38's quarterly MDS assessment, dated December 30, 2024, was coded to indicate that the resident did not receive an anticonvulsant medication during the seven-day assessment. Residents Affected - Few Interview with Registered Nurse Assessment Coordinator 1 (RNAC - a registered nurse who is responsible for the completion of MDS assessments) on April 15, 2025, at 11:20 a.m. confirmed that MDS assessments for Residents 15, 23, 28, and 38 were coded inaccurately. 28 Pa. Code 211.5(f) Clinical Records. 395891 Page 2 of 12 395891 04/16/2025 Laurel View Village 2000 Cambridge Drive Davidsville, PA 15928

F 0676 Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. Level of Harm - Minimal harm or potential for actual harm Based on a review of facility policies and clinical records, as well as resident and staff interviews, it was determined that the facility failed to ensure that restorative nursing programs to maintain or improve physical abilities were provided as per the resident's plan of care for one of 29 residents reviewed (Resident 39). Residents Affected - Few Findings include: A facility policy regarding restorative nursing programs, dated December 2024, indicated that each resident involved will have an individualized program with a realistic and measurable goal. The restorative nursing program is designed to assist each resident to achieve and maintain an optimal level of self-care, independence and quality of life. Through the resident's care plan, the goals of the restorative nursing program are reinforced in the restorative services. Restorative aides/designee will be responsible for documenting how the resident did, how far they may have ambulated, how long they stood for, or how many repetitions of exercise were performed. And if there were any issues to what they were, what was done and who was made aware. The restorative nursing coordinator will oversee the restorative nursing programs and documentation. A monthly summary assessment is to be completed by the restorative nursing aide/designee to include changes and adjustments, progress towards goals, and the needs to continue or discharge, as per team recommendations. Each resident program will be evaluated monthly for any significant change in function and discussed and revised as needed. A quarterly Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) for Resident 39, dated January 19, 2025, revealed that the resident was cognitively intact, required substantial/maximum assistance (helper provides more than half of the effort required to complete a task) with lower body dressing, moderate assistance (resident performs about half the effort required for an activity) with upper body dressing, substantial/maximum assistance with transfers and ambulation, was able to ambulate 10 feet with substantial/maximum assistance, and had a diagnosis of Parkinsonism (a neurological disorder causing slowed movements, stiffness and tremors). A care plan intervention for Resident 39, revised on December 2, 2024, indicated that the resident was on a restorative active range of motion (performance of an exercise to move a joint without any assistance or effort of another person to the muscles surrounding the joint) program to his bilateral upper extremities using five-pound weights with a goal of two sets for 15 repetitions. A care plan intervention for Resident 39, revised on December 2, 2024, indicated that the resident was on a restorative ambulation program, and he was to be walked with limited assistance (resident is highly involved in performing an activity) from one person and use of a front-wheeled walker and with a wheelchair follow for a goal of 100 feet. The restorative active range of motion and ambulation was to be documented on the activity of daily living flowsheet. Review of Resident 39's restorative active range of motion documentation from February 1, 2025, through April 14, 2025, as well as review of nursing notes, revealed no documented evidence that the restorative active range of motion program was completed as per the resident's plan of care on the day shift for the following dates: February 1, 2, 4, 8, 9, 15, 16, and 18-28; March 1, 2, 3, 8, 9, 15, 16, 17, 20, 22, 23, 29 and 30; and April 3, 5, 6, 12, and 13. Review of Resident 39's restorative ambulation documentation from February 1, 2025, through April 14, 2025, as well as review of nursing notes, revealed no documented evidence that the restorative ambulation program was completed as per the resident's plan of care on the day shift for the following 395891 Page 3 of 12 395891 04/16/2025 Laurel View Village 2000 Cambridge Drive Davidsville, PA 15928

F 0676 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few dates: February 2, 14,16, 18, 22, 23 and 25; March 4, 5, 6, 9, 17, 18, 19, 20, 23, 24, 28, 30 and 31; and April 2, 4, 5, 6, 7, 8, 9, 10, 11, 13 and 14. Review of Resident 39's restorative ambulation documentation from February 1, 2025, through April 14, 2025, as well as review of nursing notes, revealed that there was no documented evidence that the restorative ambulation program was completed as per the resident's plan of care on the evening shift for the following dates: February 2, 4, 5, 7, 8, 9, 13-18, and 20-28; March 1, 4, 6, 8-14, 17, 18, 19, 21-27, 29, 30 and 31; and April 1- 6, 8, 9 and 10. A monthly restorative review for Resident 39, dated January 23, 2025, indicated that the resident participates with range of motion exercise with the restorative aide and staff, and that he ambulates with a wheeled walker and limited assistance from two staff to his tolerance in his room. A monthly restorative review for Resident 39, dated March 5, 2025, indicated that the resident participates with range of motion exercise with the restorative aide and staff, and that he ambulates with a wheeled walker and limited assistance from two staff to his tolerance in his room. A monthly restorative review for Resident 39, dated March 24, 2025, indicated that the resident participates with range of motion exercise with the restorative aide and staff, and that he ambulates with a wheeled walker and limited assistance from two staff to his tolerance in his room. An interview with Nurse Aide 2 on April 16, 2025, at 8:14 a.m. revealed that she only walks Resident 39 in his room from his bed to his recliner chair at beside. She indicated that she would attempt to walk him to his bathroom some days, but he was usually unable to walk that far. An interview with the Nursing Home Administrator on April 16, 2025, at 11:08 a.m. confirmed that there was no documented evidence that Resident 39's restorative active range of motion and ambulation programs were completed as per his care plan on the above-mentioned dates and shifts. 28 Pa. Code 211.12(d)(3)(5) Nursing Services. 395891 Page 4 of 12 395891 04/16/2025 Laurel View Village 2000 Cambridge Drive Davidsville, PA 15928

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 reviews and staff interviews, it was determined that the facility failed to follow physician's orders related to bowel protocols for two of 29 residents reviewed (Residents 4, 41) and failed to follow physician's orders for medication administration for one of 29 resident (Resident 27). Residents Affected - Some Findings include: A facility policy for the bowel protocol, dated November 2021, indicated that on admission the following bowel protocol will be ordered for all residents to prevent constipation unless otherwise specified by the admitting physician. Give 30 milliliters (ml) of Milk of Magnesia (MOM - an oral laxative) one time if there is not bowel movement after 3 days. If Milk of Magnesia is ineffective, on day 4, give a 10 milligram (mg) Dulcolax suppository (a laxative inserted rectally). If both Milk of Magnesia and Dulcolax suppository are ineffective, on day 5 give a Fleets enema (a liquid inserted rectally to stimulate a bowel movement) unless contraindicated. Monitor the use of the bowel protocol. A quarterly Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) for Resident 4, dated February 27, 2025, indicated that the resident was cognitively impaired, was dependent on staff for daily care needs, and had diagnoses that included dementia. Current physician's orders for Resident 4 included orders for staff to administer 30 milliliters (ml) of Milk of Magnesia as needed for no bowel movement after three days; a 10 milligram (mg) Dulcolax suppository as needed if Milk of Magnesia was not effective, to be administered on day 4 if no bowel movement; and to administer a Fleets enema as needed if Milk of Magnesia and Dulcolax suppository are ineffective, to be administered on day 5 of no bowel movement. Review of the bowel record for Resident 4, dated March 2025, indicated that the resident did not have a bowel movement on March 17 through March 23, 2025, a total of seven days. Review of the Medication Administration Record (MAR) for Resident 4, dated March 2025, indicated that 30 ml of Milk of Magnesia was administered to the resident on March 20 with ineffective results. Review of the MAR revealed no documented evidence that Dulcolax was administered when Milk of Magnesia was ineffective on day 4 of not having a bowel movement as ordered, and no documented evidence that a Fleets enema was administered on day 5 of no bowel movement, as ordered. An admission MDS assessment for Resident 41, dated February 3, 2025, indicated that the resident was cognitively impaired, was dependent on staff for daily care needs, was frequently incontinent of bowel movements, and had diagnoses that included dementia. Physician's orders for Resident 41, dated January 28, 2025, included orders for staff to administer 30 ml of Milk of Magnesia as needed for no bowel movement after three days, a 10 mg Dulcolax suppository as needed if Milk of Magnesia was not effective on day 4 if no bowel movement, and to administer a Fleets enema as needed for constipation on day 5 if both Milk of Magnesia and Dulcolax suppository were ineffective. Review of the bowel records for Resident 41, dated February and April 2025, indicated that the resident did not have a bowel movement on February 2 through 6, 2025, (6 days) and on April 7 through April 11, 2025, (five days). Review of the Medication Administration Record (MAR) for Resident 41, 395891 Page 5 of 12 395891 04/16/2025 Laurel View Village 2000 Cambridge Drive Davidsville, PA 15928

F 0684 Level of Harm - Minimal harm or potential for actual harm dated February and April 2025, indicated that 30 ml of Milk of Magnesia and the Dulcolax suppository were not administered on the third and fourth day without a bowel movement, as ordered by the physician. Interview with the Nursing Home Administrator on April 16, 2025, at 11:26 a.m. confirmed that bowel protocol was not followed for Residents 4 and 41 on the above-mentioned dates. Residents Affected - Some A quarterly MDS assessment for Resident 27, dated January 31, 2025, indicated that the resident was cognitively intact, required assistance from staff for daily care needs, and had diagnoses that included left-sided hemiplegia (paralysis or weakness on one side of the body) after having a stroke. Current physician's orders for Resident 27 indicated that the resident was to receive a Salonpas patch to her left or right shoulder as needed for pain daily, and to remove the Salonpas patch no more than 12 hours after the application. Review of the MAR for Resident 27 dated February, March, and April 2025 revealed that a Salonpas patch was administered to Resident 27 on February 1 at 9:33 a.m., February 5 at 6:45 a.m., February 6 at 6:05 a.m., February 7 at 6:44 a.m., February 10 at 5:27 a.m., February 12 at 6:44 a.m., February 17 at 6:51 a.m., February 19 at 9:37 a.m., March 1 at 6:57 a.m., March 4 at 7:05 a.m., March 6 at 7:21 a.m., March 10 at 5:27 a.m., March 16 at 7:00 a.m., March 17 at 7:18 a.m., March 18 at 9:53 a.m., March 20 at 6:47 a.m., March 30 at 8:24 a.m., April 1 at 6:40 a.m., April 7 at 6:40 a.m., April 8 at 6:27 a.m., and April 12 at 6:01 a.m. There was no documented evidence that the Salonpas patch was removed within 12 hours of applying it as ordered. Interview with the Nursing Home Administrator on April 15, 2025, at 11:34 a.m. confirmed that there was no documented evidence that the Salonpas patch was removed from Resident 27 within 12 hours after it was applied as ordered on the above mentioned dates. 28 Pa. Code 211.12(d)(5) Nursing Services. 395891 Page 6 of 12 395891 04/16/2025 Laurel View Village 2000 Cambridge Drive Davidsville, PA 15928

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. Based on review of facility policies and clinical records, as well as observation and staff interviews, it was determined that the facility failed to ensure that residents received proper care for indwelling urinary catheters and failed to ensure that urinary output was measured and documented per facility policy for one of 29 residents reviewed (Resident 39) who had an indwelling urinary catheter. Findings include: A quarterly Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) for Resident 39, dated January 19, 2025, revealed that the resident was cognitively intact, required assistance with care needs, had an indwelling urinary catheter (a thin, flexible tube inserted into the bladder to drain urine from the bladder), and had a diagnosis of obstructive uropathy (blockage of the urinary tract). Physician's orders for Resident 39, dated February 10, 2025, included an order for suprapubic catheter (a type of indwelling catheter that drains urine from the bladder through the abdomen), 18 French (size) with a 10 cubic centimeters (cc) balloon (located on the bladder end of the catheter and filled with sterile water to hold the tube in place). Observations of Resident 39 on April 16, 2025, at 8:06 a.m. revealed that the resident was lying in bed with his catheter bag and tubing lying on the floor. There was no privacy bag or other type of barrier between the bag and the floor. Interview with Nurse Aide 2 on April 16, 2025, at 8:14 a.m. confirmed that Resident 39's catheter bag and tubing was lying in direct contact with the floor. She indicated that he had a basin that the catheter bag should have been in and located the basin under his bed. Interview with the Nursing Home Administrator on April 16, 2025, at 12:08 p.m. confirmed that the catheter bag and tubing should not have been in direct contact with the floor and should have been in a basin. The facility's policy regarding intake and output measurement, dated December 2024, indicated that all residents with an indwelling catheter require measurement and documentation of intake and output every shift . Daily intake and output records are maintained via the electronic medical record. Review of Resident 39's activity of daily living record from February 1, 2025, through April 14, 2025, revealed that there was no documented evidence that the resident's urinary output was measured on the day shift for the following dates: February 2 and 19; March 2, 4, 7, 22, 23, 24, 28 and 30; and April 4, 5, and 14. There was no documented evidence that the resident's urinary output was measured on the evening shift for the following dates: March 1, 7 and 20; and April 10. There was no documented evidence that the resident's urinary output was measured on the night shift for the following dates: February 11, 18, 27 and 28; and March 1, 20, 21, 22, and 31. Interview with the Nursing Home Administrator on April 16, 2025, at 11:42 a.m. confirmed that there was no documented evidence that Resident 39's urinary outputs were measured per facility policy on the above-mentioned dates and shifts. 395891 Page 7 of 12 395891 04/16/2025 Laurel View Village 2000 Cambridge Drive Davidsville, PA 15928

F 0690 28 Pa. Code 211.12(d)(1)(5) Nursing Services. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 395891 Page 8 of 12 395891 04/16/2025 Laurel View Village 2000 Cambridge Drive Davidsville, PA 15928

F 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm Based on a review of facility policies and clinical records, as well as staff interviews, it was determined that the facility failed to ensure that interventions to prevent weight loss were provided as recommended by the dietician for one of 29 residents reviewed (Resident 12). Residents Affected - Few Findings include: A facility policy for nutrition interventions, dated October 2024, indicated that the dietician/qualified nutrition professional identifies residents who are at risk and/or potential risk for nutrition-related problems. The dietician/qualified nutrition professional recommends interventions to maintain the resident's nutrition status, based on resident preference and tolerance. For residents at nutritional risk, the dietician/qualified nutrition professional updates nutrition prescriptions per community ordering writing standards, for example, diet orders, supplements, med pass, and nourishment, and monitors resident's acceptance/outcomes on a regular basis and recommends changes. A quarterly Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) for Resident 12, dated March 21, 2025, revealed that the resident had cognitive impairment, required set up and clean up assistance with eating, had diagnoses that included dementia, and had unplanned weight loss. Orders for Resident 12, dated April 3, 2025, included for the resident to have a regular mechanical soft diet with ground meats and nectar thick liquids. A dietary note for Resident 12, dated March 20, 2025, indicated that Resident 12 was agreeable to adding ice cream twice a day to her diet due to her weight loss and decreased food intake, and that the resident was to be given ice cream twice a day. Review of Resident 12's clinical record revealed no documented evidence that ice cream was provided to the resident twice a day per the dietician's recommendation. Review of the weight record for Resident 12 revealed that on March 17, 2025, the resident had a weight of 130.7 pounds (lbs) and on April 14, 2025, the resident's weight was 125.5 lbs. Observation of Resident 12 on April 16, 2025, at 12:05 p.m. revealed that she was sitting in the dining room with her lunch meal in front of her. No ice cream or magic cup supplement was observed. Interview with the Dietician on April 16, 2025, at 1:21 p.m. revealed that Resident 12 refused most nutritional supplements offered but did agree to trying ice cream twice a day, and that she believed that Resident 12 was getting ice cream or a magic cup (frozen dessert that like ice cream when frozen but is a pudding after thawing) after her diet was changed to thickened liquids, with her meals. The dietician confirmed that ice cream twice a day was not listed on her meal ticket, and there was no documented evidence that it or an equivalent magic cup was being provided per her recommendation. Interview with Dietary Manager on April 16, 2025, at 1:37 p.m. revealed that when nutritional support items are added to a residents' diet, an order for it was usually added into the resident's clinical record and the item added to the resident's meal ticket; however, there was no order for Resident 12 to have ice cream twice a day per the dietician's recommendation, and it was not added to her 395891 Page 9 of 12 395891 04/16/2025 Laurel View Village 2000 Cambridge Drive Davidsville, PA 15928

F 0692 Level of Harm - Minimal harm or potential for actual harm meal ticket. There was no documented evidence that Resident 12 was receiving or refusing ice cream or a magic cup equivalent twice a day. 28 Pa. Code 211.12(d)(3)(5) Nursing Services. Residents Affected - Few 395891 Page 10 of 12 395891 04/16/2025 Laurel View Village 2000 Cambridge Drive Davidsville, PA 15928

F 0810 Provide special eating equipment and utensils for residents who need them and appropriate assistance. Level of Harm - Minimal harm or potential for actual harm Based on review of policies and clinical records, observations, and staff interviews, it was determined that the facility failed to ensure that staff provided assistive devices to eat as ordered by the physician for one of 29 residents reviewed (Resident 23). Residents Affected - Few Findings include: A quarterly Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) for Resident 23, dated January 25, 2025, indicated that the resident was moderately cognitively impaired, required set-up assistance from staff with eating, and had diagnoses that included dementia. Physician's orders, dated February 14, 2024, included an order for the resident to utilize a divided plate (plate that allows easier access to food). Observations of Resident 23 during the lunch meal on April 15, 2025, at 12:02 p.m. revealed that the resident was in the dining room eating her meal and did not have a divided plate. The resident's meal ticket for the noon meal indicated that she was to have a divided plate. Interview with Licensed Practical Nurse 4 on April 15, 2025, at 12:04 p.m. confirmed that Resident 23 did not have a divided plate as ordered. 28 Pa. Code 211.12(d)(3)(5) Nursing Services. 395891 Page 11 of 12 395891 04/16/2025 Laurel View Village 2000 Cambridge Drive Davidsville, PA 15928

F 0867 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action. Based on review of the facility's plans of correction for previous surveys, and the results of the current survey, it was determined that the facility's Quality Assurance Performance Improvement (QAPI) committee failed to maintain compliance with nursing home regulations and ensure that plans to improve the delivery of care and services effectively addressed recurring deficiencies. Findings include: The facility's deficiencies and plans of correction for a State Survey and Certification (Department of Health) survey ending May 23, 2024, revealed that the facility developed plans of correction that included quality assurance systems to ensure that the facility maintained compliance with cited nursing home regulations. The results of the current survey, ending April 16, 2025, identified repeated deficiencies related to a failure to follow physician's orders, provide proper care of urinary catheters, and nutrition maintenance. The facility's plan of correction for a deficiency regarding following physician's orders, cited during survey ending May 23, 2024, revealed that the facility developed a plan of correction that included completing audits and reporting the results of the audits to the QAPI committee for review. The results of the current survey, cited under F684, revealed that the QAPI committee was ineffective in correcting deficient practices related to following physician's orders. The facility's plan of correction for a deficiency regarding failures to provide proper catheter care, cited during the survey ending May 23, 2024, revealed that the facility would complete audits and the results would be reviewed as part of quality assurance. The results of the current survey, cited under F690, revealed that the facility's QAPI committee was ineffective in maintaining compliance with the regulation regarding catheter care. The facility's plan of correction for a deficiency regarding nutrition maintenance, cited during the survey ending on May 23, 2024, revealed that audits would be conducted, and the results of the audits would be brought before the QAPI committee for further monitoring. The results of the current survey, cited under

F692, revealed that the QAPI committee was ineffective in maintaining compliance with the regulation regarding nutrition maintenance. Refer to F684, F690, F692. 28 Pa. Code 201.14(a) Responsibility of Licensee. 28 Pa. Code 201.18(e)(1) Management. 395891 Page 12 of 12