Health inspection·December 21, 2023

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Based on review of facility policies and clinical records, as well as staff interviews, it was determined that the facility failed to develop and implement comprehensive care plans that included specific and individualized interventions to address specific care needs for two of 33 residents reviewed (Residents 3, 35). Findings include: The facility's policy regarding care plans, dated January 12, 2023, indicated that individualized, comprehensive, person-centered care plans would be developed and implemented based on the resident's rights, including measurable objectives and timeframes to meet a resident's medical, nursing, mental, and psychosocial needs identified in the resident's comprehensive assessment. An admission Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) for Resident 3, dated November 26, 2023, revealed that the resident was cognitively impaired was understood and could understand others. Physician's orders for Resident 3, dated December 13, 2023, included an order for the resident to be on a 1500 milliliter (ml) fluid restriction per day. There was no documented evidence in Resident 3's clinical record that a comprehensive care plan was developed that included a 1500 ml per day fluid restriction. Interview with the Director of Nursing on December 19, 2023, at 2:00 p.m. confirmed that a care plan to address Resident 3's specialized care needs related to a fluid restriction was not created and that it should have been. An admission MDS assessment for Resident 35, dated October 15, 2023, revealed that the resident was cognitively impaired. Physician's orders for Resident 35, dated December 13, 2023, included an order for the resident to have the midline catheter (a form of intravenous access that is used for a prolonged period of time) flushed with 3 milliliters of normal saline solution before and after each IV medication administration. There was no documented evidence in Resident 35's clinical record to indicate that a comprehensive care plan was developed that included the care needs for a midline catheter. Page 1 of 7 395896 395896 12/21/2023 Homewood Living Martinsburg, Inc 437 Givler Drive Martinsburg, PA 16662

F 0656 Level of Harm - Minimal harm or potential for actual harm Interview with the Director of Nursing on December 20, 2023, at 1:26 p.m. confirmed that a care plan to address Resident 35's specialized care needs related to having a midline catheter was not created and that it should have been. 28 Pa. Code 211.11(d) Resident care plan. Residents Affected - Few 28 Pa. Code 211.12(d)(5) Nursing services. 395896 Page 2 of 7 395896 12/21/2023 Homewood Living Martinsburg, Inc 437 Givler Drive Martinsburg, PA 16662

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 policies and clinical records, as well as observations and staff interviews, it was determined that the facility failed to ensure that care plans were updated to reflect changes in residents' care needs for two of 34 residents reviewed (Residents 14, 101). Findings include: The facility's policy regarding care plans, dated January 12, 2023, indicated that nursing staff and/or the interdisciplinary team were to initiate and/or update care plans for the resident as warranted. A quarterly Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) for Resident 14, dated August 21, 2023, revealed that the resident was understood and could understand others, had no cognitive impairment, and was dependent on staff for daily care needs. Current physician's orders for Resident 14 revealed an order for a 1500 milliliter (ml) fluid restriction per day. A care plan for Resident 14, most recently updated November 2, 2023, indicated the resident was on a 2000 ml per day fluid restriction. Interview with the Director of Nursing on December 19, 2023, at 9:28 a.m. confirmed that Resident 14 was on a 1500 ml fluid restriction per day and that the care plan was not updated. An annual MDS assessment for Resident 101, dated December 10, 2023, revealed that the resident was cognitively impaired, required extensive assistance from staff for daily care tasks, had a care plan that indicated the resident was at risk for infection due to her indwelling catheter, and had diagnoses that included chronic kidney disease and acute kidney failure. Physician's orders for Resident 101, dated December 4, 2023, included an order for the resident to have the foley catheter changed every month. However, a care plan, dated December 19, 2023, indicated that the catheter was to be changed every three months. Interview with the Director of Nursing on December 19, 2023, at 2:40 p.m. confirmed that Resident 101's care plan was not updated to reflect the catheter was to be changed every month. 28 Pa. Code 211.11(d) Resident care plan. 28 Pa. Code 211.12(d)(5) Nursing services. 395896 Page 3 of 7 395896 12/21/2023 Homewood Living Martinsburg, Inc 437 Givler Drive Martinsburg, PA 16662

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 review of clinical records, as well as staff interviews, it was determined that the facility failed to ensure that physician's orders were followed for one of 34 residents reviewed (Resident 93). Residents Affected - Few Findings include: An admission Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) for Resident 93, dated November 23, 2023, revealed that the resident was understood, could understand others, and had diagnoses that included heart disease. Physician's orders for Resident 93, dated November 28, 2023, included orders for the resident to receive 25 milligrams (mg) of Metoprolol Tartrate (treats high blood pressure) once a day, to be held if her systolic blood pressure (top number in a blood pressure reading) was less than 100 mm/Hg and held if her heart rate was less than 60 beats per minute (bpm). A review of the December 2023 Medication Administration Record (MAR) for Resident 93 revealed that on December 5 the resident's blood pressure was 86/51 mm/Hg. The Metoprolol Tartrate dose was administered on the above date when it should have been held, according to the physician's orders. In addition, there was no documented evidence in the clinical record to indicate that Resident 93's pulse was taken as ordered during the month of December 2023. Interview with the Director of Nursing on December 20, 2023, at 2:47 p.m. confirmed that Metoprolol Tartrate was administered to Resident 93 on the above-mentioned date when it should not have been given, and that the pulse should have been taken and recorded per the physician's orders but was not. 28 Pa. Code 211.12(d)(1)(5) Nursing services. 395896 Page 4 of 7 395896 12/21/2023 Homewood Living Martinsburg, Inc 437 Givler Drive Martinsburg, PA 16662

F 0694 Provide for the safe, appropriate administration of IV fluids for a resident when needed. Level of Harm - Minimal harm or potential for actual harm Based on review of policies and clinical records, as well as staff interviews, it was determined that the facility failed to ensure that central venous catheters were flushed as ordered by the physician for one of 34 residents reviewed (Resident 35). Residents Affected - Few Findings include: The facility's policy regarding flushing central venous catheters (a thin tube inserted into a vein and used long-term for the administration of fluids and/or medications), dated January 12, 2023, indicated that the catheter was to be flushed before and after each intravenous (IV) medication administration and after each blood draw. An admission Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) for Resident 35, dated October 15, 2023, revealed that the resident was cognitively impaired, needed extensive assistance for daily care needs, had diagnoses that included wound infection, a diabetic foot ulcer, and was receiving IV medication. Physician's orders for Resident 35, dated December 13, 2023, included and order for the central catheter to be flushed with 3 milliliters (ml) of normal saline solution (NSS) after medication. There was no documented evidence in the clinical record that Resident 35's central catheter was flushed as ordered and per facility policy on December 13, 2023; December 14, 2023; and December 16, 2023. An interview with the Director of Nursing on December 20, 2023, at 12:20 p.m. confirmed that there was no documented evidence that Resident 35's midline was flushed as ordered or per the facility's policy. 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services. 395896 Page 5 of 7 395896 12/21/2023 Homewood Living Martinsburg, Inc 437 Givler Drive Martinsburg, PA 16662

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on review of policies and clinical records, as well as staff interviews, it was determined that the facility failed to maintain a complete and accurate accounting of controlled medications (medications with the potential to be abused) for one of 34 residents reviewed (Resident 3). Findings include: The facility's policy regarding medication administration, dated January 12, 2023, indicated that staff were to document that medication was given on the appropriate line of the resident's Medication Administration Record (MAR). Physician's orders for Resident 3, dated November 20, 2023, included an order for the resident to receive one 5 milligram (mg) tablet of Oxycontin (a controlled narcotic pain medication) every four hours three times daily. Resident 3's controlled drug records for December 2023 revealed that a 5 mg dose of Oxycontin was signed-out for administration once on December 9, 2023; however, the resident's clinical record, including the MAR, contained no documented evidence that the Oxycontin was actually administered to the resident. Interview with the Director of Nursing on December 19, 2023, at 2:00 p.m. confirmed that there was no documented evidence that the dose of Oxycontin signed-out by the nurse was actually administered to Resident 3 on the above date. 28 Pa. Code 211.9(h) Pharmacy services. 28 Pa. Code 211.12(d)(1)(5) Nursing services. 395896 Page 6 of 7 395896 12/21/2023 Homewood Living Martinsburg, Inc 437 Givler Drive Martinsburg, PA 16662

F 0867 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 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 from previous surveys, and the results of the current survey, it was determined that the facility's Quality Assurance Performance Improvement (QAPI) committee failed to correct quality deficiencies 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 State Survey and Certification (Department of Health) survey ending January 6, 2023, revealed that the facility developed plans of correction that included quality assurance systems with audits to ensure that the facility maintained compliance with cited nursing home regulations. The results of the audits were to be reported to the QAPI committee for review. The results of the current survey, ending December 21, 2023, identified repeated deficiencies regarding care plan development, care plan timing and revision, quality of care, and ensuring that parenteral fluids were administered consistent with professional standards of practice. The facility's plan of correction for deficiencies regarding the development of resident-centered care plans, cited during the survey ending January 6, 2023, revealed that the facility would complete audits and report the results of the audits to the QAPI committee for review. The results of the current survey, cited under

F656, revealed that the facility's QAPI committee was ineffective in maintaining compliance with the regulation regarding the development of resident-centered care plans. The facility's plan of correction for deficiencies regarding the timing and revision of resident care plans, cited during the survey ending January 6, 2023, revealed that the facility would complete audits and report the results of the audits to the QAPI committee for review. The results of the current survey, cited under

F657, revealed that the facility's QAPI committee was ineffective in maintaining compliance with the regulation regarding the timing and revision of resident care plans. The facility's plan of correction for deficiencies regarding quality of care, cited during the surveys ending on January 6, 2023, 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 F684, revealed that the QAPI committee was ineffective in maintaining compliance with the regulation regarding quality of care. The facility's plan of correction for deficiencies regarding ensuring that parenteral fluids were administered consistent with professional standards of practice, cited during the survey ending on January 6, 2023, 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 F694, revealed that the QAPI committee was ineffective in maintaining compliance with the regulation regarding ensuring that parenteral fluids were administered consistent with professional standards of practice. Refer to F656, F657, F684, F694. 28 Pa. Code 201.14(a) Responsibility of licensee. 28 Pa. Code 201.18(e)(1) Management. 395896 Page 7 of 7