Health inspection·February 15, 2024

F 0640 Encode each resident’s assessment data and transmit these data to the State within 7 days of assessment. Level of Harm - Minimal harm or potential for actual harm Based on review of the Resident Assessment Instrument User Manual, clinical record review, and staff interviews, it was determined that the facility failed to complete required Minimum Data Set (MDS) assessments for three of 24 residents reviewed (Residents 9, 27, and 71). Residents Affected - Few Findings include: Review of The Long-Term Care Facility Resident Assessment Instrument (RAI) User's Manual, which provides instructions and guidelines for completing Minimum Data Set (MDS) assessments (mandated assessments of a resident's abilities and care needs), dated October 2023, revealed that a discharge assessment must be completed when a resident is admitted to a hospital or other care setting. The manual also indicated that a Death in Facility tracking record must be completed when a resident dies in the facility. Further review revealed that the discharge assessment must be completed within 14 calendar days of discharge and the Death in Facility tracking record must be complete within seven calendar days of the death of the resident. Review of Resident 9's clinical record revealed that she passed away at the facility on November 24, 2023. Review of Resident 27's clinical record revealed that she passed away in the facility on November 12, 2023. Review of Resident 9 and 27's MDS completion and submission records on February 12, 2024, at 2:39 PM, revealed that to date no Death in Facility tracking records had been initiated, completed, or submitted for either Resident. During an interview with the Director of Nursing (DON) on February 14, 2024, at 9:15 AM, she confirmed that MDS assessments should have been completed after Residents 9 and 27 passed away. She also revealed that those submissions would be completed. Review of Resident 71's clinical record revealed that she was transferred out to the hospital on October 9, 2023, and was subsequently admitted . Review of Resident 71's MDS completion and submission records on February 12, 2024, at 2:39 PM, revealed that to date no discharge MDS related to the hospitalization had been initiated, completed, or submitted. During an interview with the DON on February 15, 2024, at 9:37 AM, she confirmed that a discharge Page 1 of 5 395898 395898 02/15/2024 Homewood Living Plum Creek, Inc 425 Westminster Avenue Hanover, PA 17331

F 0640 MDS should have been completed when Resident 71 was admitted to the hospital. She also revealed that this was corrected. Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code 201.14(a) Responsibility of licensee Residents Affected - Few 28 Pa. Code 201.18(b)(3) Management 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services 395898 Page 2 of 5 395898 02/15/2024 Homewood Living Plum Creek, Inc 425 Westminster Avenue Hanover, PA 17331

F 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm Based on clinical record review and staff interviews, it was determined that the facility failed to ensure that the resident assessment accurately reflected the resident's status for two of 23 residents reviewed (Residents 14 and 40). Residents Affected - Few Findings include: Review of Resident 14's July 5, 2023 quarterly MDS (Minimum Data Set - an assessment tool to review all care areas specific to the resident such as a resident's physical, mental or psychosocial needs) revealed that the assessment was coded to indicate that Resident 14 experienced a fall with injury since the time the last assessment was completed. Review of Resident 14's clinical record for the indicated timeframe failed to reveal any evidence of a fall. During an interview with the Director of Nursing (DON) on February 14, 2024, at 9:15 AM, she confirmed that Resident 14 did not experience a fall during the timeframe in question and that Resident 14's July 5, 2023, MDS was coded incorrectly for a fall. Review of Resident 40's November 3, 2023, quarterly MDS assessment revealed that it was coded to indicate that she received antipsychotic medication (class of medication primarily used to manage psychosis [when someone loses touch with reality]), and that a dose reduction of this medication was last documented by the physician as being contraindicated on June 5, 2023. Review of geriatric psychiatry consult notes dated September 11, 2023, revealed that on this date the physician documented that a dose reduction of Resident 40's antipsychotic medications was contraindicated. During an interview with the DON on February 14, 2024, at 9:15 AM, she confirmed that Resident 40's November 3, 2023, was incorrectly coded and that a modification had been submitted. 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services 395898 Page 3 of 5 395898 02/15/2024 Homewood Living Plum Creek, Inc 425 Westminster Avenue Hanover, PA 17331

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 observations, policy review, clinical record review, and staff interviews, it was determined that the facility failed to ensure that a comprehensive, person-centered care plan was developed for two of 23 residents reviewed (Residents 18 and 51). Findings include: Review of facility policy, titled Care Planning-Interdisciplinary Team, revised September 2013, revealed, Our facility's care planning/interdisciplinary team is responsible for the development of and individualized comprehensive care plan for each resident. Review of Resident 18's clinical record revealed diagnoses that included muscle weakness (weakness of muscle movements) and fibromyalgia (a disorder that affects muscle and soft tissue characterized by chronic muscle pain, tenderness, fatigue, and sleep disturbances). Observation of Resident 18 on February 12, 2024, at 12:14 PM, revealed Resident 18 sitting in a recliner in her room wearing custom made orthotic shoes with built in AFO (an ankle foot orthosis controls the range of motion in your foot and ankle and helps to stabilize its position). Review of Resident 18's care plan on February 12, 2024, failed to reveal any guidance regarding Resident 18's use of orthotic shoes with AFO. Interview with the Director of Nursing (DON) on February 15, 2024, at 9:45 AM, revealed that Resident 18's care plan should have included the shoes with AFO brace. Review of Resident 51's clinical record on February 12, 2024, at approximately 12:00 PM, revealed diagnoses that included cerebral infarction (stroke - sudden loss of blood to a part of the brain which results in damage and death of cells) and dysphagia (difficulty swallowing). Observation of Resident 51 on February 12, 2024, at approximately 10:10 AM, revealed Resident 51 had a disposable tissue partially placed inside Resident 51's mouth. During an interview on February 12, 2024, at approximately 10:20 AM, Employee 1 stated that Resident 51 frequently utilized a tissue placed in his mouth to soak up salivary secretion. During the interview, Employee 1 stated that staff do check Resident 51's mouth during the day to ensure pieces of tissue and/or food are not left in Resident 51's mouth. Review of Resident 51's clinical record revealed Resident 51 was not care planned for placing a tissue in his mouth. During an interview on February 14, 2024, at approximately 1:30 PM, DON confirmed that Resident 51 was known to place tissues in his mouth. DON stated that the family has provided cloth handkerchiefs, but Resident 51 still utilizes disposable tissues at times. During an interview on February 15, 2024, at approximately 9:30 AM, DON provided an updated plan of care for Resident 51 which included the intervention of, I have excessive [secretions]. Staff will encourage me to use handkerchiefs that my family provides but I like to at times use tissues. Staff 395898 Page 4 of 5 395898 02/15/2024 Homewood Living Plum Creek, Inc 425 Westminster Avenue Hanover, PA 17331

F 0656 Level of Harm - Minimal harm or potential for actual harm will monitor my tissue use for concerns. During the staff interview, DON confirmed that the care plan should have reflected Resident 51's use of cloth handkerchief or tissues placed inside the mouth for salivary secretions. 28 Pa. Code 211.12(d)(3) Nursing services Residents Affected - Few 28 Pa. Code 211.12(d)(5) Nursing services 395898 Page 5 of 5