Health inspection·January 23, 2025

F 0558 Reasonably accommodate the needs and preferences of each resident. Level of Harm - Minimal harm or potential for actual harm Based on facility policy review, observations, clinical record review, and resident and staff interviews, it was determined that the facility failed to ensure the right to receive services with reasonable accommodation of resident needs for one of 22 residents reviewed (Resident 4), and failed to ensure that resident needs were accommodated regarding call bell accessibility for one of 22 residents reviewed (Residents 87). Residents Affected - Few Findings include: Review of facility policy, titled Call Lights- Answering, last reviewed April 18, 2024, read, in part, Purpose: To identify and respond to the residents needs. Procedure: call bell will be answered timely. When leaving the room, check to see that the call signal will be within the resident's reach. Review of Resident 4's clinical record revealed diagnoses that included dementia (a chronic disorder of the mental processes caused by brain disease, marked by memory disorders, personality changes, and impaired reasoning), major depressive disorder (a mood disorder that causes a persistent feeling of sadness and loss of interest in things), and anxiety disorder (a persistent feeling of worry, nervousness, or unease). Observation of Resident 4's room on January 21, 2025, at 1:06 PM, revealed her call light was on above her room. Interview with Resident 4 on January 21, 2025, at 1:10 PM, revealed she needed to use the rest room. Observation in the hallway on January 21, 2025, at 1:14 PM, the surveyor observed Employee 1 (Registered Nurse) enter residents 4's room to administer a medication. The surveyor heard Resident 4 tell Employee 1 she needed to use the restroom, Employee 1 replied, I will let them know. Employee 1 turned off Resident 4's call light and exited the room. Observation on January 21, 2025, at 1:21 PM, the surveyor observed Employee 2 (Nurse Aide) walk past Resident 4's room and Employee 1 in the hallway. Employee 1 did not notify Employee 2 that Resident 4 needed to use the rest room. During an interview with Employee 1 on January 21, 2025, at 1:28 PM, the surveyor inquired if she was going to notify nurse aide staff that Resident 4 needed to use the restroom and if she had turned off Resident 4's call bell. Employee 1 replied that she did notify a nurse aide and turned off Resident 4's call bell. Page 1 of 6 395898 395898 01/23/2025 Homewood Living Plum Creek, Inc 425 Westminster Avenue Hanover, PA 17331

F 0558 Level of Harm - Minimal harm or potential for actual harm Observation on January 21, 2025, at 1:28 PM, Employee 1 called Employee 3 (Nurse Aide) to ask for assistance for Resident 4. Observation on January 21, 2025, at 1:29 PM, revealed Employee 3 was entering Resident 4's room to provide assistance. Residents Affected - Few Interview with the Director of Nursing (DON) on January 23, 2025, at 10:18 AM, revealed Employee 1 notified Employee 3 that Resident 4 needed assistance after she left the room via their communication devices, but Employee 3 was busy with an emergent situation for another resident, so she was unable to assist Resident 4 at that time and was delayed in assisting her. During a follow-up interview with the DON on January 23, 2025, at 1:11 PM, the surveyor revealed the concern with Employee 1 turning off Resident 4's call bell before her needs were met and lack of prompt response until surveyor inquiry. No further information was provided. Review of Resident 87's clinical record revealed diagnoses that included macular degeneration (a vision impairment resulting from deterioration of the central part of retina, a thin layer at the back of the eye on the inner side), age related nuclear cataract (hardening and cloudy eye lens leading to vision changes), and hypertension (high blood pressure). Observation in Resident 87's room on January 21, 2025, at 10:32 AM, revealed she was in her bed eating breakfast and her call bell was out of reach, laying on her recliner. Review of Resident 87's care plan revealed a focus area of, I have had falls related to poor safety awareness, with a start date of January 17, 2025, with an intervention for please keep my frequently used items within reach, with a start date of January 17, 2025. Interview with the DON on January 23, 2025, at 1:09 PM, revealed she would expect Resident 87's call bell to be in reach. 28 Pa code 201.29(a) Resident Rights 28 Pa Code 211.12(d)(1) Nursing Services 395898 Page 2 of 6 395898 01/23/2025 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 interview, it was determined that the facility failed to ensure that the resident assessment accurately reflected the resident's status for one of 25 residents reviewed (Resident 49). Residents Affected - Few Findings Include: Review of Resident 49's clinical record revealed diagnoses that included cerebral infarction (occurs when blood flow to the brain is interrupted, causing brain tissue to die) and gastro-esophageal reflux disease (a chronic condition where stomach contents flow back up into the esophagus, causing irritation and various symptoms). Review of Resident 49's quarterly MDS (Minimum Data Set is part of federally mandated process for clinical assessment of all Medicare and Medicaid certified nursing homes) dated November 8, 2024, revealed in Section I6100. Post Traumatic Stress Disorder (PTSD), that Resident 49 has been treated for PTSD in the previous 7 days while a resident. Review of Resident 49's electronic medical record failed to reveal any treatment for PTSD. Review of Resident 49's care plan failed to reveal any care plan for PTSD. Interview with the Director of Nursing on January 22, 2025, at 9:58 AM, revealed that Resident 49's MDS completed on November 8, 2024, was marked in error and that Resident 49 does not have any history of PTSD and an MDS correction will be completed. 28 Pa Code 211.12 (d)(3)(5) Nursing Services 395898 Page 3 of 6 395898 01/23/2025 Homewood Living Plum Creek, Inc 425 Westminster Avenue Hanover, PA 17331

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 observations, clinical record review, and resident and staff interviews, it was determined that the facility failed to implement resident-directed care and treatment consistent with the resident's physician orders and care plan for one of 22 residents reviewed (Resident 41). Residents Affected - Few Findings include: Review of Resident 41's clinical record revealed diagnoses that included congestive heart failure (CHF- a chronic condition in which the heart doesn't pump blood as well as it should), localized edema (swelling caused due to excess fluid accumulation), and muscle weakness. Interview with Resident 41 on January 21, 2025, at 10:17 AM, revealed he has had issues with fluid retention in his legs. Review of Resident 41's physician orders revealed an order for Tubi grips to bilateral lower extremities (BLE), on AM off HS (evening)- twice a day for edema, with a start date of September 20, 2024. Review of Resident 41's care plan revealed a focus area of, I require limited to extensive assistance with my bathing, grooming, dressing, supervision, and set up with mobility and eating related to CHF and unsteady gait, with an intervention for Tubi grips on AM off HS to BLE, with a start date of October 31, 2024. Observation of Resident 41 on January 21, 2025, at 12:18 PM, revealed he was in bed eating lunch, he had edema to his lower extremities, and his Tubi grips were not in place. Observation of Resident 41 on January 22, 2025, at 10:15 AM, revealed he was in his wheelchair, he had edema to his lower extremities, and his Tubi grips were not in place. Interview with Resident 41 on January 22, 2025, at 12:20 PM, revealed he has not worn Tubi grips to his legs in over a month since he has had a lot off weight loss and his edema has improved. Review of Resident 41's TAR (Treatment Administration Record- documentation for treatments/medication administered or monitored) revealed his physician order for Tubi grips was signed off that they were in place on January 21 and 22, 2025. During an interview with the Director of Nursing on January 23, 2025, at 10:33 AM, she revealed Resident 41 used to have a lot of edema but it has really gone down, so they changed his physician order on January 22, 2025, to be as needed. She further revealed she would expect the order not to be signed that the Tubi grips were in place when they were not. 28 Pa Code 211.12(d)(1)(3)(5) Nursing Services 395898 Page 4 of 6 395898 01/23/2025 Homewood Living Plum Creek, Inc 425 Westminster Avenue Hanover, PA 17331

F 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. Based on facility policy review, clinical record review, and staff interviews, it was determined that the facility failed to ensure PRN (as needed) orders for anti-psychotic drugs are limited to 14 days for one of five residents reviewed for unnecessary medications (Resident 4). Findings include: Review of facility policy, titled Antipsychotic Medication Use, last reviewed April 18, 2024, read, in part, Antipsychotic medications will be prescribed at the lowest possible dosage for the shortest period of time and are subject to gradual dose reduction and re-review. PRN orders for antipsychotic medications will not be renewed beyond 14 days unless the healthcare practitioner has evaluated the resident for the appropriateness of that medication and document the rationale for continued use. The duration of the PRN order will be indicated in the order. Review of Resident 4's clinical record revealed diagnoses that included dementia (a chronic disorder of the mental processes caused by brain disease, marked by memory disorders, personality changes, and impaired reasoning), major depressive disorder (a mood disorder that causes a persistent feeling of sadness and loss of interest in things), and anxiety disorder (a persistent feeling of worry, nervousness, or unease). Review of Resident 26's physician orders on January 21, 2025, revealed an order for Seroquel (antipsychotic medication) 25 mg tablet -12.5 mg by mouth twice daily as needed for hallucinations, with a start date of December 31, 2024, and no stop date. During an interview with the Director of Nursing (DON) on January 23, 2025, at 10:14 AM, she revealed Resident 4 was assessed by the practitioner on January 13, 2025, with a noted plan to continue medications as recommended by psych services, and that her next appointment with them was in February. The surveyor revealed the concern with the lack of a 14 day stop date on the PRN Seroquel order and lack of a new order past 14 days. Follow-up interview with the DON on January 23, 2025, at 1:06 PM, she revealed she would expect the facility to comply with the regulation for a stop date of 14 days for PRN antipsychotic medications without exception. 28 Pa code 211.9(a)(1) Pharmacy services 28 Pa code 211.12(d)(1)(3)(5) Nursing services 395898 Page 5 of 6 395898 01/23/2025 Homewood Living Plum Creek, Inc 425 Westminster Avenue Hanover, PA 17331

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on facility policy review, observations, clinical record review, and staff interview, it was determined that the facility failed to implement infection control practices to help prevent the development and transmission of infectious diseases for two of two residents on droplet precautions (Resident 46 and 68). Residents Affected - Some Findings include: Review of facility policy, titled Infection Control Policy, last reviewed April 18, 2024, read, in part, Purpose: The objectives of our infection control policies and procedures are to: Prevent and control the spread of communicable/contagious diseases. Establish guidelines to follow in the implementation of transmission-based precautions. It shall be the responsibility of the Administrator and Director of Nursing (DON) through the Quality Improvement committee, to assure that infection control policies and procedures are implemented and followed. Review of facility document, titled Droplet Precautions, posted outside of Resident 46 and 68's rooms, revealed Everyone must clean their hands before entering & leaving room. Make sure their eyes nose and mouth are fully covered before room entry. Remove face protection before room exit. Review of Resident 46's clinical record revealed diagnoses that included influenza (a disease caused by virus infecting the respiratory tract), congestive heart failure (a chronic condition in which the heart doesn't pump blood as well as it should), and chronic kidney disease (a condition characterized by a gradual loss of kidney function). Observation on January 21, 2025, at 12:16 PM, revealed Employee 4 (Nurse Aide) was bringing Resident 46's lunch tray into her room, he did not put on eye protection prior to room entry. Review of Resident 68's clinical record revealed diagnoses that included influenza, congestive heart failure, and muscle weakness. Observation on January 22, 2025, at 12:24 PM, revealed Employee 5 (Nurse Aide) was bringing Resident 68's lunch tray into his room. After leaving the room, she disposed of her face shield outside of the room in a trash bin outside of the room. During an interview with the DON on January 23, 2025, at 10:39 AM, she revealed the disposal bin for personal protective equipment (PPE) should have been stored inside Resident 68's room, and she would expect PPE to be worn appropriately by staff. 28 Pa Code 201.18(b)(1) Management. 28 Pa Code 211.12(d)(1)(5) Nursing Services. 395898 Page 6 of 6