Health inspection·November 16, 2023

F 0550 Level of Harm - Potential for minimal harm Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. Based on review of facility documentation, resident and staff interview it was determined that the facility failed to offer all residents the opportunity to vote for the May and November 2023 elections. Residents Affected - Some Findings include: Review of the resident council minutes for five months (October, September, August, July and June 2023) failed to include information about how the facility ask's residents if they are interested in voting. During a Resident group on 11/15/23, at 10:30 a.m. two residents stated they did not get to vote in the November and May elections. Both of the residents stated they were interested in voting. During an interview on 11/16/23, at 2:21 p.m. Director of Activities Employee E6 confirmed that the facility could not provide documentation showing all residents were asked to vote in the May and November election and that the facility failed to offer all residents the opportunity to vote. 28 Pa. Code 201.1(i)Resident rights. Page 1 of 5 395903 395903 11/16/2023 Harmony Hills Healthcare and Rehabilitation Center 194 Swinderman Road Wexford, PA 15090

F 0558 Reasonably accommodate the needs and preferences of each resident. Level of Harm - Potential for minimal harm Based on resident and staff interview it was determined that the facility failed to have a beautician available to meet resident needs for the facility. Residents Affected - Many Findings include: During an interview on 11/15/23, at 10:35 a.m. Resident R18 indicated that it beautician is not frequently available. During a follow up interview on 11/16/23 at 10:54 a.m. Resident R18 indicated that they were suppose to get their hair done last week but that did not take place. During an interview on 11/16/23, at 11:14 a.m. Director of Activities Employee E6 confirmed that the facility has a beautician but they are onsite every 6 weeks for several hours only. Director of Activities Employee E6 confirmed that the facility failed to offer beautician available to meet resident needs. 28 Pa. Code 201.29(i)Resident rights. 395903 Page 2 of 5 395903 11/16/2023 Harmony Hills Healthcare and Rehabilitation Center 194 Swinderman Road Wexford, PA 15090

F 0700 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, review of facility policy, clinical record review, and staff interview, it was determined that the facility failed to conduct ongoing assessments to ensure that bed rails were used to meet residents' needs and the risks associated with bed rail usage for three of three residents (Residents R10, R12 and R23). Findings include: Review of Title 42 Code of Federal Regulations (CFR) §483.25(n) - Bed Rails states that the facility must assess the resident for risk of entrapment from bed rails prior to installation. Additionally, there should be evidence in the resident's records that the facility performed ongoing assessments to assure that the bed rail is used to meet the resident's needs and that there is an ongoing evaluation of risks associated with bed rail usage. Review of the facility policy Proper Use of Side Rails dated 5/1/23, indicated An assessment will be made to determine the resident's symptoms or reason for using side rails. The use of quarter or half rails, as an assistive device will be addressed in the resident care plan. Review of the clinical record indicated that Resident R10 was admitted to the facility on [DATE]. Review of Resident R10's Minimum Data Set (MDS - a periodic assessment of care needs) dated 8/9/23, indicated diagnoses of high blood pressure, stroke (damage to the brain from an interruption of blood supply), and renal insufficiency (condition where the kidneys lose the ability to remove waste and balance fluids). Review of Resident R10's physician order dated 10/5/21, indicated device: side rail: one fourth side rails both for turning and repositioning. Review of Resident R10's care plan dated 11/9/23, indicated device: side rail: one fourth side rails both for turning and repositioning. Review of Resident R10's clinical record revealed the most current Bed Rail Safety Review dated 7/29/22, indicated side rails were in use. Observation on 11/14/23, at 9:30 a.m. indicated Resident R10 lying in bed with one fourth side rails on each side of the bed. Interview on 11/16/23, at 10:07 a.m. Licensed Practical Nurse (LPN) Employee E2 confirmed Resident R10 had one fourth side rails on each side of the bed. Review of the clinical record indicated that Resident R12 was admitted to the facility on [DATE] . Review of Resident R12's MDS dated [DATE], indicated diagnoses of anemia, high blood pressure, and heart failure (heart doesn't pump blood as well as it should). 395903 Page 3 of 5 395903 11/16/2023 Harmony Hills Healthcare and Rehabilitation Center 194 Swinderman Road Wexford, PA 15090

F 0700 Level of Harm - Minimal harm or potential for actual harm Review of Resident R12's physician order dated 3/23/22, indicated device: side rail: one fourth side rails both for turning and repositioning. Review of Resident R12's care plan dated 11/7/23, indicated side rails : quarter rails up for safety during care provision, to assist with bed mobility. Observe for injury or entrapment related to side rail use. Residents Affected - Few Review of Resident R12's clinical record revealed the most current Bed Rail Safety Review dated 10/6/22, indicated side rails were in use. Observation on 11/14/23, at 9:42 a.m. indicated Resident R12 lying in bed with one fourth side rails on each side of the bed. Interview on 11/16/23, at 10:08 a.m. Licensed Practical Nurse LPN Employee E2 confirmed Resident R12 had one fourth side rails on each side of the bed. Review of the clinical record indicated that Resident R23 was admitted to the facility on [DATE] . Review of Resident R23's MDS dated [DATE], indicated diagnoses of renal insufficiency, diabetes (too much sugar in the blood), and Non-Alzheimer's Dementia (a progressive disease that destroys memory and other important mental functions). Review of Resident R23's physician order dated 9/28/21, indicated device: side rail: one fourth side rails both for turning and repositioning. Review of Resident R23's care plan dated 9/1/23, failed to include interventions and goals for side rails. Review of Resident R23's clinical record revealed the most current Bed Rail Safety Review dated 8/7/22, indicated side rails were in use. Observation on 11/14/23, at 9:47 a.m. indicated Resident R23 lying in bed with one fourth side rails on each side of the bed. Interview on 11/16/23, at 10:10 a.m. Licensed Practical Nurse LPN Employee E2 confirmed Resident R23 had one fourth side rails on each side of the bed. Interview on 11/16/23, at 10:15 a.m. the Director of Nursing stated the assessments were not scheduled after the change in ownership and confirmed the facility failed to conduct ongoing assessments to ensure that bed rails were used to meet residents' needs and the risks associated with bed rail usage for three of three residents (Residents R10, R12 and R23). 28 Pa. Code 201.14(a) Responsibility of Licensee. 28 Pa. Code: 211.10(c)(d) Resident care policies. 28 Pa. Code: 211.12(d)(1)(5) Nursing services. 395903 Page 4 of 5 395903 11/16/2023 Harmony Hills Healthcare and Rehabilitation Center 194 Swinderman Road Wexford, PA 15090

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy, observations, and staff interviews, it was determined that the facility failed to implement infection control practices to prevent cross contamination during a dressing change for one of three residents (Resident R3). Residents Affected - Few Findings include: Review of the facility Wound Care policy dated 9/2017, last reviewed on 5/1/23, indicated to treat wound as ordered, apply new dressing without touching or contaminating the wound bed (open part of the wound). Review of the admission record indicated Resident R3 was admitted to the facility on [DATE]. Review of R3's Minimum Data Set (MDS-periodic assessment of care needs) dated 8/23/23, included diagnoses of high blood pressure, anemia (the blood doesn ' t have enough healthy red blood cells), and heart failure (heart doesn ' t pump blood as well as it should). Review of Resident R3's physician order dated 11/12/23, indicated Cleanse bilateral gluteal folds (skin crease separating the upper thigh from the buttock) with soap and water, pat dry. Apply Zinc (ointment to treat wounds) every shift and as needed with every incontinent episode. Observation of Resident R3's dressing change on 11/15/23, at 9:08 a.m. Licensed Practical Nurse (LPN) Employee E1 failed to treat wound without touching or contaminating the wound bed. After cleansing wound, LPN Employee E1 released Resident R3's skin fold allowing the clean wound to touch the outside of the brief. She washed her hands, applied new gloves and proceeded to place the Zinc ointment on her finger, lift the skin fold off of the brief, apply the zinc with her finger, release the skin fold to retrieve the cover dressing, lifted the skin fold from the brief and applied the covering dressing. During an interview on 11/15/23, at 9:25 a.m. LPN Employee E1 confirmed she failed to implement infection control practices to prevent cross contamination during a dressing change for Resident R3. During an interview on 11/15/23, at 11:20 a.m. the Director of Nursing confirmed the facility failed to implement infection control practices to prevent cross contamination during a dressing change for one of three residents. 28 Pa. Code 201.14(a) Responsibility of Licensee. 28 Pa. Code: 211.10(c)(d) Resident care policies. 28 Pa. Code: 211.12(d)(1)(5) Nursing services. 395903 Page 5 of 5