Health inspection·March 30, 2023

F 0623 Level of Harm - Potential for minimal harm Residents Affected - Some Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review and staff interview it was determined that the facility failed to notify the resident and the residents' representative(s) of the transfer and the reasons for transfer in writing for three out of three sampled residents who were transferred to the hospital. (Residents 43, 73, 76) Findings include: Clinical record review revealed that Resident 43 was transferred and admitted to the hospital on [DATE], after a change in condition. There was no documented evidence that the resident's responsible party was provided written information regarding the resident's transfer to the hospital. Clinical record review revealed that Resident 73 was transferred and admitted to the hospital on [DATE], after a change in condition. There was no documented evidence that the resident's responsible party was provided written information regarding the resident's transfer to the hospital. Clinical record review revealed that Resident 76 was transferred and admitted to the hospital on [DATE], and 22, 2023, after a change in condition. There was no documented evidence that the resident's responsible party was provided written information regarding the resident's transfer to the hospital on either date. In an interview on March 30, 2023, at 10:46 a.m., the Director of Nursing stated that the aforementioned residents and/or resident's representatives were not notified in writing of the transfer to the hospital. Page 1 of 7 395913 395913 03/30/2023 Huntingdon Skilled Nursing and Rehabilitation Cent 3430 Huntingdon Pike Huntingdon Valley, PA 19006

F 0637 Assess the resident when there is a significant change in condition 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 develop a comprehensive assessment of a significant change in status for one of 18 sampled residents. (Resident 79) Residents Affected - Few Findings include: Clinical record review revealed that Resident 79 was admitted to the facility with diagnoses that included Alzheimer's disease and dementia. On January 21, 2023, the resident was admitted to hospice services. There was no Minimum Data Set assessment completed to reflect the significant change in the resident's condition. In an interview on March 30, 2023, at 9:39 a.m., the Director of Nursing confirmed that a comprehensive significant change in status assessment was not completed upon change in the resident's condition. 28 Pa. Code 211.5(f) Clinical records. 395913 Page 2 of 7 395913 03/30/2023 Huntingdon Skilled Nursing and Rehabilitation Cent 3430 Huntingdon Pike Huntingdon Valley, PA 19006

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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review and interview, it was determined that the facility failed to implement physician orders and provide wound treatment for one of 18 sampled residents. (Resident 43) Residents Affected - Few Findings include: Clinical record review revealed that Resident 43 had diagnoses that included anemia, hemiplegia to the right side, protein-calorie malnutrition, and peripheral vascular disease. Review of the Minimum Data Set assessment dated [DATE], revealed that the resident required extensive assistance from staff for activities of daily living. On March 29, 2023, at 12:40 p.m., Resident 43 was observed in bed. The resident reported that staff did not always provide treatments to his leg wound as ordered, and treatments have been missed multiple times per week. On March 29, 2023, staff documented that the resident was seen by the nurse practitioner for wound care and the right calf wound presented with increased redness and edema. Review of a wound assessment dated [DATE], revealed that Resident 43 had a venous ulcer to the right calf and a physician's order dated March 2, 2023, directed staff to cleanse the right calf ulcer with normal saline, apply medihoney, and cover with a dry dressing every day shift. Review of the treatment administration record for March 2023, revealed no evidence that staff provided the treatment to the right calf as ordered on March 20, 23, and 24, 2023. In an interview on March 30, 2023, at 11:51 a.m., the Director of Nursing stated there was no evidence that staff provided or that the resident refused the application of the treatment to the right calf per the physician's order. 28 Pa. Code 211.12(d)(1)(5) Nursing services. 395913 Page 3 of 7 395913 03/30/2023 Huntingdon Skilled Nursing and Rehabilitation Cent 3430 Huntingdon Pike Huntingdon Valley, PA 19006

F 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review, observation and interview, it was determined that the faiclity failed to provide treatment and services to prevent a decline in range of motion for two of 18 sampled residents. (Resident 43, 56) Findings include: Clinical record review revealed that Resident 43 had diagnoses that included hemiplegia to the right dominant side. Review of the Minimum Data Set (MDS) assessment dated [DATE], revealed that the resident required extensive assistance from staff for activities of daily living (ADLs) and had a limitation in range of motion to the upper extremities (shoulder, elbow wrist, hand) on one side. Review of the care plan revealed a potential for an ADL performance deficit due to physical limitations and the intervention was for staff to apply a right palm guard at the beginning of day shift. A physician's order dated December 30, 2022, directed staff to apply a palm guard to the resident's hand during day shift for contracture. On March 28, 2023, at 1:30 p.m., Resident 43 was observed in his room and the palm guard was not in place. The resident stated that staff have not applied the palm guard in over one week. On March 29, 2023, at 12:40 p.m., Resident 43 was observed in bed. The right palm guard was not in place. Clinical record review revealed that Resident 56 had diagnoses that included hemiplegia to the right dominant side, contracture to the right hand, and Dementia. Review of the MDS assessment dated [DATE], revealed that the resident required extensive assistance from staff for ADLs and had a limitation in range of motion to the upper extremities on one side. Review of the care plan revealed that the resident had a potential for an ADL performance deficit due to hemiplegia and the intervention was for staff to apply a palm guard to the resident's right hand during day shift. A physician's order dated November 18, 2022, directed staff to apply a palm guard to the resident's right hand during day shift for contracture. On March 29, 2023, at 12:35 p.m., the resident was observed in bed, the right palm guard was not in place. 28 Pa. Code 211.12(d)(1)(5) Nursing services. 395913 Page 4 of 7 395913 03/30/2023 Huntingdon Skilled Nursing and Rehabilitation Cent 3430 Huntingdon Pike Huntingdon Valley, PA 19006

F 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation and interview, it was determined that the facility failed to store and serve food under sanitary conditions in the kitchen. Residents Affected - Many Findings include: Observation of the main kitchen on March 28, 2023, at 10:34 a.m., in the food preparation area, revealed a mop bucket with dirty water and a mop stored in the water. There were various particles of debris on the meat slicer. There was a small, black, winged insect above the food. Observation revealed a cart with an unidentified liquid on the bottom shelf of the cart. Clean coffee cups were on that cart. There was a dented can of peaches and a can of pineapples in dry storage. There were clean dishes stored on a rolling cart with various non-food related items. In an interview, the Director of Dining Services stated that the clean dishes should be stored on the clean dish cart. The clean dish cart was observed with various particles of debris on the cart and dishes. In the walk in refrigerator, there was a package of ham stored on a tray with raw, ground beef. 28 Pa. Code 201.18(b)(3) Management. 395913 Page 5 of 7 395913 03/30/2023 Huntingdon Skilled Nursing and Rehabilitation Cent 3430 Huntingdon Pike Huntingdon Valley, PA 19006

F 0814 Dispose of garbage and refuse properly. Level of Harm - Potential for minimal harm Based on observation, it was determined that the facility failed to dispose of garbage and refuse properly. Findings include: Residents Affected - Many Observation of the dumpster area on March 28, 2023, at 10:34 a.m., revealed various particles of debris that included gloves, masks, paper products, and a crate that contained linens scattered on the ground in the dumpster area. CFR 483.60(i)(4) Dispose of garbage and refuse properly Previosuly cited 3/10/2022 28. Pa Code 201.14(a) Responsibility of licensee. 28. Pa Code 207.2(a) Administrator's Responsibility. 395913 Page 6 of 7 395913 03/30/2023 Huntingdon Skilled Nursing and Rehabilitation Cent 3430 Huntingdon Pike Huntingdon Valley, PA 19006

F 0921 Level of Harm - Potential for minimal harm Residents Affected - Some Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, it was determined that the facility failed to ensure that a safe, clean, and comfortable environment was maintained on one of two nursing units. (The Garden) Findings include: Observations during the environmental tour of the second floor nursing unit (The Garden) on all days of the survey revealed the following: Around the window sill in room [ROOM NUMBER] there was bubbled drywall and peeling paint and the threshold between the room and bathroom had cracked tile. In rooms 30, 31, 37, 39 and 40, the walls were marred. In the bathroom of room [ROOM NUMBER], the ceiling tile was stained. In the bathroom of room [ROOM NUMBER], the molding was coming away from the wall, the wallpaper was peeling and a large area of the threshold had cracked and broken floor tile. In room [ROOM NUMBER] there was a large amber-colored stain under the glove box holder on the wall and a water stained ceiling tile in the bathroom. In room [ROOM NUMBER] there was exposed drywall on the left corner window sill. Throughout the unit, there was peeling and torn wallpaper and stained ceiling tile. Over the nursing station there was stained and missing ceiling tile. 28 Pa. Code 207.2(a) Administrator responsibility. 395913 Page 7 of 7