Health inspection·February 29, 2024

F 0584 Level of Harm - Potential for minimal harm Residents Affected - Some Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, it was determined that the facility failed to provide a clean, homelike, and comfortable environment on two of two nursing units. (Garden and Upper) Findings include: During tours of Garden and Upper nursing units on February 27, 2024, between 10:45 a.m. and 12:20 p.m., the following were observed: The wallpaper in rooms [ROOM NUMBERS] was peeling. In room [ROOM NUMBER], there was an area of loose wall molding, peeling wallpaper, and two tan stained ceiling tiles in the back right corner of the bedroom area. In the bathroom, a towel rack was absent from the wall, a white substance covered the sink faucet, and a black substance was observed on the floor behind the toilet. In room [ROOM NUMBER], the bottom drawer was missing from the end table next to bed B. In room [ROOM NUMBER], the bottom drawer was missing from the end table next to bed B. There was loose molding and a stained ceiling tile in the corner of the bedroom. In the bathroom, wallpaper was missing from the wall under the sink and two ants were seen on the floor. In room [ROOM NUMBER], there was loose wallpaper and a loose towel rack in the bathroom. In room [ROOM NUMBER], there was a black substance on the wall near the window and on the floor of the bathroom under the sink. The wall near the sink in room [ROOM NUMBER]'s bathroom was dirty. In room [ROOM NUMBER], there was detached molding at the bottom of the wall. In the bathroom, there was more detached molding, the toilet grab bar was loose, and there was cracked plaster. Also in the bathroom, a towel bar was missing. There was detached molding and chipped paint in room [ROOM NUMBER]. There were black stains on the floor in the bathroom. 28 Pa. Code 201.18(b)(1)(e)(2.1) Management. Page 1 of 4 395913 395913 02/29/2024 Huntingdon Skilled Nursing and Rehabilitation Cent 3430 Huntingdon Pike Huntingdon Valley, PA 19006

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Based on clinical record review and staff interview, it was determined that the facility failed to develop a comprehensive care plan that addressed individual resident needs as identified in the comprehensive assessment for five of 32 sampled residents. (Residents 29, 32, 57, 68, and 70) Findings include: Clinical record review revealed that Resident 29 had a Minimum Data Set (MDS) assessment completed on August 4, 2023. According to the assessment, the resident was occasionally incontinent of urine. According to the Care Area Assessment (CAA) summary from that assessment, the facility identified that urinary continence was a problem area for the resident and should have been included on the resident's comprehensive care plan. Review of the care plan revealed that the facility did not develop interventions to address this care area. Clinical record review revealed that Resident 32 had an MDS assessment completed on February 21, 2024. According to the assessment, the resident had impaired vision. According to the CAA summary from that assessment, the facility identified that vision impairment was a problem area for the resident and should have been included on the resident's comprehensive care plan. Review of the care plan revealed that the facility did not develop interventions to address this care area. Clinical record review revealed that Resident 57 had an MDS assessment completed on April 28, 2023. According to the assessment, the resident had a communication impairment. According to the CAA summary from that assessment, the facility identified that the communication impairment was a problem area for the resident and should have been included on the resident's comprehensive care plan. Review of the care plan revealed that the facility did not develop interventions to address this care area. Clinical record review revealed that Resident 68 had an MDS assessment completed on February 3, 2024. According to the assessment, the resident had impaired vision. According to the CAA summary from that assessment, the facility identified that vision impairment was a problem area for the resident and should have been included on the resident's comprehensive care plan. Review of the care plan revealed that the facility did not develop interventions to address this care area. Clinical record review revealed that Resident 70 had an MDS assessment completed on February 14, 2024. According to the assessment, the resident had cognitive impairment. According to the CAA summary from that assessment, the facility identified that cognitive impairment was a problem area for the resident and should have been included on the resident's comprehensive care plan. Review of the care plan revealed that the facility did not develop interventions to address this care area. In an interview on February 29, 2024, at 1:00 p.m., the Director of Nursing confirmed that the care plans did not include the areas of potential concern identified in the comprehensive assessments. 28 Pa. Code 211.12(d)(5) Nursing services. 395913 Page 2 of 4 395913 02/29/2024 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 Based on clinical record review and staff interview, it was determined that the facility failed to ensure physician's orders were implemented for two of 20 sampled residents. (Residents 49 and 68) Residents Affected - Few Clinical record review revealed that Resident 49 had diagnoses that included hypertension (high blood pressure). A physician's order dated November 8, 2023, directed staff to administer a medication (hydralazine) twice a day for hypertension. Staff was not to administer the medication if the resident's systolic blood pressure (SBP, the first measurement of blood pressure when the heart beats and the pressure is the highest) was less than 120 millimeters of mercury (mmHg). Review of Resident 49's medication administration record (MAR) revealed that staff documented that this medication was given six times in January 2024, and six times in February 2024, when the resident's SBP was less than 120 mmHg. In an interview on February 29, 2024, at 12:46 p.m., the Director of Nursing confirmed that the medication should have been held if the SBP was less than 120 mmHg as per physician's order. Clinical record review revealed that Resident 68 had diagnoses that included high blood pressure from chronic kidney disease and diabetes. On September 6, 2023, a physician ordered that staff administer 25 milligrams (mg) of a diuretic medication (hydrochlorothiazide) one time a day, and to hold the medication if the blood pressure reading was less than 110/65 mmHg. Review of Resident 68's MAR revealed that staff administered this medication twenty-nine times from February 1 to 29, 2024, with no documented blood pressures at the time of administration. In an interview on February 29, 2024, at 1:25 p.m., the DON confirmed that there were no documented blood pressure measurements when the medication was given. CFR 483.25 Quality of Care Previously cited 3/30/23 28 Pa. Code 211.12(d)(1)(5)Nursing services. 395913 Page 3 of 4 395913 02/29/2024 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 facility policy review, observation, and staff interview, it was determined that the facility failed to properly store food and maintain sanitary conditions in the dietary department. Residents Affected - Many Findings include: Review of the facility's policy entitled, Use-By Dating Guidelines, last reviewed May 1, 2023, revealed that prepared foods should be discarded within 72 hours. Review of the facility's policy entitled, Refrigerated/Frozen Storage, last reviewed May 1, 2023, revealed that all foods were to be labelled with a use-by date once opened, refrigeration units were kept clean and organized, and if a food was removed from the original container, the food was to be labeled with a use-by date. Observation during the kitchen tour on February 27, 2024, at 10:06 a.m., revealed the following: In the dry storage area, there was an open bag of pasta that was not dated. In the walk-in cooler, there were two bins of individual packets of butter and creamer that were removed from the original containers and were not dated. There were two containers of opened sour cream and parmesan cheese and a box of grapes that had dried white food and liquid on the outside. There were three opened bags of bread that were not dated. There were two packages of lettuce removed from the original container that were not dated. In the freezer, there were two opened packages of beef patties and garden burgers that were not dated. There was a package of pie shells removed from the original container that was not dated. In the trayline area, there was an opened bottle of cooking oil that was not dated. In the cooks' preparation station, there were multiple small fruit flies. The can opener blade had dried food debris on it and there was an uncovered container of thickener. The garbage disposal was uncovered and had food debris and liquid exposed to air. There was a foul odor in the area. Several flies were observed by the floor drain. In the cooks' cooler, there was a soiled and sticky thermometer. There was a sandwich dated February 21, 2024. A baked potato was not dated. There was dried food and liquid on the inside wall and bottom of the cooler. The wall by the tray line had a large hole. In an interview on February 27, 2024, at 11:00 a.m., the Dietary Manager confirmed that the food items should have been dated and the expired items should have been removed. CFR 483.60(i) Food Safety Requirement Previously cited 3/30/23. 28 Pa. Code 201.14(a) Responsibility of licensee. 395913 Page 4 of 4