Health inspection·July 13, 2023

F 0698 Provide safe, appropriate dialysis care/services for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm Based upon clinical record review and interview, it was determined the facility failed to communicate with a dialysis center regarding an incident and fall that occurred at the dialysis facility resulting in dialysis not being completed and failed to investigate the fall at the dialysis center for one of one resident reviewed (Resident 5). Residents Affected - Few Findings include: Review of Resident 5's clinical progress note dated June 5, 2023, revealed Pt [patient] evaluated post fall while at dialysis (he tipped backwards in wheelchair going up a hill into the facility). Pt. denies injury or hitting head. [resident] does state [resident's] shoulders are sore. [resident's] pain is managed with Oxycodone. Pt. has been more compliant with dialysis and pleasant for the most part. However, [resident] did not receive tx [treatment] today bc [because] he was too late. Unit clerk aware. Will follow. Further review of Resident 5's clinical record failed to reveal evidence of investigation into Resident 5's fall at the dialysis center on June 5, 2023. Interview with the Director of Nursing on July 13, 2023, at 11:50 a.m. confirmed that no investigation into Resident 5's fall, which resulted in Resident 5 not receiving dialysis on June 5, 2023, was conducted. No investigation or information was available to determine Resident 5's arrival time at the dialysis center, where resident was dropped off or what time resident arrived at the facility. The facility failed to communicate with the dialysis center and failed to timely investigate a fall that occurred at the dialysis center. 28 Pa. Code 201.18(b)(1) Management 28 Pa. Code 211.12(d)(1) Nursing Services Page 1 of 4 395917 395917 07/13/2023 Brinton Manor Nursing and Rehabilitation Center 549 Baltimore Pike Glen Mills, PA 19342

F 0755 Level of Harm - Minimal harm or potential for actual harm Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on clinical record review, it was determined that the facility failed to ensure residents' medications were readily available from the pharmacy for one of 18 residents reviewed (Resident 38). Residents Affected - Few Findings include: Review of Resident 38's clinical record revealed diagnoses including Schizophrenia (mental disorder characterized by delusions, hallucinations, disorganized thoughts, speech, and behavior), Anxiety (condition with exaggerated tension, worrying, and nervousness about daily life events), Major Depressive Disorder (mood disorder that causes a persistent feeling of sadness and loss of interest), and suicidal ideation. Review of Resident 38's physician orders revealed an order dated March 30, 2023, for Clozapine (antipsychotic medication) 25 milligrams (mg) three tablets twice daily. Review of Resident 38's April 2023 Medication Administration Record (MAR) and corresponding nurse's notes revealed the resident's clozapine was unavailable due to waiting on the pharmacy to deliver the medication from April 9, 2023, through April 13, 2023, for a total of 10 missed doses of the medication. The above findings were confirmed with the Director of Nursing on July 13, 2023, at 12:50 p.m. The facility failed to ensure Resident 38's medications were available from the pharmcy. 28 Pa. Code 201.18(b)(1) Management 28 Pa. Code 211.12(d)(1) Nursing Services 395917 Page 2 of 4 395917 07/13/2023 Brinton Manor Nursing and Rehabilitation Center 549 Baltimore Pike Glen Mills, PA 19342

F 0756 Level of Harm - Minimal harm or potential for actual harm Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. Based on clinical record review, it was determined that the facility failed to act on recommendations made by the consultant pharmacist for one of five residents reviewed for unnecessary medications (Resident 38). Residents Affected - Few Findings include: Review of Resident 38's April 2023 pharmacy review dated April 3, 2023, revealed the pharmacist recommended: PRN [(as needed)] Zolpidem [(hypnotic medication used to treat insomnia)] suggested to indicate 'x14 days' or length of therapy per .14 day regulation. The recommendation was signed by the prescriber on April 4, 2023, with the response being Agree. Review of Resident 38's April 2023 Medication Administration Record (MAR) revealed the resident's PRN order for zolpidem was not changed, and the resident continued to receive the medication. Review of Resident 38's May 2023 pharmacy review dated May 15, 2023, revealed the pharmacist again recommended adding a stop date of 14 days for the resident's PRN zolpidem. The recommendation was signed by the prescriber on May 16, 2023, with the response being Agree. Review of Resident 38's May 2023 MAR revealed the resident's PRN order for zolpidem was not changed, that the resident continued to receive the medication. Review of Resident 38's June 2023 pharmacy review dated June 11, 2023, revealed the pharmacist again recommended adding a stop date of 14 days for the resident's PRN zolpidem. The recommendation was signed by the prescriber on June 12, 2023, with the response being Agree. Review of Resident 38's June and July 2023 MARs revealed the resident's PRN order for zolpidem was not changed until July 12, 2023, when it was discontinued. Interview with the Director of Nursing on July 13, 2023, at 12:50 p.m. confirmed that the facility failed to act on the pharmacist's recommendations for Resident 38 for three months. The facility failed to act on pharmascist recommendation for Resident 38. 28 Pa. Code 201.18(b)(1)(2) Management 395917 Page 3 of 4 395917 07/13/2023 Brinton Manor Nursing and Rehabilitation Center 549 Baltimore Pike Glen Mills, PA 19342

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 review of facility policy and clinical record review, it was determined the facility failed to ensure PRN (as needed) orders for psychotropic medications were limited to fourteen days for one of five residents reviewed for unnecessary medications (Resident 38). Findings include: Review of facility policy, Psychotropic Medication Use, last revised December 2016, revealed: The need to continue PRN orders for psychotropic medications beyond 14 days requires that the practitioner document the rationale for the extended order. The duration of the PRN order will be indicated in the order. Review of Resident 38's physician orders revealed an order dated March 29, 2023, for zolpidem tartrate (hypnotic medication used for treatment of insomnia) 5 milligrams (mg) take 1 tablet sublingually (under the tongue) as needed. Review of Resident 38's pharmacy reviews for April 2023, May 2023, and June 2023, all revealed the pharmacist recommended that the resident's PRN order for zolpidem be updated to indicate the medication be used for 14 days. The physician signed each month's pharmacist recommendation and agreed to the recommendation. Review of Resident 38's April 2023, May 2023, June 2023, and July 2023 Medication Administration Records (MARs) revealed the resident continued to receive PRN zolpidem tartrate until the medication was discontinued on July 12, 2023. Interview with the Director of Nursing on July 13, 2023, confirmed that Resident 38 continued to receive PRN zolpidem tartrate past 14 days, and the facility did not follow the pharmacist's recommendations for three months to discontinue Resident 38's zolpidem tartrate until July 12, 2023. The facility failed to ensure as needed (PRN) medications were limited to 14 days pertaining to unnecessary medications. 28 Pa. Code 211.2(a) Physician services 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services 395917 Page 4 of 4