Health inspection·October 13, 2023

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of clinical records, resident and staff interviews, it was determined that the facility failed to implement individualized approaches to restore normal bladder function and prevent continued decline of bladder continency for one of one resident reviewed for bowel and bladder management (Resident R38). Findings include: Interview with Resident R38 on October 11, 2023, at 11:54 a.m. stated she was continent 6 weeks ago, now she was incontinent after her recent hospitalization. Resident stated she was not using her bathroom or staff did not make any toileting plan. A review of Resident 38's admission assessment dated [DATE], revealed an assessment of resident's genitourinary system review which indicated that the resident was incontinent of urine, and she had a new onset of incontinence. Further review of the assessment revealed that the resident also had bowel incontinence. A review of Resident 38's bladder elimination record from September 19, 2023, to October 13, 2023, revealed the resident had 58 documented occurrences of incontinence. It was also revealed that continent of bladder was documented 6 times. Review of Resident R38's admission MDS (Minimum Data Set- assessment of resident care needs) dated September 26, 2023, revealed that the resident was frequently incontinent of urine (7 or more episodes of urinary incontinence, but at least one episode of continent voiding). Further review of the MDS revealed that there was no trial of a toileting program (e.g. Scheduled toileting, prompted voiding, or bladder training) been attempted on admission or reentry or since urinary incontinence was noted in the facility. Review of the resident's plan of care dated September 20, 2023, revealed that the resident was noted with new onset of urinary incontinence with interventions included, evaluate if resident was aware of the need to void, evaluate for urinary complaints, evaluate medication schedule and possible pharmacological causes of new urinary incontinence, and evaluate resident's ability for toileting self-care. Review of clinical record for Resident R38 revealed no documented evidence that the staff assessed and implemented interventions to restore urinary continence or to prevent further decline in urinary continence. Page 1 of 5 395922 395922 10/13/2023 Artman Lutheran Home 250 North Bethlehem Pike Ambler, PA 19002

F 0690 Level of Harm - Minimal harm or potential for actual harm Interview with the Director of Nursing on October 13, 2023, at 11:00 a.m. confirmed that the facility did not implement interventions to restore urinary continence or to prevent further decline in urinary continence for Resident R38. 28 Pa. Code 211.12 (c)(d)(1)(5) Nursing services Residents Affected - Few 395922 Page 2 of 5 395922 10/13/2023 Artman Lutheran Home 250 North Bethlehem Pike Ambler, PA 19002

F 0740 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure each resident must receive and the facility must provide necessary behavioral health care and services. Based on observations, clinical record review and interviews with staff, it was determined that the facility failed to implement psychiatry recommendations in a timely manner for one of two residents reviewed for behavioral health services (Resident R26). Findings include: Review of nursing progress note for Resident R26 dated August 18, 2023, revealed that the resident refused repositioning and at times refused care despite of continuous education and encouragement. Review of nursing progress notes for Resident R26 dated September 1, 2023, September 4, 2023 and September 10, 2023 revealed that the resident refused shower and at times refused care. Further review of nursing progress note for Resident R26 dated September 10, 2023, revealed that the resident was combative during treatment, and he was rolling nurses aide's wrist. The resident repeatedly hit the nurse. Review of resident's care plan for Resident R26 dated June 6, 2023, revealed that the resident had behavioral problem with interventions included, administer medications as ordered. Monitor/document for side effects. Review of Psychiatry Note for Resident R26 revealed that the staff stated resident was irritable and at times uncooperative. It was also revealed that the psychiatrist recommended to increase resident's Bupropion (It can treat depression) to 100 milligrams (mg) in the morning and 50 mg in the evening for irritability and low motivation. Review of physician orders for Resident R26 revealed an active physician's order, dated August 15, 2023, for Bupropion 50 mg twice daily. Continued review of physician orders revealed that there were no orders to adjust the dosage of the Bupropion as per the psychiatrist's recommendations. Interview on October 13, 2023, at 11:00 a.m., with. Employee E2, Director of Nursing, confirmed that there was no documented evidence that the psychiatrist recommendation was addressed by the staff or attending physician. 28 Pa Code 211.2(a) Physician services 28 Pa Code 211.12(d)(3) Nursing services 395922 Page 3 of 5 395922 10/13/2023 Artman Lutheran Home 250 North Bethlehem Pike Ambler, PA 19002

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, staff interviews and review of manufacturers' guidelines, it was determined that the facility failed to ensure that all drugs and biologicals used in the facility were labeled and stored in accordance with professional standards of practice for one of two medication carts observed. (Second floor medication cart). Findings Include: Review of manufacturer's guidelines for Humalog Insulin (insulin lispro) (medication used to treat high blood sugar levels) revealed that Humalog must be discarded 28 days after opening. Review of manufacturer's guidelines for Lantus Insulin(insulin glargine) revealed that the medication must be discarded 28 days after opening. Review of manufacturer's guidelines for Basaglar(insulin glargine) revealed that the medication must be discarded 28 days after opening. Review of manufacturer's guidelines for Novolog Insulin (insulin aspart) revealed that the medication must be discarded 28 days after opening. Unopened vials should be refrigerated unit use. Observation on October 11, 2023, at 9:20 a.m. of the second-floor medication cart with Registered Nurse, Employee E11, revealed open and undated vials of insulin pen, Basaglar, Humalog, Lantus and Novolog in room temperature. Further observation of the mediation cart revealed opened Refresh eye drops, Tobramycin eye drops, Latanoprost eye drops, and Timolol eye drops with no open date or expiration date. Interview with Licensed nurse, Employee E11, on October 11, 2023, at 9:20 a.m. stated staff label insulin pens and eye drops with open dates and expiration dates. 28 Pa. Code 211.9(a)(1) Pharmacy services. 28 Pa. Code 211.12(d)(1)(5) Nursing services. 395922 Page 4 of 5 395922 10/13/2023 Artman Lutheran Home 250 North Bethlehem Pike Ambler, PA 19002

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observations, interviews with staff, and a review of facility policies and documentation, it was determined that the facility did not ensure that food was stored, prepared, distributed, and served in accordance with professional standards for food service safely. Findings Include: Review of facility policy titled: PQA: Food Product Shelf Life Guidelines with the last revision date of January 28, 2022 it states, Safety of food after expiration dates: dates usually refer to best quality and are not safety dates. Products with a Sell by, or Best By or (Before) or Use-By: Adhere to that date for quality reasons. Further review of facility policy titled: PQA: Food Product Dating Reference with the last revision date of August 1, 2020 states, What is the safety of food after expiration dates? Products with a use by date, follow that date. An initial tour was conducted on October 10, 2023 at 10:03 a.m. of the first floor rehabilitation unit's satellite kitchen. The toured revealed a freezer with hot dogs unlabeled and storage in a way that it was exposed to air. Three hamburger patties in the freezer with visible freezer burned and storage in a way that it was exposed to the air. An initial tour of the kitchen was conducted on October 10, 2023 at 10:33a.m. with Employee E5, Director of Dining Services. A tour of the walk in dry store pantry revealed the following: two bags of pasta open in the pantry unlabeled and one bag of brown sugar opened in the pantry unlabeled. Observation of the walk in refrigerator revealed: two fresh fruit past date of Use by October 5, 2023 and four fresh fruit past date of Use by October 8, 2023. There were six bags of lettuce with a Use by date of October 7, 2023. Observation of the walk in freezer revealed: a meatloaf tray with a date of October 3, 2023 and spaghetti tray with freezer burn dated October 6, 2023. Both trays of food were not wrapped properly with saran plastic wrap, exposed them to the elements of the freezer causing them to be freezer burned. This conclusion was confirmed by Employee E5, Director of Dining. An initial tour was conducted on October 10, 2023 at 12:34 p.m. of the second floor unit's satellite kitchen. The tour revealed items in the dry store pantry unlabeled: a large container of peanut butter, and two large plastic containers of cereal. One large container of cereal half full with an open date labeled June 11, 2023. Interview at the time of observation with the chef, Employee E9, revealed items get sent up from the main kitchen to the satellite kitchens and should be labeled when they get up to the satellite kitchens. 28 Pa Code: 201.14(a) Responsibility of licensee 28 Pa Code: 201.18(e)(1) Management. 28 Pa. Code 201.18(b)(3) Management 395922 Page 5 of 5