Health inspection·February 8, 2024

F 0610 Respond appropriately to all alleged violations. Level of Harm - Minimal harm or potential for actual harm Based on review of facility policy and clinical records, and staff interviews, it was determined that the facility failed to fully investigate an injury of unknown origin in a timely manner for one of one residents reviewed (Resident R1). Residents Affected - Few Findings include: Review of facility policy entitled Incidents and Accident Reports, Resident dated 9/2023, revealed An incident report is completed whenever there is an occurrence ., The following is a list of the types of occurrences for which an incident report is prepared . Injury of unknown origin and Those incidents requiring investigation . will be reported to the Administrator and Director of Nursing . Review of Resident R1's clinical record revealed an admission date of 11/16/23, with diagnoses that included hypothyroidism (a condition when the thyroid produces low amounts of thyroid hormones), hypertension (high blood pressure), and anxiety (a condition that causes a person to be nervous, uneasy, or worried about something or someone). Review of Resident R1's nursing documentation revealed a progress note dated 12/12/23, that identified he/she was seen by his/her physician and a new order was given from his/her physician for x-rays of left shoulder, left humerus, and left foot and deformity. Further review of Resident R1's nursing documentation revealed a progress note dated 12/13/23, that indicated x-ray results were received by the facility. Physician was updated on Resident R1's acute fracture of the fifth metatarsal (foot bone between the ankle and toe) and gave an order to have Resident R1 seen by an orthopedic physician (a physician that specializes in bone care). Review of Resident R1's care plan revealed a care plan dated 12/14/23, for left foot fracture related to previous fall. Review of a Minimum Data Set (MDS-a periodic assessment of resident care needs) dated 12/15/23, section J 1800 indicated Resident R1 had not had any falls since admission/reentry. Review of facility incident report for December 2023, revealed no evidence that Resident R1 had any type of incident. Review of Resident R1's clinical record lacked evidence that an investigation was started or completed, regarding the identified of the fracture of the fifth metatarsal. Further review of clinical record lacked evidence of interviews from staff present at the time of the incident or handwritten statements from staff. Page 1 of 2 395959 395959 02/08/2024 Caring Place, The 103 N. Thirteenth Street Franklin, PA 16323

F 0610 Level of Harm - Minimal harm or potential for actual harm During an interview on 2/8/2024, at 11:46 a.m. the Nursing Home Administrator (NHA) confirmed that there was no investigation started or completed on Resident R1's injury of unknown origin. NHA also confirmed that the injury of unknown origin should have been investigated. 28 Pa. Code 201.14(a) Responsibility of licensee Residents Affected - Few 28 Pa. Code 211.12(d)(1)(5) Nursing services 395959 Page 2 of 2