Health inspection·April 22, 2025

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 review of clinical records, as well as staff interviews, it was determined that the facility failed to follow physician's orders for one of five residents reviewed (Resident 2). Residents Affected - Few Findings include: A quarterly Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) assessment for Resident 2, dated April 7, 2025, indicated that the resident was sometimes understood and able to sometimes understand others, was dependent on staff for personal hygiene care, and was always incontinent of urine and bowel. An incontinence care plan for Resident 2, dated July 4, 2023, revealed that the resident was to have barrier cream applied every shift and after every incontinent episode. Physician's orders for Resident 2, dated June 29, 2023, revealed that triad (barrier) cream was to be applied every shift and after each incontinent episode as needed. A wound care note for Resident 2, dated March 26, 2025, revealed that the resident was seen by wound care due to redness in the perineal region and denudement (missing the outer layer of skin). New orders were received to ensure that physician's orders were being followed to apply barrier cream every shift and as needed. Interview with Resident 2 on April 22, 2025, at 9:50 a.m. revealed that the staff apply cream every shift; however, they do not apply barrier cream after episodes of incontinence. Interview with Licensed Practical nurse 5 on April 22, 2025, at 2:01 p.m. confirmed that the Triad barrier cream was only applied every shift, and it was not applied after incontinent episodes per care plan and physician's order. A review of Resident 2's clinical record revealed no documented evidence that the Triad Cream was applied on first shift on March 1, 2, 4, 5, 6, 8, 14, 20, 21, 25, 29, and 30, 2025; on second shift on March 25 and 30, 2025; and third shift on March 5, 11, 19, and 20, 2025; and no documented evidence that it was applied after each incontinent episode as needed. Interview with the Director of Nursing on April 22, 2025, at 1:56 p.m. confirmed that Resident 2 did not have barrier cream applied as ordered by the physician. 28 Pa. Code 211.12(d)(1)(5) Nursing Services. Page 1 of 3 395985 395985 04/22/2025 Midtown Oaks Health & Rehab Center 1020 Green Avenue Altoona, PA 16601

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on review of facility policies, as well as observations and staff interviews, it was determined that the facility failed to store and prepare food in accordance with professional standards for food service safety by failing to have staff wear appropriate hair restraints during food preparation and tray line service. Findings include: The facility's policy regarding dress and personal hygiene, dated February 14, 2025, revealed that staff working in Food and Nutrition Services will wear a clean and appropriate hairnet and hair restraint. The hairnet/hair restraint will cover all hair. Beards and facial hair will be contained. Observations in the main kitchen on April 22, 2025, at 8:34 a.m. revealed three dietary staff on the tray line. Dietary Staff 2 was plating the breakfast meal cheesy eggs, cinnamon rolls, toast, and hot cereal without wearing a facial hair restraint. Interview with Dietary Staff 2, on April 22, 2025, at 8:43 a.m. confirmed that he should be wearing a facial hair restraint, but he took it off because it was hot and he had to answer the phone multiple times. Observations in the main kitchen on April 22, 2025, at 12:20 p.m. revealed dietary staff on the tray line for lunch. Dietary Aide 3 was pushing carts in the main kitchen. Dietary Aide 3 was not wearing a hair restraint. Interview with Dietary Aide 3 at the time of the observation confirmed that she should have had a hair restraint on and it must have fallen off when she went outside. Interview with the Interim Certified Dietary Director on April 22, 2025, at 10:04 a.m. confirmed that the dietary department was fully staffed on April 21, 2025, and that staff should have had hair covered appropriately with hair restraints. 28 Pa. Code 211.6(f) Dietary Services. 395985 Page 2 of 3 395985 04/22/2025 Midtown Oaks Health & Rehab Center 1020 Green Avenue Altoona, PA 16601

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Based on review of clinical records, as well as staff interviews, it was determined that the facility failed to ensure that clinical records were complete and accurately documented for one of five residents reviewed (Resident 2). Findings included: A quarterly Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) assessment for Resident 2, dated April 7, 2025, indicated that the resident was sometimes understood and able to sometimes understand others, and was dependent on staff for personal hygiene care. A nursing note for Resident 2, dated April 24, 2025, at 10:00 a.m., revealed that the Registered Nurse Supervisor was made aware that the resident's daughter was requesting testing be completed to check for urinary tract infection (UTI). A nursing note for Resident 2, dated April 2, 2025, at 11:54 p.m., revealed that a straight catheterization (a tube used to drain urine from the bladder) was attempted three times without success. Interview with the Director of Nursing on April 22, 2025, at 1:56 p.m. revealed that a straight catheterization was not attempted on Resident 2, and that the nursing note was placed in the wrong chart. 28 Pa. Code 211.5(f) Clinical Records. 395985 Page 3 of 3