Health inspection·June 25, 2025

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policies, clinical records, and shower schedules, as well as staff and resident interviews, it was determined that the facility failed to ensure that residents were provided with showers as scheduled for four of nine residents reviewed (Residents 4, 5, 6, 7). Residents Affected - Few Findings include: The facility policy for bathing and showering, dated April 29, 2025, indicated that residents will be bathed or showered according to their preferences in order to maintain healthy hygiene and skin condition. Each resident will be asked about his/her bathing preferences upon admission (type of bath, preferred days and times). Each resident will be scheduled to receive bathing a minimum of two times per week. If the bath/shower cannot be given or the resident refuses, the nursing assistant will promptly report this to the charge nurse. The charge nurse will speak to the resident who refuses to ascertain why they are refusing and to determine if alternative arrangements that suit the resident can be made. If the resident continues to refuse, the charge nurse will document the resident's refusal in the medical record. An admission Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) assessment for Resident 4, dated June 12, 2025, revealed that the resident was cognitively intact, required assistance with care needs including bathing and toileting hygiene, was frequently incontinent of bowel and bladder, and had a diagnosis of diabetes. An interview with Resident 4 on June 25, 2025, at 10:05 a.m. revealed that he has had one shower since he was admitted to the facility, and he had been at the facility for about two weeks. A review of Resident 4's clinical record revealed that the resident was admitted on [DATE]. A review of Resident 4's bathing detail report for June 2025 revealed that he had received one shower since he was admitted to the facility. There was no documented evidence that the resident's bathing/shower preferences were obtained on admission and no documented evidence that the resident received a bath/shower a minimum of two times per week per facility policy. Interview with the Director of Nursing on June 25, 2025, at 3:50 p.m. indicated that shower preferences were obtained for Resident 4 on admission; however, the preferences were not documented in the resident's clinical record including the resident's care plan and shower schedule. She confirmed that there was no documented evidence that Resident 4 received showers per facility policy. An admission MDS assessment for Resident 5, dated May 18, 2025, revealed that the resident was cognitively intact, required assistance with care needs including bathing and toileting hygiene, was frequently incontinent of bowel and occasionally incontinent of bladder, and had a diagnosis including Page 1 of 3 395985 395985 06/25/2025 Midtown Oaks Health & Rehab Center 1020 Green Avenue Altoona, PA 16601

F 0677 morbid obesity. Level of Harm - Minimal harm or potential for actual harm A physician's order for Resident 5, dated May 12, 2025, included an order for the resident to receive a shower on Wednesday and Friday mornings. A care plan for Resident 5, dated May 14, 2025, included an intervention that the resident was to receive a shower in the mornings on Wednesdays and Fridays and to offer bed baths if he refused and document. Residents Affected - Few A review of the bathing detail report for Resident 5 for May and June 2025 revealed that there was no documented evidence that the resident received his showers per physician's orders and preference, and there was no documented evidence that the resident refused his showers, requiring a bed bath be given. Interview with the Director of Nursing on June 25, 2025, at 3:50 p.m. confirmed that there was no documented evidence that Resident 5 received or refused showers from May to June 2025 as per the resident's orders/preferences and plan of care. A quarterly MDS assessment for Resident 6, dated May 6, 2025, revealed that the resident was cognitively impaired, required assistance with care needs including bathing and toileting hygiene, was occasionally incontinent of bowel and bladder, and had a diagnosis of diabetes. A physician's order for Resident 6, dated March 11, 2025, included an order for the resident to receive a shower every other day in the evening and to document in the progress notes any refusal, offer bed bath, notify medical director and power of attorney. A care plan for Resident 6, dated December 19, 2024, included an intervention that the resident prefers to shower every other day in the evenings. A review of the bathing detail report for Resident 6 from March 2025 through June 2025 revealed that there was no documented evidence that the resident received her shower's per physician's orders and preference, and there was no documented evidence that the resident refused her showers, requiring a bed bath be given. Interview with the Director of Nursing on June 25, 2025, at 3:50 p.m. confirmed that there was no documented evidence that Resident 6 received and/or refused showers from March 2025 through June 2025 as per the resident's orders/preferences and plan of care. An annual MDS assessment for Resident 7, dated June 9, 2025, revealed that the resident was cognitively intact, required assistance with care needs including bathing and toileting hygiene, was occasionally incontinent of bowel and bladder, and had diagnoses including diabetes and peripheral vascular disease (a disease causing poor blood circulation to lower limbs). A physician's order for Resident 7, dated March 11, 2025, included an order for the resident to receive a shower on Mondays, Wednesdays, and Fridays in the a.m. and to document in the progress notes any refusal, offer bed bath, notify medical director and power of attorney. A care plan for Resident 7, dated August 6, 2024, included an intervention that the resident prefers to shower on Monday, Wednesday, and Friday on the first shift and may have a complete bed bath if she refuses a shower. A review of the bathing detail report for Resident 7 from March 2025 through June 2025 revealed that there was no documented evidence that the resident received her shower's per physician's orders and preference, and there was no documented evidence that the resident refused her showers, requiring 395985 Page 2 of 3 395985 06/25/2025 Midtown Oaks Health & Rehab Center 1020 Green Avenue Altoona, PA 16601

F 0677 a bed bath be given. Level of Harm - Minimal harm or potential for actual harm Interview with the Director of Nursing on June 25, 2025, at 3:50 p.m. confirmed that there was no documented evidence that Resident 7 received and/or refused showers from March 2025 through June 2025 as per the resident's orders/preferences and plan of care. Residents Affected - Few 28 Pa. Code 211.12(d)(5) Nursing Services. 395985 Page 3 of 3