Health inspection·September 20, 2023

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. Based on clinical record reviews and staff interviews, it was determined that the facility failed to ensure that the physician was notified about medications not being available for administration on multiple days for one of 10 residents reviewed (Resident 6). Findings include: A quarterly Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) for Resident 6, dated September 24, 2023, indicated that the resident was cognitively intact, required limited to extensive assistance from staff for daily care needs, was incontinent of bladder, and had diagnoses that included a urinary tract infection within the past 30 days and end-stage renal (kidney) disease. Physician's orders for Resident 6, dated September 14, 2023, included an order for the resident to receive 500 milligrams (mg) of cefuroxime axetil (antibiotic) twice a day for five days for a urinary tract infection. The Medication Administration Record (MAR) for Resident 6, dated September 2023, indicated that the resident did not receive cefuroxime axetil on September 14, 2023, at 8:00 a.m. and 8:00 p.m. and September 18, 2023, at 8:00 a.m. due to not being available from the pharmacy. There was no documented evidence that the physician was notified that cefuroxime axetil was not available from the pharmacy and that the cefuroxime axetil was not administered to Resident 6 twice a day for five days. Physician's order for Resident 6, dated September 14, 2023, included an order for the resident to receive 800 mg of Sevelamer HCl (used to control high blood levels of phosphorus in people with chronic kidney disease) with meals (8:00 a.m., 12:00 p.m., 5:00 p.m.) for end-stage renal failure. The MAR for Resident 6, dated September 2023, indicated that the resident did not receive Sevelamer from September 14, 2023, through September 18, 2023. There was no documented evidence that the physician was notified that the Sevelamer was not available and not administered to Resident 6 with meals September 14 through 18, 2023. Interview with the Director of Nursing on September 20, 2023, at 1:40 p.m. confirmed that there was no documented evidence that the physician was notified that the cefuroxime axetil and Sevelamer for Resident 6 were not available and not administered as ordered. Page 1 of 9 396035 396035 09/20/2023 Scottdale Healthcare & Rehabilitation Center 900 Porter Avenue Scottdale, PA 15683

F 0580 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 396035 Page 2 of 9 396035 09/20/2023 Scottdale Healthcare & Rehabilitation Center 900 Porter Avenue Scottdale, PA 15683

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. Based on clinical record reviews, as well as staff interviews, it was determined that the facility failed to ensure that a resident's care plan was updated regarding fall precaution interventions for two of 10 residents reviewed (Residents 3, 8) Findings include: A quarterly Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) for Resident 3, dated August 2, 2023, indicated that the resident was cognitively intact, was independent with bed mobility and transfers, and had a history of falls. A nursing note, dated August 12, 2023, at 3:41 p.m. revealed that Resident 3 was observed sitting in his wheelchair in the bathroom. Blood was noted on the floor next to his bed, on his bed sheets, and on his clothing. A laceration was observed on the resident's forehead that measured 9.0 x 0.5 centimeters (cm) as well as a skin tear on his right forearm. When asked what happened, the resident stated he was sitting on his bed and leaned over to reach for something and fell off the bed and hit his head on the floor. He then got himself up into his wheelchair and wheeled into the bathroom. The Certified Registered Nurse Practitioner (CRNP) was notified and an order was received to send the resident to the hospital. A physician's order, dated August 14, 2023, included an order for a perimeter mattress (mattress with raised edges to prevent rolling out) to decrease the risk of falling from bed. Observations on September 20, 2023, at 2:45 p.m. revealed that a perimeter mattress was on Resident 3's bed. There was no documented evidence that Resident 3's care plan regarding fall prevention was revised to reflect the use of a perimeter mattress on his bed. Interview with the RNAC (Registered Nurse Assessment Coordinator - responsible for developing and revising care plans) on September 28, 2023, at 2:52 p.m. confirmed that she was not aware that Resident 3 had a perimeter mattress ordered and the care plan should have been updated. A quarterly MDS assessment for Resident 8, dated June 25, 2023, revealed that the resident was confused, required extensive assistance with mobility, and was not ambulatory. A nursing note for Resident 8, dated August 6, 2023, indicated that on August 5, 2023, at 11:25 p.m. the resident rolled out of bed. The CRNP note for Resident 8, dated August 7, 2023, indicated that her current bed had a bolster but an additional wedge was needed for her to maintain her bed positioning. A CRNP order for Resident 8, dated August 7, 2023, included an order to add an extra bolster to the right side of her bed. There was no documented evidence that Resident 8's care plan regarding fall prevention/positioning in bed was revised to reflect the use of an extra bolster on the right side of her bed. 396035 Page 3 of 9 396035 09/20/2023 Scottdale Healthcare & Rehabilitation Center 900 Porter Avenue Scottdale, PA 15683

F 0657 Level of Harm - Minimal harm or potential for actual harm Interview with the Assistant Director of Nursing on September 20, 2023 at 12:26 p.m. confirmed that the plan of care was not updated related to the resident's additional bolster to be in use and that it should have been updated. 28 Pa. Code 211.11(d) Resident care plan. Residents Affected - Few 396035 Page 4 of 9 396035 09/20/2023 Scottdale Healthcare & Rehabilitation Center 900 Porter Avenue Scottdale, PA 15683

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 clinical records reviews and staff interviews, it was determined that the facility failed to ensure that physician's orders for medications were followed for one of 10 residents reviewed (Resident 6). Residents Affected - Few Findings include: A quarterly Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) for Resident 6, dated September 24, 2023, indicated that the resident was cognitively intact, required limited to extensive assistance from staff for daily care needs, was incontinent of bladder, and had diagnoses that included a urinary tract infection within the past 30 days and end-stage renal (kidney) disease. Physician's orders for Resident 6, dated September 14, 2023, included an order for the resident to receive 500 milligrams (mg) of cefuroxime axetil (antibiotic) twice a day for five days for a urinary tract infection. The Medication Administration Record (MAR) for Resident 6, dated September 2023, indicated that the resident did not receive cefuroxime axetil on September 14, 2023, at 8:00 a.m. and 8:00 p.m. and September 18, 2023, at 8:00 a.m. due to not being available from the pharmacy. There was no documented evidence that the cefuroxime axetil was administered to Resident 6 twice a day for five days as ordered by the physician. Physician's order for Resident 6, dated September 14, 2023, included an order for the resident to receive 800 mg of Sevelamer HCl (used to control high blood levels of phosphorus in people with chronic kidney disease) with meals (8:00 a.m., 12:00 p.m., 5:00 p.m.) for end-stage renal failure. The MAR for Resident 6, dated September 2023, indicated that the resident did not receive Sevelamer from September 14, 2023, through September 18, 2023. A nursing note, dated September 18, 2023, at 3:12 p.m. revealed that the Sevelamer was discontinued and the resident ordered calcium acetate as per the pharmacy's recommendation. There was no documented evidence that the Sevelamer was administered to Resident 6 with meals as ordered by the physician September 14 through 18, 2023. Interview with the Director of Nursing on September 20, 2023, at 1:40 p.m. confirmed that Resident 6 did not receive the cefuroxime axetil and Sevelamer as ordered by the physician. 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services. 396035 Page 5 of 9 396035 09/20/2023 Scottdale Healthcare & Rehabilitation Center 900 Porter Avenue Scottdale, PA 15683

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Based on clinical record reviews, observations, and staff interviews, it was determined that the facility failed to attempt new interventions for fall prevention for one of the 10 residents reviewed (Resident 3) and failed to ensure that fall prevention interventions were in place as ordered for one of 10 residents reviewed (Resident 8). Findings include: A quarterly Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) for Resident 3, dated August 2, 2023, indicated that the resident was cognitively intact, was independent with bed mobility and transfers, and had a history of falls. A nursing note, dated June 24, 2023, at 4:45 a.m. revealed that Resident 3 was found on the floor with both legs bent at the knees. He said that he was getting out of bed and slid down to his knees. He had an abrasion on the left knee measuring 4.0 x 3.0 centimeters (cm) and two abrasions noted on the right knee measuring 1.0 x 1.0 cm and 4.0 x 2.5 cm. There was no documented evidence that any new interventions were put into place to prevent falls for Resident 3. Interview with the RNAC (Registered Nurse Assessment Coordinator - responsible for developing and revising care plans) on September 28, 2023, at 2:52 p.m. confirmed that there was no evidence that any new fall interventions were put into place following the resident's fall on June 24, 2023. A quarterly MDS assessment for Resident 8, dated June 25, 2023, revealed that the resident was confused, required extensive assistance with mobility, and was not ambulatory, A nursing note for Resident 8, dated August 6, 2023, indicated that on August 5, 2023, at 11:25 p.m. the resident rolled out of bed. The Certified Registered Nurse Practitioner( CRNP- registered nurse with specialized training) note for Resident 8, dated August 7, 2023, indicated that her current bed had a bolster but an additional wedge was needed for her to maintain her bed positioning. CRNP order for Resident 8, dated August 7, 2023, included an order to add an extra bolster to the right side of her bed. Observations of Resident 8 on September 20, 2023, at 9:51 a.m. during care and at 11:28 a.m. revealed that the resident was in bed and that there was no extra bolster placed on the right side of the bed. There was a bolster noted in her room on her chair. Interview with Licensed Practical Nurse 1 on September 20, 2023, at 11:28 a.m. indicated that the resident should have the bolster in use when in bed because she tends to lean to the right. Interview with the Nursing Home Administrator on September 20, 2023, at 12:09 p.m. indicated that the bolster should have been in place. 396035 Page 6 of 9 396035 09/20/2023 Scottdale Healthcare & Rehabilitation Center 900 Porter Avenue Scottdale, PA 15683

F 0689 28 Pa. Code 211.12(d)(5) Nursing services. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 396035 Page 7 of 9 396035 09/20/2023 Scottdale Healthcare & Rehabilitation Center 900 Porter Avenue Scottdale, PA 15683

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 clinical records reviews and staff interviews, it was determined that the facility failed to ensure that a resident's clinical record was complete and accurately documented for one of 10 residents reviewed (Resident 6). Findings include: A quarterly Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) for Resident 6, dated September 24, 2023, indicated that the resident was cognitively intact, required limited to extensive assistance from staff for daily care needs, did not receive bathing during the review period, and received dialysis. Physician's orders, dated July 12, 2023, revealed that the resident received dialysis every Tuesday, Thursday and Saturday. A shower/bathing record, dated December 21, 2022, revealed that Resident 6 was to receive a bath/shower during the evening on non-dialysis days. Nurse aide documentation for August and September 2023 revealed no documented evidence that Resident 6 received a shower from August 1 through 14 and September 1 through September 7, 2023. Interview with Resident 6 on September 20, 2023, at 8:43 a.m. revealed that she was receiving her scheduled showers/baths. Interview with the Assistant Director of Nursing on September 20, 2023, at 4:16 p.m. confirmed that there was no documentation of Resident 6's bathing/showers during the mentioned time frames. 28 Pa. Code 211.5(f) Clinical records. 396035 Page 8 of 9 396035 09/20/2023 Scottdale Healthcare & Rehabilitation Center 900 Porter Avenue Scottdale, PA 15683

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on review of facility policies and clinical records, as well as observations and staff interviews, it was determined that the facility failed to use proper infection control practices during care for one of 10 residents reviewed (Resident 8). Residents Affected - Few Findings include: The facility policy for handwashing/hygiene, dated November 17, 2022, indicated that the use of gloves do not replace handwashing/hygiene. Hand hygiene is the final step after removing and disposing of personal protective equipment. A quarterly Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) for Resident 8, dated June 5, 2023, revealed that the resident was frequently incontinent of bowel and bladder and required extensive assistance of two for hygiene. Physician's orders for Resident 8, dated September 6, 2023, indicated that she had a pressure ulcer on her right and left buttocks and the wounds were to be cleaned with soap and water, apply zinc, and then apply a foam dressing three times a day and as needed. Observations of Resident 8 during hygiene and wound care on September 20, 2023, at 9:51 a.m. revealed that the resident was removed from a bedpan, she had smeared bowel on her buttocks and with gloves on Licensed Practical Nurse 1 cleaned the resident. After providing her care she removed her gloves, and without performing hand hygiene, she donned new gloves and proceeded to provide wound care to the resident's right and left buttocks. Interview with Licensed Practical Nurse 1 on September 20, 2023, at 10:11 a m. revealed that she should have washed her hands after removing her gloves. Interview with the Nursing Home Administrator on September 20, 2023, at 12:09 p.m. confirmed that Licensed Practical Nurse 1 should have washed her hands after providing hygiene care to Resident 8 and removing her gloves. 28 Pa. Code 211.12(d)(1)(5) Nursing services. 396035 Page 9 of 9