Health inspection·December 8, 2022

F 0610 Respond appropriately to all alleged violations. Level of Harm - Minimal harm or potential for actual harm Based on a review of the facility's policy, clinical record reviews, and staff interview, it was determined that the facility failed to investigate an injury of unknown origin for one of the 12 residents reviewed (Resident 8). Residents Affected - Few Findings include: Review of the facility's policy titled Abuse Prevention Program, revised in July 2021, revealed that if the cause of the injury is unknown, the person gathering facts will document the injury, the location and time it was observed, any treatment given and whether the physician, responsible party and/or the Department of Health were notified. The appointed investigator will, at a minimum, attempt to interview the person who reported the incident, anyone likely to have direct knowledge of the incident, and the resident if can be interviewed. Review of Resident 8's diagnosis list revealed Alzheimer's disease (irreversible, progressive degenerative disease of the brain, resulting in loss of reality contact and functioning ability), Dementia (term used to describe a group of symptoms affecting memory, thinking, and social abilities severely enough to interfere with daily life), Anxiety Disorder, Psychotic and Mood Disturbance. Review of Resident 8's Minimum Data Set (MDS- standardized assessment tool that measures health status in long-term care residents) dated July 6, 2022, revealed that the resident had severe cognitive impairment. The same MDS assessment revealed the resident required extensive bed mobility, transferring, personal hygiene, and grooming. Review of Resident 8's active care plan revealed resident had physical behaviors during hands-on care and was resistant to care. Both plans of care were developed on June 3, 2020. Review of Resident 8's clinical record including document titled Change in Condition, dated October 3, 2022 (6:57 p.m.), revealed the resident was observed with a bruise to the left forearm with a measurement of 6.5 x 4.0 cm. Interview with the Director of Nursing was conducted on December 7, 2022, at 1:00 p.m. The Director of Nursing reported the resident did not have documented falls or trauma. The DON confirmed the bruise observed on Resident 8's left forearm on October 3, 2022, was not investigated. An interview with the Nursing Home Administrator (NHA) was conducted on December 8, 2022, at 10:30 a.m. The NHA confirmed that the resident did not have falls/trauma before the discovery of the left forearm bruise. The NHA confirmed that Resident 8's left forearm bruise from an unknown source should have been investigated. Page 1 of 3 396062 396062 12/08/2022 Inn at Freedom Village,the 35 Freedom Boulevard West Brandywine, PA 19320

F 0610 The facility failed to ensure Resident 8's left forearm bruise (injury of unknown origin) was investigated. Level of Harm - Minimal harm or potential for actual harm 483.13 - Resident Behavior and Facility Practices, 10-1-1998 edition 28 Pa. Code 201.18(a)(b)(3) Management Residents Affected - Few Previously cited 11/23/21 28 Pa. Code 211.5(f) Clinical Records Previously cited 11/23/21 28 Pa. Code 211.10(a)(c)(d) Resident Care Policies Previously cited 11/23/21 28 Pa. Code 211.12(c)(d)(1)(3)(5) Nursing Services Previously cited 11/23/21 396062 Page 2 of 3 396062 12/08/2022 Inn at Freedom Village,the 35 Freedom Boulevard West Brandywine, PA 19320

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 record reviews, staff, and resident interviews, it was determined that the facility failed to ensure the physician's order was followed for one of the 12 residents reviewed (Resident 9). Residents Affected - Few Findings include: Review of Resident 9's diagnosis list revealed End Stage Kidney Disease (condition when your kidneys no longer work as they should to meet your body's needs). Interview with Resident 9 conducted on December 5, 2022, at 10:00 a.m., revealed that she/he goes to Hemodialysis (process of purifying the blood /remove toxins of a person whose kidneys are not working normally) every Monday, Wednesday, and Friday. The resident reported being picked up around 10:30 a.m. and returning to the facility around 2:00 p.m. Review of Resident 9's Physician's order sheet revealed an order for a Calcium Acetate capsule given 667 mg (milligrams) by mouth with meals. The medication was ordered to be administered at 8:00 a.m., 12:00 noon, and 5:00 p.m. Review of Resident 9's November and December 2022, Medication Administration Record (MAR) revealed the Calcium Acetate medication was not administered at noon on the following dates: November 18, 23, 25, 28, 30, 2022, and on December 2, 5, and December 7, 2022. Interview with the Director of Nursing was conducted on December 8, 2022, at 10:00 a.m., and revealed that the medication was missed on the days mentioned above due the resident was out of the facility for Hemodialysis. A clinical records review failed to reveal the attending physician was notified of the missed medication doses. The above information was conveyed to the NHA on December 8, 2022, at 10:30 a.m. The facility failed to ensure Resident 9's medication order was followed. 28 Pa. Code 201.18(a)(b)(3) Management Previously cited 11/23/21 28 Pa. Code 211.5(f) Clinical Records Previously cited 11/23/21 28 Pa. Code 211.12(c)(d)(1)(3)(5) Nursing Services Previously cited 11/23/21 396062 Page 3 of 3