Inspection·May 3, 2023

F 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a review of clinical records and pharmacist drug regimen reviews and staff interview it was determined that the pharmacist failed to identify an irregularity in the drug regimen of one resident (Resident A1) out of five residents reviewed. Findings include: Regulatory guidance indicates that a drug irregularity includes, but is not limited to, use of medications without adequate indication, without adequate monitoring, in excessive doses, and/or in the presence of adverse consequences, as well as the identification of conditions that may warrant initiation of medication therapy. The guidance further notes that a Medication Regimen Review (MRR) or Drug Regimen Review is a thorough evaluation of the medication regimen of a resident, with the goal of promoting positive outcomes and minimizing adverse consequences and potential risks associated with medication. The MRR includes review of the resident's medical record in order to prevent, identify, report, and resolve medication-related problems, medication errors, or other irregularities A review of Resident A1's clinical record revealed that the resident was admitted to the facility on [DATE], with diagnoses, which included hemiplegia (paralysis on one side of the body) and hemiparesis (weakness on one side of the body) following stroke affecting left non-dominant side and hypertensive chronic kidney disease (chronic kidney disease due to chronic high blood pressure). A physician progress note completed upon the resident's admission to the facility revealed that the resident was prescribed Metoprolol 25 mg twice a day for hypertension with a goal (to maintain the resident's blood pressure) below 140/90. (Diastolic blood pressure is the pressure on the blood vessels when the heart muscle relaxes. The diastolic pressure is always lower than the systolic pressure. Blood pressure is measured in units of millimeters of mercury (mmHg). The readings are always given in pairs, with the upper (systolic) value first, followed by the lower (diastolic) value). Review of Resident 1's Medication Administration Records dated September 2022 through April 2023, and clinical record revealed no documented evidence that the resident's blood pressure was monitored to evaluate the effectiveness of the antihypertensive medication and to achieve the physician established goal for the resident's blood pressure to be maintained below 140/90 A physician progress note dated April 25, 2023, indicated that the physician noted that the resident complained of visual changes, difficulty reading, and experiencing a tension headache that would come and go. The physician performed a physical exam, revealing that the blood pressure was 166/88, heart rate was 75, and the resident was not in acute distress. The physician ordered an increase in the resident's blood pressure medication. The entry noted that on April 25, 2023, the physician increased the resident's Metoprolol (antihypertensive medication) to 50 mg two times per day with a blood pressure goal below 140/90. Review of Resident A1's Medication Administration Record (MAR) and clinical record dated April 2023 revealed that there was no documented evidence that the resident's blood pressure was monitored to evaluate the effectiveness of the increase in antihypertensive medication and that the resident's blood pressure goal below 140/90 was met. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396074 If continuation sheet Page 2 of 3 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 396074 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Allied Services Skilled Nursing Center 303 Smallacombe Drive Scranton, PA 18501 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few A review of the monthly Medication Regimen Clinical Reviews conducted by the pharmacist from October 2022 through April 2023, revealed no indication that the pharmacist identified that the resident's blood pressure was not being monitored in conjunction with the administration of antihypertensive medication to meet the established goal for maintaining the resident's blood pressure below 140/90. An interview with the Nursing Home Administrator and Director of Nursing on May 3, 2023, at approximately 2:15 PM, confirmed that there was no documented evidence that the pharmacist had identified the lack of blood pressure monitoring being conducted for Resident A1 in coordination with the administration of the antihypertensive drug and established goal for maintaining the resident's blood pressure levels. 28 Pa. Code 211.9 (k) Pharmacy services. 28 Pa. Code 211.12 (c) Nursing services. 28 Pa. Code 211.2(a) Physician services 28 Pa. Code 211.5(h) Clinical records FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396074 If continuation sheet Page 3 of 3