Inspection·February 8, 2024

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review and staff interview it was determined that the facility failed to ensure that the pharmacy provided medications timely for two of three residents reviewed (Resident R1 and R2). Findings include: Review of Resident R1's clinical record revealed Resident R1 was admitted [DATE], with diagnoses of but not limited to Hematuria (blood in the urine), acute angle-closure Glaucoma (condition that causes pressure to go up quickly in the eye and block the drainage system), CVA (cerebral vascular accident - stroke), hypertension (high blood pressure), and Depression. Review of Resident R1's physician's admission orders included an order for Dorzolamide HCl Ophthalmic Solution 2%, instill 1 drop in both eyes two times a day related to acute angle-closure glaucoma, bilateral. Review of the February 2024 Medication Administration Record (MAR) revealed that Dorzolamide was not administered January 18-23, 2024 for a total of ten times. Review of progress notes of January 19, January 20, and January 21, 2024, revealed awaiting delivery and delivery is pending for eye drops. Review of progress note of January 22, 2024, revealed pharmacy was called and assured eye drop would be delivered late tonight. Review of progress note of January 23, 2024, revealed med [eye drops] not available at this time. Pharmacy said they will be here tonites run. Review of progress note of January 23, 2024, revealed staff spoke with pharmacy at 3:30 p.m. regarding the eye drops and pharmacy indicated they may need authorization from the Director of Nursing (DON) for new bottle to be delivered. Review of progress note of January 23, 2024, revealed family brought in eye drops which were administered. Review of Resident R2's clinical record revealed that Resident R2 was admitted [DATE], with diagnoses of but not limited to hypothyroidism (underactive thyroid), multiple sclerosis (disease affect the central nervous system), hypertension, type II diabetes(disease that occurs when blood sugar is too high) and respiratory failure (syndrome in which the respiratory system fails). Review of physician admission orders included orders for, but not limited to, Fluticasone-Salmeterol Inhalation Aerosol Powder Breath Activated 250-50 MCG/ACT 1 puff inhale orally two times a day related to respiratory failure, Ascorbic Acid Oral Tablet 500 MG (milligrams) Give 1 tablet by mouth two times a day for vitamin deficiency, Amlodipe Besylate Oral Tablet 2.5 MG Give 1 tablet by mouth one time a day related to essential (primary) hypertension, Aspirin Low Dose Oral Tablet Chewable 81 (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 2 Event ID: 396083 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 396083 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/08/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sterling Health Care and Rehab Center 318 South Orange Street Media, PA 19063 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)