Health inspection·December 27, 2023

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of clinical records, select facility policy and grievances lodged with the facility, and resident and staff interviews, it was determined that the facility failed to provide care in an environment, which promotes each resident's quality of life by failing to respond timely to residents' request for assistance as reported by five residents out of nine interviewed (Residents 2, 7, 1, 6, and 8 ). Findings include: A review of the undated facility policy Resident Call Light provided during the survey ending December 27, 2023, revealed that it was the policy of the facility to respond to a resident's call light within 3-5 minutes and assess their immediate need and provide assistance. Resident's immediate needs e.g., needing the bathroom, safety issues, pain or acute illness, will be addressed at the time of need. A review of Resident 2's clinical record revealed admission to the facility on February 6, 2023, revealed that the resident was cognitively intact and required staff supervision or touch assistance with toileting. An interview with Resident 2 on December 27, 2023, at approximately 10:15 AM, revealed that last night (December 26, 2023) the resident waited over 30 minutes for staff to respond to her call bell and assist the resident to the bathroom. The resident stated that after waiting over 30 minutes for staff to respond she took herself to the bathroom to prevent becoming incontinent of urine. Resident 2 also stated that she slid off the toilet last evening trying to transfer herself back into her wheelchair after self-toileting. The resident stated that the facility staff do the best they can to take care of everyone, but sometimes there isn't enough staff to tend to everyone timely. A review of Resident 7's clinical record revealed that she was admitted to the facility on [DATE], with diagnoses of a hip fracture, required substantial/maximum assistance with transfers, toileting, and bed mobility and was cognitively intact. Resident 7 filed a Grievance/Complaint Report dated November 14, 2023, which revealed that she was incontinent of bowel and had a BM (bowel movement) in her brief and waited four hours for staff to change her brief and provide incontinence care. Resident 7 also indicated that staff would not bring her fresh water. An interview with Resident 7 on December 27, 2023, at approximately 10:35 AM, revealed that earlier this morning she waited over an hour for staff to respond to her call bell. She then asked staff to Page 1 of 3 396086 396086 12/27/2023 Green Valley Skilled Nursing and Rehabilitation Ce 1 Matthew Drive Pottsville, PA 17901

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some bring her a drink but staff failed to bring her a drink as requested approximately 2-hours earilier. The resident stated, I'm at the mercy of staff to do things that I can't do for myself and it's frustrating when it takes them hours to come in and care for you. A review of Resident 1's clinical record revealed that she was admitted to the facility on [DATE], with diagnoses that included arthritis, malnutrition, and a history of cancer. The resident was cognitively intact and dependent for transfers and toileting. Interview with Resident 1 on December 27, 2023, at approximately 10:45 AM, revealed that this morning at 6:00 AM she was incontinent of BM (bowel movement) and pressed her call bell for staff to change her soiled brief. The resident stated that she waited until 6:50 AM (50-minutes later) for staff to provide her incontinence care. The resident stated that she was upset that she had to sit in feces for that length of time and didn't want it {feces} to soil her blankets. A review of clinical record revealed Resident 6 was admitted to the facility on [DATE], with diagnosis to include cerebral infarction (stroke), Cauda Equina Syndrome (extreme pressure and swelling of the nerves at the bottom of the spinal cord which cuts off sensation and movement to the lower body and can affect control of the bladder and bowel) and retention of urine (Urinary retention is when you can't empty your bladder completely or at all). A review of Resident 6's care plan, dated December 16, 2023, revealed that the resident had functional bladder incontinence due to impaired mobility and Cauda Equina Syndrome with a planned intervention for staff to straight catheterize the resident every 6 hours (tube inserted into the bladder to drain the urine). Interview with Resident 6 on December 27, 2023, at approximately 12:00 PM, revealed that he has waited 30 minutes or more for staff to answer his call bell when he requests assistance. He expressed concern that since he is unable to empty his bladder on his own due to his medical condition and requires nursing staff to perform a straight catheterization, he has experienced uncomfortable abdominal pressure and pain waiting for staff to respond to his call bell when he needs to be catheterized. He reported that nursing staff perform the straight catheterization every six hours as ordered but sometimes he needs it more frequently, especially at night. He stated that the extended wait times generally occurred during the middle of the night or early morning shifts. A review of clinical records revealed Resident 8 was admitted to the facility on [DATE], with diagnoses of hemiplegia (paralysis of one side of the body) and hemiparesis (weakness on one side of the body) following a cerebral infarction (stroke). Interview with Resident 8 on December 27, 2023, at 12:30 PM revealed that he feels that short staffing is a problem in the facility because he waits up to 45 minutes to an hour for staff to answer his call bell. The resident stated that staff have told him you have to wait in line, we're short staffed and that there have been times he has soiled himself while waiting for staff to answer his call bell when he needs toileting assistance. Interview on December 27, 2023, at approximately 2:15 PM with the Nursing Home Administrator (NHA) and Director of Nursing (DON) verified that it is the expectation that all residents be treated with dignity and respect. The DON was unable to explain why multiple residents are reporting untimely staff response to their requests for assistance and staff's failure to provide needed care and services in a timely manner, which was negatively affecting the residents' quality of life in the facility. 396086 Page 2 of 3 396086 12/27/2023 Green Valley Skilled Nursing and Rehabilitation Ce 1 Matthew Drive Pottsville, PA 17901

F 0550 28 Pa. Code 201.18 (e)(1) Management Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code 211.12 (d)(5) Nursing Services 28 Pa. Code 201.29 (a) Resident rights Residents Affected - Some 396086 Page 3 of 3