Health inspection·September 8, 2023

F 0584 Level of Harm - Minimal harm or potential for actual harm Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. Based on observations and interviews with residents and staff, it was determined that the facility failed to ensure a homelike atmosphere during mealtime for two of two floors (Second and Third floor). Residents Affected - Few Findings include: Observations conducted of Resident R75 revealed that the resident was served lunch in his room on September 5, 2023, at approximately 12:00 p.m. The resident stated,There's no other place to eat. On September 6, 2023, at 11:15 a.m. Resident R3's son stated, Ever since Covid the residents are confined to their rooms for dining. I'd think they would have them opened for social interaction. They say that helps with healing. During the same time Resident R277 stated, I was here five years ago, and you would eat in the dining room next to the courtyard. It's a shame because it's such a beautiful room but we eat in our rooms now. On September 6, 2023 at 1:16 p.m. Resident R60's wife stated, Residents aren't served meals in the dining room they eat in their rooms. I would think they would want the residents to get out of their rooms. It's a holistic (comprehensive) approach to healing. On September 5, 2023, at 2:30 p.m., the Nursing Home Administrator confirmed the facility no longer serves meals in the dining room and all residents are served meals in their room. 28 Pa. Code 201.14(a) Responsibility of licensee Page 1 of 6 396101 396101 09/08/2023 Rehab at Shannondell 5000 Shannondell Drive Audubon, PA 19403

F 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances. Based on observation, review of facility policy, and interview with residents and staff, it was determined that the facility failed to ensure that grievance/concern forms were available for residents, family or guests for two of two floors (Second and Third floors). Findings include: Review of the facility's Grievance Policy revised on December 2021 states the facility will respond to grievances in a timely manner and seeks resolution that is satisfactory to the resident and prioritizes ongoing communication (phone calls, text messaging, emails, meetings, patient portal) to keep the residents/families informed. Further review of the grievance policy did not indicate nor provide the procedure necessary for submitting an anonymous compliant. September 5, 2023, at approximately 12:00 p.m. Resident R75 indicated he was not aware he could submit an anonymous complaint. September 6. 2023 at 1:16 p.m. Resident R60's wife indicated she was not aware she could submit an anonymous complaint. On September 8, 2023, at 9:30 a.m., the Nursing Home Administrator confirmed the facility failed to ensure methods of submitting an anonymous grievance was obtainable for the residents and/or the process of submission. 28 Pa. Code 201.29(a) Resident Rights 396101 Page 2 of 6 396101 09/08/2023 Rehab at Shannondell 5000 Shannondell Drive Audubon, PA 19403

F 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted Based on clinical record review, review of faciltiy policy and interviews with the staff, it was determined that the facility failed to develop and implement a baseline care plan for one of 25 residents reviewed (Resident R210). Findings include: Review of the facility's policy titled, Care Plan, revised on March 2023, stated that the resident's care plan shall be used in developing the resident's daily care routine and will be available to staff personnel, who have responsibility for providing care or services to the residents. It is required that a baseline care plan to meet the residents' immediate needs should be developed within forty-eight hours of the residents' admission. Review of the admission record indicated, Resident R210 was admitted to the facility, on September 1, 2023, with the diagnoses of Acute Respiratory Failure (Respiratory Failure is a serious condition that makes it difficult to breathe), Chronic Obstructive Pulmonary Disease (COPD)(COPD, refers to a group of diseases that cause airflow blockage and breathing-related problems), and Malignant Neoplasm of Right Kidney (Cancerous Tumor of Right Kidney). Review of Resident R210's care plan indicated that it was initiated only on September 5, 2023, beyond the forty-eight-hour requirement. Interview on September 7, 2023, at 12:23 p.m., with the charge Nurse of 3 C Unit, Licensed nurse, Employee E10, confirmed that the baseline care plan for Resident R210, was not developed in 48 hours of Resident R210's admission to the facility, to address his immediate care needs. 28 Pa. Code 211.11(a)(b)(c) Resident care plan 28 Pa. Code 211.12(d)(3)(5) Nursing services 396101 Page 3 of 6 396101 09/08/2023 Rehab at Shannondell 5000 Shannondell Drive Audubon, PA 19403

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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of clinical records and review of facility policy, it was determined the facility failed to ensure a resident's care plan was updated and revised to reflect the resident's specific care needs after a change in condition for one of 25 resident records reviewed (Resident R60). Findings include: Review of the facility's policy titled, Care Plan revised on March 2023 stated the resident's care plan shall be used in developing the resident's daily care routine and will be available to staff personnel who have responsibility for providing care or services to the resident. Review of Resident R60's clinical record revealed the resident was admitted on [DATE], with the diagnoses of heart diseases and atrial fibrillation (abnormal heartbeat). Review of physician note dated August 16, 2023, stated that orthostatic blood pressure (a sudden drop in blood pressure upon standing from a sitting or supine position) and TED stockings (compression stockings) were added to Resident R60's regimen. Review of Resident R60's physician orders dated August 16, 2023, instructed to take orthostatic blood pressures for three days and to notify the physician of a 10 point drop in the resident's blood pressure and to apply [NAME] Stockings to the resident's bilateral lower extremities daily. Review of Resident R60's care plan failed to include his diagnosis of orthostatic blood pressure and the intervention of compression stockings. 28 Pa. Code 211.12(d)(3) Nursing services 396101 Page 4 of 6 396101 09/08/2023 Rehab at Shannondell 5000 Shannondell Drive Audubon, PA 19403

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on a review of facility policy, observation, review of incident report, review of manufacture guidelines, and interview staff , it was determined that the facility failed to ensure that a medication was administered in accordance with profession standards for one of 8 residents reviewed. (Resident R262) Findings include: Review of facility policy titled Medication Administration dated February 2017, revealed the employee administrating the medication must stay with the resident/ patient until the resident is finished taking the medication. Review of manufacture Glenmark Pharmaceuticals Limited guidelines dated October 2022 package insert, revealed that the medication Pravastatin instructed the medication to be taken at the same time each day with or without food. If a dose is missed, take the medication as soon as you can but skip the missed dose if close to time for next dose. Do not take two doses at one time. Observation on the second floor, on September 5, 2023, at 10:05 a.m. revealed that Resident R262's daughter reported that there was a medication found on the resident's tray table. Surveyor observed Llicensed nurse, Employee E13 took the medication from resident's daughter and said she would call the doctor for further instruction. Review of Resident R262's physician orders revealed an order for Pravastatin (a medication used to lower cholesterol) a 40 milligrams (mg) tablet to be given daily at bedtime. Further review of Resident R262's September 2023 Medication Administration Record revealed that the medication Pravastatin was administered to Resident R262 on September 4, 2023, at 8:30 p.m., the evening before the medication was found. Interview with the Director of nursing (DON) on September 6, 2023, revealed that the medication was identified as Pravastatin 40 mg ordered to be given daily at bedtime. The DON stated that the found pill was administered to the resident the previous evening. Review of facility incident report revealed that it is unknown how the pill ended up on the resident's tray. A staff message was sent to all staff reminding them to stay with remain with residents when administering medication to ensure that the medications are swallowed without difficulty and taken as prescribed. Pa Code 211.9(a)(1) Pharmacy Services Pa Code 211.10(c) Resident care policies Pa Code 211.12 (d)(1) Nursing Services 396101 Page 5 of 6 396101 09/08/2023 Rehab at Shannondell 5000 Shannondell Drive Audubon, PA 19403

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based of a review of facility policies and procedures, observation, review of manufactures' guidelines, interview with staff, it was determined that the facility failed to store and label medication in accordance with acceptable professional standards for one of three medications carts reviewed. (second floor Cart B) Findings include: Review of facility policy titled dated Medication Storage dated July 2021 revealed that medications that require refrigeration will be stored in the medication room refrigerator when not in use or as soon as possible after use. Further review of the facility's policy revealed that all medications with current physician orders will be store in the medication cart that is designated for the unit that the resident is residing. Review of manufacture of Tubersol, Sanofi Pasteur's guidelines, revealed that this drug must be stored at 2°C to 8°C (35°F to 46°F). Do not freeze. Discard product if exposed to freezing. Observation on September 5, 2023, at 11:20 a.m. on the Second-floor nursing station cart B, revealed that there were 2 vials of Tubersol (Tuberculin, purified Derivative used to aid in the diagnosis of tuberculosis infection), were found in the opened an at room temperature. Further observation of Cart B revealed a bubble pack medication card containing five yellow pills. This package of medication was not labeled with prescribing information (US Food and Drug Administration requirement to identify information containing propriety name, the brand name, generic name, dosage, strength, and route of administration. Further observation of the package of medication had a handwritten identifier labeling it Zofran (a medication used to prevent nausea and vomiting). Interview with Licensed nurse, Employee E14 on September 5, 2023, at 11:31a.m. confirmed that the 2 vials of Tubersol should not have been stored in refrigeration. Further interview with Employee E14 revealed that the medication Zofran was not acceptable without labeling information. 28 Pa. Code 211.9(k) Pharmacy services 28 Pa. Code 211.12(c) Nursing services 396101 Page 6 of 6