Health inspection·November 2, 2023

F 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm Based on clinical record review and staff interviews, it was determined that the facility failed to ensure that the resident assessment accurately reflected the resident's status for one of 13 residents reviewed (Resident 23). Residents Affected - Few Findings Include: Review of Resident 23's clinical record revealed diagnoses that included chronic diastolic heart failure (a condition in which your heart's main pumping chamber becomes stiff and unable to fill properly) and essential hypertension (high blood pressure). Review of Resident 23's admission MDS (Minimum Data Set is part of federally mandated process for clinical assessment of all Medicare and Medicaid certified nursing homes) dated July 8, 2023, revealed that Section O0100, Special Treatments, Procedures, and Programs (K. Hospice Care, 1. While not a resident of this facility and within the last 14 days) was marked No. Review of a Promedica Revocation of Hospice Benefit document dated October 10, 2023, revealed that Resident 23 started hospice care on April 3, 2023, and revoked hospice on October 10, 2023. Written communication received from Employee 3 (Registered Nurse Assessment Coordinator) on November 1, 2023, revealed that Section O was marked in error and has since been amended to reflect Resident 23 was receiving hospice services prior to coming into the facility. Interview with the Nursing Home Administrator and Director of Nursing on November 2, 2023, at 12:05 PM, revealed that they would have expected Section O. K. Hospice care to have been captured on the MDS completed on July 8, 2023. 28 Pa. Code 211.5(f) Clinical records 28 Pa Code 211.12 (d)(3)(5) Nursing Services Page 1 of 3 396119 396119 11/02/2023 MT Hope Nazarene Retirement Community 3026 Mount Hope Home Road Manheim, PA 17545

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy, observation, clinical record review, and resident and staff interviews, it was determined that the facility failed to provide respiratory care/oxygen services consistent with professional standards of practice of one of 13 residents reviewed (Resident 45). Residents Affected - Few Findings include: Review of facility policy, titled Continuous Positive Airway Pressure [CPAP- a method of respiratory therapy in which air is pumped into the lungs through the nose or nose and mouth during spontaneous breathing] disinfecting, effective June 24, 2019, revised October 1, 2023, read, in part, orders to clean and sanitize CPAP machines will be placed into the resident's treatment administration record. Review of Resident 45's clinical record documented they were admitted to the facility on [DATE], with diagnoses that included chronic obstructive pulmonary disease (COPD - a group of lung disease that block airflow and make it difficult to breathe), asthma (a condition in which a person's airway becomes inflamed, narrow, and swells, and produce extra mucus, which makes it difficult to breathe), anxiety (a feeling of worry, nervousness, or unease), and depression (feelings of severe despondency and dejection). Additionally, on November 2, 2023, the diagnosis of obstructive sleep apnea (intermittent airflow blockage during sleep) was added. Observation on October 31, 2023, at 9:25 AM, in Resident 45's room revealed, on the top of the dresser to the right of the recliner, was a CPAP machine, and the mask was uncovered and resting on the floor. During an interview with Resident 45 on October 31, 2023, at 9:29 AM, it was revealed that she utilizes a CPAP machine and is able to manage use of and care of the machine herself. It was revealed that she brought 2 gallons of water from home and also fills the humidifier herself. Continued discussion revealed that the tubing hasn't been changed, the mask hasn't been cleaned, and that she didn't have a bag to store the mask in between use. Observation with Employee 1 (Licensed Practical Nurse) on October 31, 2023, at 1:23 PM, in Resident 45's room revealed the CPAP mask was on the floor in front of her dresser, to the right of her recliner. During an interview with Employee 1 on October 31, 2023, at 1:24 PM, it was revealed that the CPAP mask should be in a plastic bag. It was further reveled that Employee 1 would obtain a bag and let Resident 45 know how to properly store the mask in the bag. Review of Resident 45's September 2023 and October 2023 physician orders and treatment administration records failed to document orders for use of a CPAP machine or cleaning of the CPAP machine. Review of hospital emergency after visit summary dated September 26, 2023, read, in part, to continue use of ResMed with Modem CPAP 10 cm (unit of measure) water, mask, supplies, heated humidifier, compliance data, and small dream [NAME] nasal mask. Review of progress note dated September 27, 2023, (a Wednesday) at 1:40 PM read, in part, Resident 396119 Page 2 of 3 396119 11/02/2023 MT Hope Nazarene Retirement Community 3026 Mount Hope Home Road Manheim, PA 17545

F 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few post ER for dizziness and headache. No complaint of headache at this time. Resident said she feels dizzy occasionally throughout the shift. And that the oxygen that she wears at night helps a lot. Resident is to receive her CPAP machine Friday per resident. Review of Cardiology consult dated September 22, 2023, documented to continue durable medical equipment -ResMed with Modem CPAP 10cm water, mask, supplies heated humidifier, compliance data, and small dream [NAME] nasal mask, LON99. During an interview with the Nursing Home administrator and Employee 2 (Registered Nurse) Infection Preventionist on November 1, 2023, at 9:40 AM, it was revealed that Resident 45 was admitted to the facility from another skilled Nursing Care facility, and the discharge summary didn't include use of a CPAP machine. It was further revealed that Resident 45's family brought her personal belongings from her home, and the facility didn't realize that Resident 45 had a CPAP machine. It was also revealed that the staff missed the CPAP on the hospital summary and the cardiology consult. Further, it was revealed an order for use of the CPAP should've been obtained and the Resident provided with supplies and educated on the care and storage of the machine and mask. 28 Pa code 211.12(d)(1)(2)-Nursing Services 396119 Page 3 of 3