Health inspection·September 5, 2024

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. Based on facility policy review, observations, clinical record review, and resident and staff interviews, it was determined that the facility failed to ensure the care plan was reviewed and revised for two of 14 residents reviewed (Residents 8 and 40). Findings include: Review of facility policy, titled Comprehensive Care Plan, last revised June 10, 2024, read, in part, The Comprehensive Care Plan will describe treatments and services to assist the resident to attain or maintain the highest level of physical, mental, emotional, and psychosocial wellbeing. Care Plans will be revised as information about the resident and the resident's condition changes. The Interdisciplinary Team is responsible for the review and updating of the care plans. Review of Resident 8's clinical record revealed diagnoses that included jaw pain, anxiety disorder (a persistent feeling of worry, nervousness, or unease), and major depressive disorder (a mood disorder that causes a persistent feeling of sadness and loss of interest in things). Review of Resident 8's care plan revealed an activities care plan that had not been updated since October 21, 2022. Further review of Resident 8's activities care plan revealed an intervention for I prefer to dine in the lounge or dining hall, initiated on October 21, 2022. Observation of Resident 8 on September 3, 2024, at 11:57 AM, revealed she was sitting in her room, eating lunch in her recliner. Observation of Resident 8 on September 4, 2024, at 12:04 PM, revealed she was sitting in her room, eating lunch in her recliner. Interview with Employee 1 (Nurse Aide) on September 5, 2024, at 9:52 AM, revealed Resident 8 has been eating in her room since she came here. Interview with Resident 8 on September 5, 2024, at 9:55 AM, revealed she has been eating in her room since she admitted to the skilled nursing facility from her cottage in 2022, because of her issues with her jaw and she can't wear her dentures. Interview with the Director of Nursing (DON) on September 5, 2024, at 11:54 AM, revealed he would expect Resident 8's care plan to be updated to reflect that she prefers to dine in her room. Review of Resident 40's clinical record revealed diagnoses of post-traumatic stress disorder Page 1 of 4 396119 396119 09/05/2024 MT Hope Nazarene Retirement Community 3026 Mount Hope Home Road Manheim, PA 17545

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some (PTSD-a mental and behavioral disorder that can develop after a person experiences or witnesses a traumatic event) and generalized anxiety disorder (a mental health condition that causes people to feel excessive, irrational, and uncontrollable worry about everyday things for months or years). Review of Resident 40's electronic medical record revealed the diagnosis of post-traumatic stress disorder was added to her medical diagnoses on October 24, 2023. Review of Resident 40's care plan on September 3, 2024, revealed a care plan with a focus area of, I have a mood problem related to depression, anxiety, vitamin D deficiency and PTSD, with a date initiated of October 12, 2023. No triggers for Resident 40's PTSD were found on the care plan. Interview with the Nursing Home Administrator on September 4, 2024, at 1:20 PM, revealed that Resident 40's PTSD triggers were identified at the time of Resident 40's admission and should have been added to the care plan. 28 Pa. Code 211.10(d)(a) Resident care policies 28 Pa. Code 211.12(d)(3)(5) Nursing services 396119 Page 2 of 4 396119 09/05/2024 MT Hope Nazarene Retirement Community 3026 Mount Hope Home Road Manheim, PA 17545

F 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. Based on facility policy review, clinical record review, and staff interview, it was determined that the facility failed to ensure residents with limited mobility received appropriate services, equipment, and assistance to maintain or improve mobility for one of four residents reviewed for limited range of motion (Resident 9). Findings include: Review of facility policy, titled Restorative Nursing Program (RNP), last revised June 2024, read, in part, Restorative care is promoted to enable residents to attain or maintain the highest practicable physical, mental, and psychosocial well-being. A licensed nurse shall be appointed as the Restorative Nurse to oversee, coordinate and monitor the RNP. A Certified Nursing Aid will be appointed as the Restorative Aide to implement programs put in place by the restorative nurse. The Restorative Aide will complete task documentation as indicated by program requirements. Review of Resident 9's clinical record revealed diagnoses that included dementia (a chronic disorder of the mental processes caused by brain disease, marked by memory disorders, personality changes, and impaired reasoning), hemiplegia and hemiparesis following a cerebral infarction affecting the left dominant side (a condition where a stroke has caused paralysis or weakness on one side of the body), and pain in left ankle. Review of Resident 9's care plan revealed a focus area I have limited physical mobility related to weakness, hemiplegic affecting left side, initiated on February 21, 2024, with interventions for three restorative nursing programs, initiated on February 21, 2024. Further review of Resident 9's care plan revealed a focus area that read, in part, I have an activities of daily living self-care performance deficit related to dementia, history of falling, muscle weakness, initiated on January 10, 2024, with interventions for two nursing restorative programs, initiated on February 21, 2024 Review of Resident 9's nurse aid task documentation starting in February 2024, revealed a task for Nursing Rehab/Restorative Active Range of Motion Program #1 Standing at hall rail with gait belt remind to straighten posture every day shift 7-3. Further review of the nurse aide task documentation revealed Resident 9 was marked not applicable under the minutes and tolerance documentation on February 25, 2024; March 4, 10, 12, 21, 23, and 24, 2024; April 1, 7, 12, 20, 21, 24, and 28, 2024; May 2, 4, 16, 22 and 27, 2024; June 15 and 16, 2024; July 3, 2024; and August 11, 2024. The task documentation was left completely blank on March 8, 2024; May 1 and 26, 2024; June 7 and 28, 2024; July 1 and 10, 2024; and August 5 and 8, 2024. Review of Resident 9's nurse aid task documentation starting in February 2024, revealed a task for Nursing Rehab/Restorative Active Range of Motion Program Using 2# free weight, do right shoulder press, chest press, bicep curls, forearm pro/supination, wrist flex/extension. Further review of the nurse aide task documentation revealed Resident 9 was marked not applicable under the minutes and tolerance documentation on February 25, 2024; March 4, 10, 12, 23, and 31, 2024; April 7, 12, 20, and 28, 2024; May 2, 4, 16, and 27, 2024; June 2 and 16, 2024; July 3, 2024; and August 11, 2024. The task documentation was left completely blank on March 8, 2024; May 1 and 26, 2024; June 6 and 28, 2024; July 1 and 10, 2024; and August 5 and 8, 2024. 396119 Page 3 of 4 396119 09/05/2024 MT Hope Nazarene Retirement Community 3026 Mount Hope Home Road Manheim, PA 17545

F 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of Resident 9's nurse aid task documentation starting in February 2024, revealed a task for Nursing Rehab/Restorative Dressing/Grooming Program #1 Give washcloth in right hand to wash face, chest and left hand. Cue to lift right arm for sleeve of clothing. Cue to lift right leg for pant leg, sock and shoe. Further review of the nurse aide task documentation revealed Resident 9 was marked not applicable under the minutes and tolerance documentation on March 16, 2024, and April 12, 2024. The task documentation was left completely blank on May 26, 2024, and August 12, 2024. Review of Resident 9's nurse aid task documentation starting in February 2024, revealed a task for Nursing Rehab/Restorative Transfer Program #1 provide minimum assist to contact guard assistance for stand pivot transfer to bed, toilet, wheelchair. Transfer to [Resident 9's] right side when able. Further review of the nurse aide task documentation revealed Resident 9 was marked not applicable under the minutes and tolerance documentation on February 25, 2024; March 12 and 23, 2024; April 7, 12, and 28, 2024; May 3, 4, 16 and 27, 2024; July 3, 2024; and August 11, 2024. The task documentation was left completely blank on March 8, 2024; May 1 and 26, 2024; June 6 and 28, 2024; July 1 and 10, 2024; and August 8, 2024. Review of Resident 9's nurse aid task documentation starting in February 2024, revealed a task for Nursing Rehab/Restorative Walking Program #1 Left lower extremity bracing and gait belt with wheelchair following and cueing for sequencing with quad cane. 50-70' with contact guard assistance/minimum assist. Further review of the nurse aide task documentation revealed Resident 9 was marked not applicable under the minutes and tolerance documentation on February 25, 2024; March 10, 12, 23, 24, 30 and 31, 2024; April 6, 7, 10, 12, 14, 20, 21, 27 and 28, 2024; May 2-4, 15, 16, 22, and 27, 2024; June 1,2, 5, 9, 13, 16, 22, 29 and 30, 2024; July 7, 19, and 31, 2024; and August 4, 6, 11, and 24, 2024. The task documentation was left completely blank on March 8, 2024; May 1 and 26, 2024; June 6 and 28, 2024; July 1 and 10, 2024; and August 5 and 8, 2024. Interview with the Director of Nursing on September 5, 2024, at 10:34 AM, revealed he was unable to locate documentation to indicate Resident 9's restorative programs were implemented or that he had refused them on the aforementioned dates. No further information was provided. 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services 396119 Page 4 of 4