Health inspection·October 21, 2024

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. Based on facility policy review, clinical record review, and staff interviews, it was determined that the facility failed to notify the listed emergency contact person (Resident's Representative) of a critical lab value for one of three residents reviewed (Resident 1). Findings Include: Review of facility policy, titled Notification of Change in Status, updated November 30, 2018, revealed Purpose: To notify patient and/or family of any change in treatments or status, and to allow patient and/or family the opportunity to be involved in treatment or care if they so desire. Procedure: .B. Non-life threatening situation or a change in care due to a minor process i.e. pneumonia, change in treatment or medication, test results. Documentation: B. Non-life threatening situation: 1. The nurse taking off or receiving new information will discuss the change(s) with the patient and/or family member and document the discussion. Review of Resident 1's clinical record revealed diagnoses that included anemia (a condition in which the blood doesn't have enough healthy red blood cells and hemoglobin, a protein found in red blood cells, to carry oxygen all through the body) and atrial fibrillation (Afib - an irregular, often rapid heart rate that commonly causes poor blood flow). Review of Resident 1's lab work dated August 9, 2024, revealed that Resident 1's hemoglobin was critically low, at 6.0, with the reference range being listed as 12.8-16.6. Review of Resident 1's clinical record revealed no evidence that Resident 1's Representative was notified of the critically low hemoglobin. During an interview with the Assistant Director of Nursing (ADON) on October 21, 2024, at 11:25 AM, she stated that Resident 1's Representative should have been notified of Resident 1's hemoglobin lab result. In a follow-up interview with the Nursing Home Administrator and the ADON on October 21, 2024, at 2:37 PM, no additional information was provided. 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services Page 1 of 3 396122 396122 10/21/2024 Fox Subacute at Mechanicsburg 120 South Filbert St Mechanicsburg, PA 17055

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. 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 care and services were provided in accordance with professional standards of practice to meet each resident's physical, mental, and psychosocial needs for one of three residents reviewed (Resident 1). Residents Affected - Few Findings Include: Review of Resident 1's clinical record revealed diagnoses that included anemia (a condition in which the blood doesn't have enough healthy red blood cells and hemoglobin, a protein found in red blood cells, to carry oxygen all through the body) and atrial fibrillation (Afib - an irregular, often rapid heart rate that commonly causes poor blood flow). Review of Resident 1's physician note dated August 8, 2024, revealed that the physician assessed Resident 1 for an episode of hematuria (blood in the urine). Further review of the physician note revealed I told nurses we will hold blood thinners for 2 days and will check CBC [complete blood count lab work], BMP [basic metabolic panel blood test] and magnesium [a blood test to measure the amount of magnesium in the blood]. Review of Resident 1's clinical record revealed an order written and signed by the physician on August 8, 2024, to discontinue blood thinners and get a CBC, BMP, and Magnesium level. Review of Resident 1's Medication Administration Record (MAR) dated August 2024, revealed that Resident 1's aspirin (a type of nonsteroidal anti-inflammatory drug [NSAID] that can treat mild to moderate pain, inflammation, or arthritis. It also lowers the risk of heart attack, stroke, or blood clot) was to be on hold from August 8, 2024, at 1:59 PM, to August 10, 2024, at 1:58 PM. Further review of the MAR revealed Resident 1's aspirin was documented as being held on August 9, 2024, at 9:00 AM, and August 10, 2024, at 9:00 AM. Review of Resident 1's MAR for August 2024, revealed that Resident 1 received Coumadin (blood thinner medication) on August 9 and 10, 2024. Review of Resident 1's clinical record revealed no evidence that Resident 1's Coumadin was discontinued, per the written physician order to discontinue blood thinners. There was also no evidence that the order was clarified with the physician to determine which blood thinner medications should be discontinued, and no evidence of any order to hold the aspirin. During an interview with the Nursing Home Administrator and Assistant Director of Nursing (ADON) on October 22, 2024, at 2:37 PM, they were made aware that the written physician order to discontinue the blood thinners was not followed, and there was no evidence that the order was clarified to confirm which medications the physician was referring to as blood thinners. In an email correspondence from the ADON on October 22, 2024, at 2:43 PM, she stated that the facility was unable to find any clarification for the order to discontinue blood thinners. Review of Resident 1's clinical record revealed an order for a PT (prothrombin time-measures how long it takes for a blood sample to clot), INR (international normalized ratio- measures how long it takes for blood to clot), and BMP blood test weekly. 396122 Page 2 of 3 396122 10/21/2024 Fox Subacute at Mechanicsburg 120 South Filbert St Mechanicsburg, PA 17055

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of Resident 1's INR results from August 2, 2024, revealed an INR of 3.9 (therapeutic range is 2.0 to 3.0 for standard oral anticoagulation therapy and 2.5 to 3.5 for high dose therapy). Review of Resident 1's physician orders, based off of the INR result from August 2, 2024, revealed an order to hold one dose of Coumadin and then decrease the dosage from 6 mg (milligrams) at bedtime to 5 mg at bedtime. Review of Resident 1's MAR dated August 2024, revealed the Coumadin was held on August 2, 2024, and then decreased to 5 mg starting August 3, 2024. Review of Resident 1's clinical record revealed the next INR blood draw was due on August 9, 2024. Review of Resident 1's clinical record revealed that the INR lab results from August 9, 2024, were not part of the clinical record. On October 21, 2024, at 12:57 PM, the ADON provided the INR result from August 9, 2024, which was 4.2. In an email correspondence from the ADON on October 22, 2024, at 2:43 PM, she stated that the facility was unable to find any evidence indicating that the INR lab result was ever faxed to the facility from the lab. She also stated that in a conversation with the physician assistant (PA), the PA stated she was not aware of the INR of 4.2. 28 Pa. Code 211.5(f)(ix) Medical Records 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services 396122 Page 3 of 3