Health inspection·April 28, 2025

F 0658 Ensure services provided by the nursing facility meet professional standards of quality. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on facility policy review, 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 for one of three residents reviewed (Resident 1). Residents Affected - Few Findings Include: Review of facility policy, titled Controlled Drugs, Accountability and Responsibility, updated November 30, 2018, revealed The Controlled Drug Record, specific to the drug being administered, is to be signed by the nurse at the time the drug is given to avoid medication errors and discrepancies. Review of Resident 1's clinical record revealed diagnoses that included quadriplegia (paralysis of all four limbs) and hypotension (low blood pressure). Review of Resident 1's physician orders revealed an order for oxycodone (narcotic pain medication), 2.5 mg (milligrams) every four hours as needed for moderate pain and oxycodone, 5 mg, every four hours as needed for severe pain. Review of Resident 1's controlled drug record for the oxycodone (a form used to maintain accurate records of all controlled substances that are being administered) revealed a signature for the nurse dispensing the medication, the date, time and amount dispensed, and the amount of medication remaining. Further review of the form revealed 17 times the oxycodone was documented as being dispensed, between March 4, 2025, and April 14, 2025. Review of Resident 1's MARs (medication administration record), dated March 2025 and April 2025, revealed only eight times that the oxycodone was signed off as being given. Further review of the MAR revealed that two of the eight administrations were documented on the MAR well after the time that the oxycodone was documented as being dispensed; and three of the eight administrations were documented as being administered prior to the time documented as being dispensed. Review of the oxycodone drug record revealed the oxycodone was signed out as being dispensed on the following dates and times, with review of the corresponding [DATE] for those dates and times: March 4 at 11:00 PM- not signed off on the MAR as being administered; (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 2 Event ID: 396122 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 396122 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fox Subacute at Mechanicsburg 120 South Filbert St Mechanicsburg, PA 17055 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)