Health inspection·January 4, 2024

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 interview, 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 three of three residents reviewed (Residents 3, 4, and 6). Residents Affected - Some Findings Include: Review of Resident 3's clinical record revealed diagnoses that included fracture of medial condyle of left femur (lower extremity of the upper leg bone near the knee) and chronic obstructive pulmonary disease (COPD - chronic inflammatory lung disease that causes obstructed airflow from the lungs). Review of Resident 3's December 2023 MAR (Medication Administration Record - form used to document physician orders as well as when and how medications are administered to a resident) revealed an order for Lovenox (anticoagulant) injection each morning for deep vein thrombosis prevention (condition where blood clots form in veins located deep inside the body, usually in the thigh or lower legs causing pain and swelling ). Further review of the MAR revealed that Lovenox was not administered to Resident 3 on December 24-29, 2023. Review of nursing progress notes revealed that on the aforementioned dates, Resident 3's Lovenox was not administered because the medication was unavailable. Further review of available clinical documentation revealed that the physician was notified of the missed dose of Lovenox on December 27, 2023, but not of any other missed doses. Review of Resident 4's clinical record revealed diagnoses that included paroxysmal atrial fibrillation (irregular heart rhythm that can cause symptoms such as fatigue, lightheadedness, and stroke) and major depressive disorder (mental disorder characterized by at least two weeks of low mood that is present across most situations). Review of Resident 4's December 2023 MAR revealed an order for Rivaroxaban (anticoagulant) daily for anticoagulation, and trazodone (used to treat depression) at bedtime for antidepressant. Further review of the MAR revealed that she did not receive Rivaroxaban on December 9-11, 2023; and did not receive trazodone December 9, 24, and 28-30, 2023. Review of Resident 4's nursing progress notes for the aforementioned dates revealed that Rivaroxaban and trazodone were not administered because the medications were unavailable at the time. Additionally, review of Resident 4's nursing progress notes indicated that she did not receive her scheduled doses of trazodone on January 1-4, 2024, due to the medication being unavailable. Page 1 of 4 396133 396133 01/04/2024 Vibra Rehabilitation Center 707 Sheperdstown Rd Mechanicsburg, PA 17055

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Further review of available clinical documentation failed to reveal any evidence that the physician was notified that Rivaroxaban and trazodone were not administered to Resident 4 as noted above. Review of Resident 6's clinical record revealed diagnoses that included paroxysmal atrial fibrillation and congestive heart failure (CHF - weakness of the heart that leads to buildup of fluid in the lungs and surrounding body tissues). Review of Resident 6's December 2023 MAR revealed an order for Warfarin (anticoagulant) at bedtime daily Tuesday through Sunday for atrial fibrillation. Further review of the MAR revealed that this medication was not administered to Resident 6 on December 9-10, and 12-13, 2023. Review of Resident 6's nursing progress notes for the aforementioned dates revealed that Warfarin was not administered due to being unavailable. Further review of available clinical documentation failed to reveal any evidence that the physician was notified that Warfarin was not administered to Resident 6 as noted above. During an interview with the Nursing Home Administrator on January 4, 2024, at 2:26 PM, she did not provide any additional information regarding physician notification of missed medications for the aforementioned residents. 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services 396133 Page 2 of 4 396133 01/04/2024 Vibra Rehabilitation Center 707 Sheperdstown Rd Mechanicsburg, PA 17055

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on clinical record review and staff interview, it was determined that the facility failed to ensure that medication was obtained and provided as ordered by the physician for three of three residents reviewed for medication administration (Residents 3, 4, and 6). Findings include: Review of Resident 3's clinical record revealed diagnoses that included fracture of medial condyle of left femur (lower extremity of the upper leg bone near the knee) and chronic obstructive pulmonary disease (COPD - chronic inflammatory lung disease that causes obstructed airflow from the lungs). Review of Resident 3's December 2023 MAR (Medication Administration Record - form used to document physician orders as well as when and how medications are administered to a resident) revealed an order for Lovenox (anticoagulant) injection each morning for deep vein thrombosis prevention (condition where blood clots form in veins located deep inside the body, usually in the thigh or lower legs causing pain and swelling ). Further review of the MAR revealed that Lovenox was not administered to Resident 3 on December 24-29, 2023. Review of nursing progress notes revealed the following regarding Resident 3's Lovenox: December 24, 2023 - waiting on pharmacy; December 25, 2023 - waiting on pharmacy; December 26, 2023 - out of stock waiting on pharmacy; December 27, 2023 - awaiting delivery from pharmacy, dr [doctor] aware; December 27, 2023 - pharmacy contacted, medications will be on next delivery. Lovenox not available in Omnicell [on-site pharmacy supply] or in med cart; December 28, 2023 - medication unavailable; December 29, 2023 - on order. Review of Resident 4's clinical record revealed diagnoses that included paroxysmal atrial fibrillation (irregular heart rhythm that can cause symptoms such as fatigue, lightheadedness and stroke) and major depressive disorder (mental disorder characterized by at least two weeks of low mood that is present across most situations). Review of Resident 4's December 2023 MAR revealed an order for Rivaroxaban (anticoagulant) daily for anticoagulation, and trazodone (used to treat depression) at bedtime for antidepressant. Further review of the MAR revealed that she did not receive Rivaroxaban on December 9-11, 2023; and did not receive trazodone December 9, 24, and 28-30, 2023. Review of Resident 4's nursing progress notes revealed the following regarding Rivaroxaban: December 9, 2023 - awaiting delivery from pharmacy; December 10, 2023 - med not available; December 11, 2023 awaiting delivery from pharmacy. Further review revealed the following regarding trazodone: December 9, 2023 - Medication not available; December 24, 2023 - Med not available; December 28, 2023 - Med not available; December 29, 2023 - not available; December 30, 2023 - Medication not available. Additional review of Resident 4's nursing progress notes indicated that she did not receive her scheduled doses of trazodone on January 1-4, 2024, due to the medication being unavailable. Review of Resident 6's clinical record revealed diagnoses that included paroxysmal atrial fibrillation and congestive heart failure (CHF - weakness of the heart that leads to buildup of fluid in the lungs and surrounding body tissues). 396133 Page 3 of 4 396133 01/04/2024 Vibra Rehabilitation Center 707 Sheperdstown Rd Mechanicsburg, PA 17055

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Review of Resident 6's December 2023 MAR revealed an order for Warfarin (anticoagulant) at bedtime daily Tuesday through Sunday for atrial fibrillation. Further review of the MAR revealed that this medication was not administered to Resident 6 on December 9-10, and 12-13, 2023. Review of Resident 6's nursing progress notes revealed the following regarding Warfarin: December 9, 2023 - med not available; December 10, 2023 - out of stock; December 12, 2023 - medication unavailable awaiting for delivery from pharmacy; December 13, 2023 - medication unavailable - awaiting for delivery from pharmacy. During an interview with the Nursing Home Administrator on January 4, 2024, at 12:00 PM, she did not provide any additional information regarding the aforementioned residents at that time. 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services 28 Pa. Code 211.9(a)(1) Pharmacy services 396133 Page 4 of 4