Health inspection·November 14, 2023

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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of clinical records, and staff interview, it was determined that the facility failed to implement procedures to ensure availability of prescribed medications for four of six residents (Residents R1, R2, R3, and R4). Findings include: Review of the National Institute of Health, National Institute on Aging published information reviewed on 10/1/22, defined high blood pressure as systolic pressure of 130 or higher (first/top number, or a diastolic pressure of 80 or higher (second/bottom number). Review of the clinical record indicated Resident R1 was admitted to the facility on [DATE]. Review of the facility diagnosis list included anemia (too little iron in the body causing fatigue) and aftercare following joint replacement surgery. Review of a physician's orders dated 11/5/23, indicated Resident R1 was to receive Pantoprazole (medication to treat too much stomach acid and/or damaged esophagus) 40 mg one time daily and Citalopram (anti-depressant medication) 20 mg one time daily. Review of Resident R1's Medication Administration Record (MAR) for November 2023, indicated: 11/6/23 Pantoprazole: no documentation. 11/6/23 Citalopram: documented as 14 (14 is code for order clarification). Review of progress notes for Resident R1 failed to include notes on 11/6/23, related to whether the Pantoprazole was provided, and related to the need for an order clarification for the Citalopram. Review of the facility provided inventory for the Omnicell (automated medication dispensing machine) included Citalopram 10 mg tablets and Pantoprazole 40 mg tablets. Review of the clinical record indicated Resident R2 was admitted to the facility on [DATE]. Review of the facility diagnosis list included heart failure (a progressive heart disease that affects pumping action of the heart muscles) and high blood pressure. Review of a physician's orders dated 11/5/23, indicated Resident R2 was to receive Finasteride (medication to treat enlarged prostate) 5 mg once daily, Rosuvastatin (medication to treat high Page 1 of 3 396138 396138 11/14/2023 Harmony Physical Rehabilitation 4365 Northern Pike Monroeville, PA 15146

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some cholesterol and triglycerides) 10 mg once daily, and Carvedilol (medication to treat high blood pressure) 25 mg twice daily. Review of Resident R2's Medication Administration Record (MAR) for November 2023, indicated: 11/9/23 Finasteride, Rosuvastatin, Carvedilol: documented as 9 (9 is code for order Other/See Nurse Notes). Review of progress notes for Resident R2 dated 11/9/23 at 10:38 a.m. and 10:39 a.m., revealed that the above medications were not in cart. Review of Resident R2's blood pressure record on 11/9/23, included a reading of 183/89 mmHg (millimeters of mercury) at 9:34 a.m. and a reading of 182/79 mmHg at 6:23 p.m. Review of the facility provided inventory for the Omnicell included Carvedilol 3.125 mg tablets. Review of the clinical record indicated Resident R3 was admitted to the facility on [DATE]. Review of the facility diagnosis list included diabetes (a metabolic disorder in which the body has high sugar levels for prolonged periods of time) and urinary tract infection. Review of a physician's orders dated 11/13/23, indicated Resident R3 was to receive calcium 600+D (vitamin and mineral supplement) once in the morning, Gemfibrozil (medication to treat cholesterol), a multivitamin, and Lidoderm 5% patch (medicated patch placed on the skin for pain relief) on for 12 hours, off for 12 hours. Review of Resident R3's Medication Administration Record (MAR) for November 2023, indicated: 11/14/23 calcium 600+D, gemfibrozil, multivitamin, and Lidoderm patch 5% were documented as 9. Review of progress notes for Resident R3 dated 11/14/23 at 9:07 a.m. and 9:08 a.m., revealed that the above medications were not in cart. Review of the facility provided inventory for the Omnicell (automated medication dispensing machine) included Lidoderm 5% patches. Review of the clinical record indicated Resident R4 was admitted to the facility on [DATE]. Review of the facility diagnosis list included lung cancer with cancer spread to the bone, cancer related pain, and cancer related anemia. Review of a physician's orders dated 11/13/23, indicated Resident R4 was to receive Cetirizine (allergy medication) 10 mg in the morning, Cholecalciferol (vitamin supplement) 25 mcg one time per day, cyanocobalamin (medication to treat types of anemia) 1000 mcg in the morning, dronabinol (medication for appetite stimulation and to prevent nausea and vomiting caused by chemotherapy) 2.5 mg in the morning, ferrous sulfate (iron supplement for anemia) 325 mg one time per day, folic acid (vitamin supplement) 1mg one time per day, and Lidoderm 5% patch Lidoderm 5% patch (medicated patch placed on the skin for pain relief) on in AM (morning), off at HS (hour of sleep). Review of Resident R4's Medication Administration Record (MAR) for November 2023, indicated: 396138 Page 2 of 3 396138 11/14/2023 Harmony Physical Rehabilitation 4365 Northern Pike Monroeville, PA 15146

F 0755 Level of Harm - Minimal harm or potential for actual harm 11/14/23: Cetirizine, Cholecalciferol, cyanocobalamin, dronabinol, ferrous sulfate, folic acid, and Lidoderm 5% patch were documented as 9. Review of progress notes for Resident R4 dated 11/14/23 at 8:16 a.m., 8:17 a.m., and 9:21 a.m., revealed that the above medications were not in cart. Residents Affected - Some Review of the facility provided inventory for the Omnicell included Lidoderm 5% patches. During an interview on 11/14/23, at approximately 1:30 p.m. the Director of Nursing confirmed that the facility failed to implement procedures to ensure availability of prescribed medications for four of six residents. 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services. 396138 Page 3 of 3