Health inspection·September 7, 2023

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 reviews and staff interviews, it was determined that the facility failed to complete wound treatments as ordered by the physician for one of 19 residents reviewed (Resident 17). Residents Affected - Few Findings include: An admission Minimum Data Set (MDS) assessment for Resident 17, dated August 17, 2023, indicated that the resident was cognitively intact, required limited to extensive assistance for daily care tasks, and had a venous or arterial ulcer (ulcer caused by poor circulation). Physician's orders for Resident 17, dated August 15 and 29, 2023, included orders for the resident's right ankle to be cleansed with normal saline solution (sterile water), Opticell Ag (absorbent anti-bacterial dressing) applied, and covered with optifoam (foam dressing) three times a week. A care plan, dated August 14, 2023, indicated that wound care was to be provided as ordered. Review of Resident 17's Treatment Administration Records (TAR's) for August and September 2023 revealed that there was no documented evidence that the treatment to the resident's right ankle was completed three times a week as ordered on August 18 and 30, 2023. Interview with the Director of Nursing on September 7, 2023, at 11:57 a.m. confirmed that Resident 17's treatment to the right ankle was not completed as ordered on August 18 and 30, 2023. 28 Pa. Code 211.12(d)(3)(5) Nursing services. Page 1 of 3 396145 396145 09/07/2023 Menno Haven Rehabilitation Center 2055 Scotland Avenue Chambersburg, PA 17201

F 0694 Provide for the safe, appropriate administration of IV fluids for a resident when needed. Level of Harm - Minimal harm or potential for actual harm Based on review of policies and clinical records, as well as staff interviews, it was determined that the facility failed to ensure that long-term intravenous catheters were flushed according to physician's orders for one of 19 residents reviewed (Resident 42). Residents Affected - Some Findings include: The facility's policy regarding flushing intravenous catheters (a thin tube inserted into a vein and used long-term for the administration of fluids and/or medications), dated July 12, 2023, indicated that central venous access catheters would be flushed after each infusion to clear infused medications. The facility's policy regarding medication administration, dated July 12, 2023, revealed that medications were to be administered by licensed nurses, or other staff who were legally authorized to do so in the state, as ordered by the physician and in accordance with professional standards. Staff were to sign the Medication Administration Record (MAR) after the medication was administered. An admission Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) for Resident 42, dated August 27, 2023, indicated that the resident was cognitively intact, received an antibiotic, and received intravenous therapy (IV therapy - medications administered directly into a vein). Physician's orders for Resident 42, dated August 21, 2023, included an order for the resident to receive 3000 milligrams of Ampicillin-Sulbactam Sodium Intravenous Solution (an antibiotic) intravenously (IV administered directly into a vein) every six hours for 23 days for bacteriuria (bacteria in the urine) and to use the SASH method (flush with 0.9 percent normal saline (sterile salt water solution), administer antibiotic, flush with 0.9 percent saline and flush with 50 units of heparin (blood thinner)) when administering an antibiotic. Staff were to check the resident's PICC line (peripherally inserted central catheter) site for signs and symptoms of infection/infiltration every day and night shift. Resident 42's MAR's for August and September 2023 revealed that the resident received IV Ampicillin-Sulbactam every six hours from August 21 through September 6, 2023; however, there was no documented evidence that staff flushed the resident's IV catheter with the SASH method every six hours with the administration of Ampicillin-Sulbactam. The MAR's indicated that the SASH method was administered one time on the day shift and one time on the night shift. Interview with the Director of Nursing on September 7, 2023, at 8:45 a.m. confirmed that there was no documented evidence that Residents 42's IV catheter was flushed with the SASH method with every administration of IV antibiotics. 28 Pa. Code 211.12(d)(3)(5) Nursing services. 396145 Page 2 of 3 396145 09/07/2023 Menno Haven Rehabilitation Center 2055 Scotland Avenue Chambersburg, PA 17201

F 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on the review of the facility policies, as well as obervations and staff interviews, it was determined that the facility failed to ensure that food stored in the walk-in freezer was properly dated and labeled. Residents Affected - Some Findings include: The facility's policy for food storage, dated July 12, 2023, indicated that all products were to be labeled and dated with the receiving date. All open items will have an open date and will be resealed to prevent contamination. Observations of the dietary walk-in freezer on September 5, 2023, at 11:14 a.m. revealed undated and/or unlabeled items that were not in their original delivery box, including a bin of chicken breasts (8 cases -multiple breasts in separate clear plastic bags), beef brisket in a clear sealed bag, one angel food cake in a tied plastic bag, multiple single serving macaroni and cheese in a plastic bin, two packages of sandwich buns in a plastic bag, and a partial loaf of gluten-free bread. Interview with the Executive Chef on September 5, 2023, at 11:30 a.m. confirmed that all items should have been dated and/or labeled. 28 Pa. Code 211.6(f) Dietary services. 396145 Page 3 of 3