Health inspection·July 3, 2024

F 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. Level of Harm - Potential for minimal harm Based on facility policy review, personnel file review, and staff interview, it was determined that the facility failed to verify professional license/registration prior to the start of employment for two of five newly hired employees. (E3 and E4) Residents Affected - Some Findings include: A review of facility policy entitled, Abuse, dated April 23, 2024, revealed that the facility was to conduct screening for all potential hires. This included license/registration verification. Employee 3 (E3) had been working in the facility as a Registered Nurse since May 24, 2024, and an inquiry to the state licensure board was not completed until July 2, 2024. Employee 4 (E4) had been working in the facility as a nurse aide since May 23, 2024, and an inquiry to the state nurse aide registry had not been completed. In an interview on July 3, 2024, at 9:00 a.m., the Regional [NAME] President of Operations confirmed the license/registry verification for E3 and E4 was not done per facility policy. 28 Pa. Code 201.14(a) Responsibility of licensee. 28 Pa. Code 201.19(3) Personnel policies and procedures. Page 1 of 5 396150 396150 07/03/2024 Advanced Health Care of Hanover 3370 High Pointe Boulevard Bethlehem, PA 18017

F 0640 Encode each resident’s assessment data and transmit these data to the State within 7 days of assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of the Resident Assessment Instrument (RAI) User's Manual, clinical record review, and staff interview, it was determined that the facility failed to complete a Minimum Data Set (MDS) assessment in a timely manner for one of three closed records sampled. (Resident 29) Residents Affected - Few Findings include: Review of the Long-Term Care Facility RAI User's Manual dated October 2023, which provided instructions and guidelines for completing required MDS assessments (federally mandated assessment tool that evaluates resident's functional capabilities and helps nursing home staff identify health problems), revealed that a Discharge assessment is warranted when a resident is admitted to a hospital or other care setting. The Discharge assessment was to be completed and transmitted to the Centers for Medicare and Medicaid Services' Quality Improvement and Evaluation System Assessment Submission and Processing System within 14 days after the Assessment Reference Date (ARD), the day the resident leaves the facility. Clinical record review revealed that Resident 29 was admitted to the facility on [DATE], and remained there until being hospitalized on [DATE]. A Discharge MDS was not completed until July 3, 2024. In an interview on July 3, 2024, at 9:50 a.m., the Regional [NAME] President of Operations confirmed that the MDS assessment had not been completed within the required time frame. 28 Pa. Code 211.5(f) Medical records. 396150 Page 2 of 5 396150 07/03/2024 Advanced Health Care of Hanover 3370 High Pointe Boulevard Bethlehem, PA 18017

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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review and staff interview, it was determined that the facility failed to ensure that physician's orders were implemented for two of 14 sampled residents. (Residents 4, 25) Residents Affected - Few Findings include: Clinical record review revealed that Resident 4 was admitted on [DATE], and had diagnoses that included chronic kidney disease and heart failure. On June 18, 2024, a physician ordered that staff obtain a daily weight for the resident. A review of Resident 4's weights revealed that there was no documented evidence to support a weight was obtained on June 21, 2024. Clinical record review revealed that Resident 25 was admitted on [DATE], and had diagnoses that included end stage renal disease and heart failure. On June 21, 2024, a physician ordered that staff obtain a daily weight for the resident. A review of Resident 25's weights revealed that there was no documented evidence to support a weight was obtained on June 23 and 30, 2024. In an interview on July 3, 2024, at 1:39 p.m., the Regional [NAME] President of Operations confirmed there was no documentation to support that weights were obtained by staff or refused by the residents on the previously mentioned dates. 28 Pa. Code 211.12(d)(1)(5) Nursing services 396150 Page 3 of 5 396150 07/03/2024 Advanced Health Care of Hanover 3370 High Pointe Boulevard Bethlehem, PA 18017

F 0698 Provide safe, appropriate dialysis care/services for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on the facility policy review, clinical record review, and staff interview, it was determined that the facility failed to provide ongoing assessment and monitoring for one of one sampled residents receiving hemodialysis. (Resident 101) Residents Affected - Few Findings include: A review of a facility policy entitled, Dialysis Assessment, last reviewed April 23, 2024, revealed that all patients receiving hemodialysis would have their access site (where the blood is accessed for dialysis) assessed every shift. The assessment was to include appearance, signs of infection, drainage, bleeding, and bruit and thrill (sight and sound of blood flow at the site). The assessment was to be documented in the treatment administration record (TAR) by the nurse that conducted the assessment. Clinical record review revealed that Resident 101 was readmitted to the facility on [DATE], and had diagnoses that included end stage renal disease and congestive heart failure. The resident received hemodialysis three times per week. Review of the clinical record, including the TAR for June and July 2024, revealed no evidence that staff assessed the residents access site for appearance, signs of infection, bleeding, or bruit and thrill every shift, per facility policy, since June 27, 2024. In an interview on July 3, 2024, at 2:27 p.m., the Regional [NAME] President of Operations confirmed that there was no evidence that staff assessed the access site. 28 Pa. Code 211.12(1)(3)(5) Nursing services. 396150 Page 4 of 5 396150 07/03/2024 Advanced Health Care of Hanover 3370 High Pointe Boulevard Bethlehem, PA 18017

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 facility policy review, observation, and staff interview, it was determined that the facility failed to store food under sanitary conditions in the kitchen. Residents Affected - Many Findings include: A review of a facility policy entitled, Food Storage, last reviewed April 23, 2024, revealed that a thermometer would be present in the dry storage room and the temperature would be monitored on a regular basis. Scoops were not to be stored in food containers. Observation of the kitchen on July 2, 2024, at 9:15 a.m., revealed the following: There was a container of baking chocolate powder that had been removed from the original package; it was not dated. In the walk-in refrigerator, there was a bin of raw chicken stored over a bin of raw shrimp. The shrimp and chicken had been pulled from the freezer to be thawed and were not dated with a pull date. There was a bin of raw pork and a bin of raw turkey that were pulled from the freezer to be thawed and were not dated with a pull date. In an interview, the Director of Dietary confirmed that the items should have been dated. A scoop was in the bulk bin of all-purpose flour; it was in direct contact with the flour. In the dry storage room, there were funnels in a container of salt and a container of pepper; they were in direct contact with the salt and pepper. There was a Styrofoam bowl in a second container of salt; it was in direct contact with the salt. There was no thermometer in the dry storage room. 28 Pa. Code 201.18(e)(1) Management. 396150 Page 5 of 5