Nightingale Nursing And Rehab Center

Review of Resident R72's clinical record revealed an admission date of 12/11/25, with diagnoses that included chronic diastolic heart failure (The stiffening of the heart muscle causing it to not be able to properly relax to fill with blood, despite normal pumping strength), type 2 diabetes (a chronic metabolic disorder where the body develops insulin resistance, causing high blood sugar levels because cells fail to respond properly to insulin.), and morbid obesity (chronic life threatening disease defined as having a body mass index of 40 or higher or over 35 with severe obesity related health conditions such as diabetes).

Review of Resident R72's progress notes revealed notes dated 11/10/25, and 12/26/25, identifying transfers to the hospital.

The clinical record lacked evidence that his/her necessary clinical information was communicated to the receiving health care provider.

The clinical record also lacked evidence indicating that he/she and/or his/her representative were provided with a copy of the bed-hold policy upon transfers on 11/10/25, and 12/26/25.

Review of Resident R95's clinical record revealed an admission date of 10/31/25, with diagnoses that included chronic respiratory failure (a condition where your lungs don't exchange air properly), diabetes, and hypertension.

Review of Resident R95's progress notes revealed notes dated 11/16/25, 12/9/25, and 12/28/25, identifying transfers to the hospital.

The clinical record lacked evidence that his/her necessary clinical information was communicated to the receiving health care provider.

The clinical record also lacked evidence indicating that he/she and/or his/her representative were provided with a copy of the bed-hold policy upon transfers on 11/16/25, 12/9/25, and 12/28/25.

Review of Resident R99's clinical record revealed an admission date of 11/3/25, with diagnoses that included diabetes, dependence of renal dialysis, and hyperlipidemia (high cholesterol).

Review of Resident R99's progress notes revealed notes dated 11/12/25, identifying a transfer to the hospital.

The clinical record lacked evidence that his/her necessary clinical information was communicated to the receiving health care provider.

The clinical record also lacked evidence indicating that he/she and/or his/her representative were provided with a copy of the bed-hold policy upon transfers on 11/12/25.

Review of Resident R149's clinical record revealed an admission date of 10/31/25, with diagnoses that included diabetes, sleep apnea (a condition when a person repeatedly stops and starts breathing when they are sleeping), and hypothyroidism (a condition when the thyroid produces low amounts of thyroid hormones).

Review of Resident R149's progress notes revealed notes dated 12/10/25, identifying a transfer to the hospital.

The clinical record lacked evidence that his/her necessary clinical information was communicated to the receiving health care provider.

The clinical record also lacked evidence indicating that he/she and/or his/her representative were provided with a copy of the bed-hold policy upon transfers on 12/10/25.

During an interview on 2/19/26, at 2:13 p.m. the Director of Nursing confirmed that Resident's R3, R9, R11, R14, R72, R95, R99 and R149's clinical records lacked evidence that the necessary clinical information was provided to the receiving healthcare provider upon transfer and the clinical records lacked evidence indicating that he/she and/or his/her representative were provided with a copy of the bed-hold policy upon transfer as required. 28 Pa.

Code 201.18(e)(1) Management 28 Pa.

Code 201.29(c.3)(2) Resident rights

395042 02/20/2026

Nightingale Nursing and Rehab Center 607 East 26th Street Erie, PA 16504

Review of Resident R9's clinical record revealed an admission date of 10/20/25, with diagnoses that included dependence of renal dialysis (a treatment that helps remove extra fluid and waste products from the blood when the kidneys cannot), atrial fibrillation (irregular heartbeat), and chronic pain.

Review of physician's orders revealed the following orders: change medications and treatment timing from facility's medication and treatment administration time to accommodate hemodialysis treatment; Carafate (medication used to treat stomach ulcers) one gram (GM) give one tablet by mouth before meals and at bedtime; Gabapentin (medication used to treat nerve pain) capsule 100 milligrams (mg) give one capsule by mouth three times a day; Hydralazine (medication used to treat high blood pressure) 10 mg give one tablet by mouth three times a day; Insulin Lispro routine (medication used to lower blood sugar) dose before meals; Insulin Lispro sliding scale (medication used to lower blood sugar, sliding scale determines amount administered based on blood glucose level) before meals; and Losartan (medication used to treat high blood pressure) 50 mg give one tablet by mouth in the afternoon.

Review of Resident R9's progress notes and Medication Administration Records for November 2025, December 2025, January 2026, and February 2026 revealed Resident R9 did not receive the following medications as ordered on the following days:11/21/25 Carafate, Insulin Lispro, and Insulin Lispro sliding scale11/26/25 Insulin Lispro sliding scale12/15/25 Carafate, Hydralazine, Gabapentin, Insulin Lispro, and Insulin Lispro sliding scale12/31/25 Insulin Lispro, Insulin Lispro sliding sale, and Hydralazine 1/19/26 Losartan, Gabapentin, Hydralazine, and Carafate1/21/25 Gabapentin and Hydralazine1/26/26 Insulin Lispro sliding scale and Insulin Lispro2/13/26 Carafate, Hydralazine, and GabapentinThere was no documentation that the physician was notified of a need to hold or alter the time of administration for the above listed medications for Resident R9 on dialysis days.

During an interview on 2/19/26, at 2:54 p.m. the Director of Nursing confirmed that the above medications for Resident R9 were not administered on dialysis days as ordered by the physician. 28 Pa.

Code 211.12(d)(1)(3)(5) Nursing services

395042 02/20/2026

Nightingale Nursing and Rehab Center 607 East 26th Street Erie, PA 16504

Based on review of facility policy, manufacturer's guidelines, observations, and staff interviews, it

failed to ensure expired medications were discarded in a timely manner, and failed to ensure medications were properly labeled with a resident name in one of three medication rooms reviewed and in one of three medication carts reviewed (D-North medication room and D-North medication cart).

Findings include: Review of a facility policy entitled Medication Labeling and Storage dated 2/9/26, revealed that, .The medication label includes, at a minimum: resident's name.multi-dose vials that have been opened or accessed are dated and discarded within 28 days unless the manufacturer specifies a shorter or longer date for the open vial.

Manufacturer's guidelines for Tubersol PPD (solution used for tuberculosis testing upon admission and for employment), indicate that vials which are entered and in use for 30 days should be discarded.

Observation on 2/17/26, at 2:50 p.m. of the D-North medication room refrigerator revealed an opened vial of Tubersol PPD without an open date, therefore the staff were unable to determine the discard date.

During an interview at that time, the Director of Nursing confirmed that the opened Tubersol PPD vial lacked an open date, and staff were unable to determine the discard date.

Observation on 2/17/26, at 3:02 p.m. of the D-North medication cart revealed an open Fluticasone Propionate inhaler (medication used for asthma or other conditions that cause difficulty with breathing) with instructions to discard 30 days after opening and with an open date of 1/9/26, therefore the medication was expired.

There was also an open Trelegy inhaler (used for asthma or other conditions that cause difficulty with breathing) without a resident name.

During an interview at that time, Licensed Practical Nurse Employee E1 confirmed that the Fluticasone Propionate inhaler with the open date of 1/9/26, was expired and should have been discarded and the Trelegy inhaler should have had a resident's name. 28 Pa.

Code 211.9(a)(1) Pharmacy services 28 Pa.

Code 211.10(c) Resident care policies 28 Pa.

Code 211.12(d)(1)(3)(5) Nursing services