Brookline Nursing And Rehab

Review of a Bed-Hold Notification form dated January 27, 2026, indicated that Resident 12 signed the notice on January 27, 2026.

The section of the notice for the resident's responsible party (representative) signature was blank.

Review of a Notice of Transfer or discharge date d January 27, 2026, indicated that Resident 12 signed the notice on January 27,

• There was no documentation on the notice to indicate that the facility ensured that either of

Resident 12's designated resident representatives received a written copy of the notice.

Interview with the Nursing Home Administrator and the Director of Nursing on February 26, 2026, at 2:00 PM confirmed that the facility did not take measures to ensure Resident 12's representative received a written copy of either the Bed-Hold Notification or Notice of Transfer in response to his January 27, 2026, transfer to the hospital. 28 Pa.

Code 201.14(a) Responsibility of licensee 28 Pa.

Code 201.29(a) Resident rights

395418 02/27/2026

Brookline Nursing and Rehab 2 Manor Boulevard Mifflintown, PA 17059

Review of an admission MDS (Minimum Data Set, an assessment tool completed at specific intervals to determine resident care needs) dated [DATE], revealed that staff coded the MDS item for PTSD incorrectly as that Resident 9 did not have PTSD.

Interview with the Director of Nursing on February 27, 2026, at 8:45 AM confirmed that staff failed to code Resident 9's admission MDS to include his PTSD diagnosis. 28 Pa.

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

395418 02/27/2026

Brookline Nursing and Rehab 2 Manor Boulevard Mifflintown, PA 17059

Review of an admission MDS (Minimum Data Set, an assessment tool completed at specific intervals to determine resident care needs) dated [DATE], revealed that staff coded the MDS item for PTSD incorrectly as that Resident 9 did not have PTSD. Resident 9's clinical record did not include evidence that the facility identified the traumatic event that precipitated his PTSD, identified potential triggers that could worsen the symptoms of the disorder, implemented ongoing tracking of his distressing target behaviors, or established non-medicinal behavioral interventions used to reduce or eliminate distressing target behaviors.

Review of plans of care developed by the facility to address Resident 9's care needs did not provide evidence of a plan of care to address his potential distressing behaviors or symptoms (e.g., hallucinations, aggression, self-harm, isolation, etc.).

The surveyor reviewed the concern that the facility had not developed a plan of care for Resident 9's PTSD diagnosis during an interview with the Nursing Home Administrator and the Director of Nursing on February 26, 2026, at 10:50 AM.

The facility initiated a plan of care following the surveyor's questioning (dated February 26, 2026) to address Resident 9's potential to exhibit behaviors that are a result of past trauma, which may impact moods or behaviors, including his suicide attempt on [DATE].

The facility also obtained a physician's order (dated February 26, 2026) to monitor potential side effects of antipsychotic medication use (e.g., blurred vision, dry mouth, drowsiness, muscle spasms or tremors, weight gain, hallucinations) every shift; and a physician's order (dated February 26, 2026) to monitor potential socially inappropriate or disruptive behaviors (self-injury, pacing/wandering, screaming/yelling out, suicidal ideations, physically abusive behavior: hitting, kicking, pushing, biting, etc.) every shift.

Interview with the Director of Nursing on February 27, 2026, at 8:45 AM confirmed that staff failed to initiate a plan of care upon Resident 9's readmission to the facility following his in-patient psychiatric stay to incorporate his PTSD diagnosis, grief secondary to the recent death of his wife, and his suicide attempt. 28 Pa.

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

395418 02/27/2026

Brookline Nursing and Rehab 2 Manor Boulevard Mifflintown, PA 17059

Review of a plan of care developed by the facility on December 11, 2025, to address Resident 66's self-care deficits with activities of daily living (ADL) revealed that Resident 66 was dependent on staff for showering/bathing and personal hygiene needs.

Observation of Resident 66 on February 25, 2026, at 8:50 AM revealed that his hair was cut short. Resident 66 stated that he was on his way to the therapy department where he was going to shave.

Interview with Resident 66 on February 25, 2026, at 9:12 AM indicated that the barber cut his hair that morning.

Observation of Resident 66's fingernails revealed that they were long (several millimeters beyond the tips of his fingers), uneven, and the fingernail of his right ring finger was broken. Resident 66 stated that he needed to cut his fingernails, however, he confirmed that he did not have clippers to cut his fingernails.

Interview with Employee 4 (nurse aide) on February 25, 2026, at 9:11 AM indicated that staff should trim a resident's nails with each shower, however, Employee 4 confirmed that it appeared that Resident 66 did not have his fingernails trimmed with his shower.

Employee 4 asked Resident 66's permission to cut his fingernails at that time and Resident 66 offered no resistance to the care.

Review of Documentation Survey Report (electronic documentation completed by nurse aide staff to record completed assistance with ADL care) information for Resident 66 revealed that he had a shower on January 7, 14, 21, and 28, 2026.

Staff documented that a shower was, not applicable, on February 4, 2026, and that he only had a bed bath on February 11 and 15, 2026.

Staff initialed the completion of a shower for Resident 66 on February 22, 2026 (three days before the observation of his fingernails documented above).

Although the documentation indicated that Resident 66 was to shower every Sunday, staff only referenced bathing for Resident 66 on Wednesdays; and that he only received one shower between January 28, 2026, and February 22, 2026.

The surveyor reviewed the above concerns regarding Resident 66's showers and nail care during an interview with the Nursing Home Administrator and the Director of Nursing on February 26, 2026, at 2:00 PM. 28 Pa.

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

395418 02/27/2026

Brookline Nursing and Rehab 2 Manor Boulevard Mifflintown, PA 17059

Observation of the restorative dining room on February 26, 2026, at 9:40 AM revealed a suction unit on a countertop.

The following packaged items kept with the suction were expired: connection tubing (expired February 1, 2024), connective tubing (expired [DATE]), and connection tubing 6' (expired [DATE]).

Observation of the main dining room on February 26, 2026, at 9:55 AM revealed a suction unit on a countertop.

The following packaged items kept with the suction were expired: connective tubing (expired [DATE]) and a yankauer suction tip (expired [DATE]).

The Director of Nursing was notified of the expired items on February 26, 2026, at 10:05 AM.

The above information for Resident 5 was reviewed in a meeting with the Nursing Home Administrator and Director of Nursing on February 26, 2026, at 10:45 AM. 483.25(i) Respiratory/tracheostomy Care and SuctioningPreviously cited deficiency [DATE] 28 Pa.

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

395418 02/27/2026

Brookline Nursing and Rehab 2 Manor Boulevard Mifflintown, PA 17059

pain medications and pain parameters for one of one resident reviewed for pain (Resident 3).Findings

unspecified shoulder and myalgia (muscle pain). Resident 3's care plan revealed the resident has pain related to the medical history. An intervention included pain medications per physician orders.

Review of the current physician orders for Resident 3 revealed the following medications for pain: Tramadol (a pain medication used to treat moderate to moderate severe pain) HCl oral tablet 50 milligrams (mg) give one tablet by mouth every four hours as needed for moderate to severe pain AND give one tablet by mouth two times a day for moderate to severe pain dated December 3, 2025, at 4:45 PM.

Acetaminophen (Tylenol, a medication used to treat mild pain and reduce fever) tablet 325 mg give two tablets by mouth every four hours as needed for pain dated August 21, 2025, at 11:52 AM.

The order did not specify the pain parameters for administration.

Morphine Sulfate (an opioid medication used to treat moderate to severe pain) oral solution 20 mg/ml (milliliter) give 0.5 ml by mouth every one hour as needed for shortness of breath / pain dated February 24, 2026, at 11:30 AM.

The order did not specify the pain parameters for administration.

The above information for Resident 3 was reviewed in a meeting with the Nursing Home Administrator and Director of Nursing on February 26, 2026, at 2:10 PM. 28 Pa.

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

395418 02/27/2026

Brookline Nursing and Rehab 2 Manor Boulevard Mifflintown, PA 17059

Observation of an adjacent area (one foot by one foot) where pipes extend from the wall to a sink revealed a large open area on the wall exposing the wall joists and pieces of insulation.

Observation on February 24, 2026, at 10:25 AM revealed the dishwasher was not in use. A manufacturer placard located adjacent to the temperature monitoring gauge noted the required operating wash temperature as a minimum of 155 degrees Fahrenheit.

Concurrent observation of the dishwasher through several cycles revealed that the dishwasher temperature monitoring gauge only reached a maximum temperature of 152 degrees Fahrenheit during the wash cycle and not the minimum 155 degrees as specified by the placard.

Observation on February 26, 2026, at 10:06 AM with Employee 5 revealed that the dishwasher was in use by two staff members.

Two observations of the dishwasher cycle revealed that the maximum temperature reached for the wash cycle was 150 degrees Fahrenheit and not the minimum 155 degrees as specified by the placard. A concurrent interview with Employee 5 revealed that the dishwasher was a hot water sanitizing dishwasher. A review of the facility documentation titled, Dishwasher Temperature Log dated February 2026, revealed that staff are to record temperatures three times daily (after breakfast, dinner, and supper).

The staff documentation revealed that staff documented the temperature as below the minimum 155 degrees specified by the manufacturer placard on the following: February 7, 2026, supper; 150 degreesFebruary 10, 2026, supper; 150 degreesFebruary 14, 2026, supper; 150 degreesFebruary 15, 2026, supper; 150 degreesFebruary 16, 2026, breakfast and dinner; 152 degreesFebruary 17, 2026, breakfast and dinner; 150 degreesFebruary 18, 2026, breakfast; 150 degreesFebruary 19, 2026, breakfast; 152 degreesFebruary 19, 2026, supper; 150 degreesFebruary 20, 2026, supper; 150 degreesFebruary 21, 2026, supper; 150 degreesFebruary 22, 2026; supper; 150 degrees The above information for the dishwasher was reviewed in a meeting with the Nursing Home Administrator on February 26, 2026, at 10:15 AM.

The above information about the kitchen was reviewed in a meeting with the Nursing Home Administrator and Director of Nursing on February 26, 2026, at 2:10 PM. 483.60(i)(1)-(2) Food safety requirementsPreviously cited deficiency 3/21/25 28 Pa.

Code 201.14(a) Responsibility of licensee Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided.

For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.

LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER TITLE (X6) DATE REPRESENTATIVE'S SIGNATURE

395418 02/27/2026

Brookline Nursing and Rehab 2 Manor Boulevard Mifflintown, PA 17059

Review of Resident 9's active physician orders revealed instructions for staff to change a Foley catheter (flexible tubing inserted through the penis into the bladder to drain urine) as needed for obstruction or dislodgement, and every thirty days for routine care of the indwelling urinary catheter. An active physician order instructed staff to place a leg bag (smaller urinary collection bag secured by straps onto the leg underneath clothing) on Resident 9 in the morning and a drainage bag (larger bag used to contain a larger amount of urine that is hung below the bladder on an item such as the side of the bed) for Resident 9 during hours of sleep.

Observation of Resident 9 on February 24, 2026, at 3:26 PM revealed him in his wheelchair, fully clothed. Resident 9 stated that his Foley urine collection bag was underneath his clothing, secured to his leg.

Observation of the storage of the larger urinary collection bag equipment that was not in use at the time on February 24, 2026, at 3:26 PM with Employee 1 (licensed practical nurse), revealed that the larger urine collection bag was stored in an open plastic bag that was tied to the toilet assist bar.

The tubing connected to the larger urinary collection bag was not capped, which exposed the tip to potential contamination.

The plastic bag containing the collection bag also contained a plastic graduate (container marked with units of measurement such as milliliters for accurate measurements of urinary output).

Interview with Employee 1 at the time of the observation confirmed that Resident 9's roommate ambulates independently and utilizes the bathroom for his toileting needs.

Interview with the Nursing Home Administrator and the Director of Nursing on February 25, 2026, at 2:00 PM indicated that the facility had no policy, procedure, or competency education materials that relayed to staff the appropriate storage of indwelling urinary catheter equipment to prevent potential contamination from the environment (e.g., ensure the ends of all tubing are capped, and store equipment outside the bathroom area where another resident/roommate could inadvertently contaminate the equipment) during non-use.

The surveyor reviewed the above concerns regarding Resident 9's urinary catheter equipment storage during the interview. 28 Pa.

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

395418 02/27/2026

Brookline Nursing and Rehab 2 Manor Boulevard Mifflintown, PA 17059

The surveyor requested any evidence of education provided to Resident 12 regarding the risks and benefits of pneumococcal vaccination administrations after November 2018 during an interview with the Director of Nursing on February 25, 2026, at 2:00 PM.

Review of a Vaccination Consent Form, dated September 12, 2025 (provided after the surveyor's questioning), revealed an acknowledgement by Resident 12 that he understood the benefits and risks of a PCV20 (Prevnar 20 pneumococcal) vaccination, and that he requested that the vaccination be given to him.

There was no evidence that the facility administered the PCV20 immunization to Resident 12.

The surveyor reviewed the above concerns regarding Resident 12's pneumococcal vaccinations during an interview with the Director of Nursing on February 27, 2026, at 9:23 AM. 28 Pa.

Code 211.5(f)(i)-(xi) Medical records 28 Pa.

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