Julia Ribaudo Extended Care Center

Inspectors wroteBased on observation and staff interview, it was determined that the facility failed to maintain sanitary food storage, dishwashing, and ice machine sanitation practices in the food and nutrition services department. These failures had the potential to contaminate food and ice served to residents and increased the risk of foodborne illness.

Inspectors wroteBased on review of facility infection control records, clinical records, facility policy, and staff interview, it was determined that the facility failed to implement and maintain an antibiotic stewardship program and conduct and document antibiotic stewardship monitoring for eight of 8 months reviewed (November 2025 through June 2026) and failed to follow its antibiotic stewardship process for 1 of 20 residents reviewed (Resident 97).

Inspectors wroteBased on observation and staff interview, it was determined the facility failed to ensure that essential equipment was in safe operating condition in the facility's food and nutrition area.

Inspectors wroteBased on observations and interview, it was determined the facility failed to maintain a clean, comfortable and homelike environment for residents on five of 5 resident units. (Units A,B,C,D and E )

Inspectors wroteBased on review of clinical records, facility policies, observations, and staff interviews, it was determined that the facility failed to implement procedures to maintain accurate records of controlled substances and ensure accountability for controlled drug administration for one resident (Resident 35), and failed to notify the physician when a prescribed medication could not be administered as ordered for one resident (Resident 98) out of 20 residents reviewed.

Inspectors wroteBased on a review of scheduled facility mealtimes, facility policy, resident interviews, and staff interview, it was determined that the facility failed to consistently offer nourishing evening snacks when the scheduled time between dinner and breakfast exceeded 14 hours for residents residing on four nursing units. This deficient practice affected six of six residents who participated in a resident council interview (Residents 48, 95, 39, 33, 75, and 69).

Inspectors wroteBased on review of facility policy, clinical record review, medication administration records, and staff interview, it was determined the facility failed to document the use of non-pharmacological interventions prior to the administration of an as needed psychotropic medication and failed to obtain and document a clinical rationale to support continuation of the psychotropic medication beyond the federally permitted 14-day period for one of 20 residents reviewed (Resident 98).

Inspectors wroteBased on a review of clinical records, select facility policy, and staff interviews, it was determined the facility failed to provide nursing services consistent with professional standards of quality by failing to ensure licensed nurses administered medications in accordance with physician-ordered parameters for one of 20 residents reviewed (Resident 38).

Inspectors wroteBased on observations, clinical record review, and resident and staff interviews, it was determined the facility failed to ensure residents with limited mobility received appropriate services, equipment, and assistance to maintain or improve mobility for one of 20 residents reviewed (Resident 84). Findings Include: Review of the clinical record revealed Resident 84 was admitted to the facility on [DATE], with diagnoses including hemiplegia and hemiparesis following cerebral infarction affecting the left dominant side. Hemiplegia is paralysis of one side of the body. Hemiparesis is weakness on one side of the body. A cerebral infarction is a stroke caused by an interruption of blood flow to an area of the brain. [...]

Inspectors wroteBased on clinical record review, observation, review of facility policy, and staff interview, it was determined that the facility failed to ensure oxygen was administered in accordance with physician orders for one of 20 residents reviewed (Resident 98).

Inspectors wroteBased on a review of clinical records, laboratory reports, facility policy, and staff interviews, it was determined the facility failed to ensure a resident was free from unnecessary medication by administering an antibiotic without documented clinical evidence supporting an active infection for one of 20 residents reviewed (Resident 97). Findings Include:A review of Resident 97's clinical record revealed the resident was admitted to the facility on [DATE], with diagnoses that included epilepsy (a chronic neurological disorder characterized by recurring seizures) and parkinsonism (a group of neurological disorders that cause movement problems such as tremors, stiffness, and slowed movement). [...]

Inspectors wroteBased on observation, review of select facility policy, and staff interviews, it was determined the facility failed to adhere to acceptable storage and labeling practices for multi-dose medications for two of two medication carts observed (A Hall and B Hall medication carts).

Inspectors wroteBased on review of facility policies, Centers for Disease Control and Prevention (CDC) guidance, staff interviews, clinical record review, and direct observation, it was determined the facility failed to establish, maintain, and implement an effective infection prevention and control program to prevent the spread of infections regarding animal visitation and indwelling urinary catheter maintenance for 2 of 6 sampled residents. (Residents 1 and 2).

Inspectors wroteBased on a review of clinical records, resident council meeting minutes, and resident and staff interviews, it was determined the facility failed to provide an environment that promotes each resident's quality of life by ensuring residents' personal space was free from intrusions by other residents (Residents 16 and 19), including experiences reported by two residents out of the 25 residents sampled (Residents 3 and 29) and experiences reported by six out of the eight residents during a resident group interview (Residents 26, 28, 32, 49, 69, and 90).

Inspectors wroteBased on resident council meeting minutes, resident and staff interviews, and observations it was determined the facility failed to maintain an adequate supply of clean linens to meet the needs of residents for 2 of 4 resident care units observed (E Hallway and A Hallway).

Inspectors wroteBased on a review of scheduled facility mealtimes, select facility policy, and resident and staff interviews, it was determined that the facility failed to consistently provide snacks as desired by residents, including experiences reported by four out of eight residents during a group interview (Residents 28, 32, 69, and 90).

Inspectors wroteBased on observations, a review of facility-provided documents, and resident and staff interviews, it was determined the facility failed to maintain an effective pest control program on two of two nursing units (South Nursing B Hall and North Nursing D Hall) and in the North Nursing Resident Dining/Lounge area. In addition, two residents out of twenty-five sampled (Residents 62 and 81) and six residents out of eight during a resident group interview (Residents 26, 28, 32, 49, 69, and 90) reported ongoing problems with small black flies, gnats, or ants in resident rooms and common areas.

Inspectors wroteBased on clinical record review, staff interviews, and resident interviews, it was determined the facility failed to develop and implement a comprehensive, person-centered care plan that addressed the resident's individualized needs and interventions for safe transfers for one out of 25 residents sampled (Resident 22).

Inspectors wroteBased on observations, a review of clinical records, documentation provided by the facility, and resident and staff interviews, it was determined that the facility failed to implement adequate safety measures to prevent accidents for two out of 25 residents sampled (Resident 62 and 63).

Inspectors wroteBased on a review of clinical records, facility policy, observations, and staff and resident interviews, it was determined the facility failed to ensure oxygen therapy was administered and maintained in accordance with physician orders and facility policy, including requirements for equipment labeling, dating, and routine maintenance, in a manner that minimized the risk for infection for two residents out of twenty-five sampled (Residents 3 and 62).

Inspectors wroteBased on clinical record review and select facility policy review and staff interview, it was determined the facility failed to attempt non-pharmacological interventions to alleviate pain prior to the administration of a narcotic pain medication prescribed on an as needed basis for one resident out of 25 sampled residents (Resident 19).

Inspectors wroteBased on review of Pennsylvania's Nursing Practice Act, facility policies, clinical records, and facility investigative documents, and staff interviews, it was determined the facility failed to implement a physician's order as written for one of 8 residents reviewed (Resident 1).

Inspectors wroteBased on staff interview and review of professional literature, the facility's assessment, facility provided documentation, and review of the medical, psychiatric, and mental health conditions of the resident census, it was determined that the facility failed to conduct and document a facility-wide assessment, using evidence-based methods, which identified the specific resources necessary to care for its specific resident population.

Inspectors wroteBased on review of select facility policy, the facility's infection control log and staff interview, it was determined the facility failed to maintain and implement a comprehensive program to monitor and prevent infections in the facility.

Inspectors wroteBased on a review of clinical records, select facility policy, and staff interview, it was determined the facility failed to provide appropriate treatment and services to restore normal bowel function for one out of 21 residents sampled (Resident 75).

Inspectors wroteBased on review of clinical records, select facility policy, observation, and staff interview, it was determined the facility failed to implement procedures to maintain records of controlled drugs and ensure accurate drug administration for one out of the 21 residents sampled (Resident 75) and failed to store drugs in a safe manner for one out of the 21 residents sampled (Resident 39).

Inspectors wroteBased on a review of clinical records, select facility policies, investigative reports, and staff interviews, it was determined the facility failed to ensure that two residents out of 21 sampled (Residents 35 and 64) were free from abuse perpetrated by another resident (Resident 76).

Inspectors wroteBased on clinical record review, observation, and staff interview, it was determined that the facility failed to provide adaptive dining equipment as required and prescribed for one resident out of 21 sampled (Resident 52).

Inspectors wroteBased on review of clinical records and facility-initiated transfer notices and a staff interview, it was determined the facility failed to provide written notices of facility-initiated hospital transfers of residents, with the reasons for the move in writing, to one out of 21 residents reviewed (Resident 53).

Inspectors wroteBased on clinical record review and staff interviews it was determined that the facility failed to ensure that one resident out of five sampled was free of chemical restraints used to most readily control the resident's behavior and not required to treat the resident's medical symptoms (Resident B1).

Inspectors wroteBased on observation and staff interviews, it was determined that the facility failed to ensure residents had access to a telephone that afforded privacy for residents during telephone calls on two out of two resident units.

Inspectors wroteBased on review of clinical records and staff interview, it was determined that the facility failed to timely notify the resident's interested representative of a change in condition for one resident out of 12 sampled (Resident A1).

Inspectors wroteBased on review of clinical records and staff interview, it was determined that the facility failed to consistently provide timely and necessary foot care for one of eight residents sampled (Resident A1).

Inspectors wroteBased on observations, clinical record review and resident and staff interview it was determined that the facility failed to provide services necessary to maintain adequate personal hygiene of residents who need assistance with activities of daily living for three out of 8 residents reviewed. (Residents 1, 2 and 3).

Inspectors wroteBased on a review of clinical records, resident, family and staff interviews it was determined that the facility failed to provide care in a manner and environment that promotes each residents' quality of life by failing to respond timely to residents' requests for assistance, which negatively impacted the residents' quality of life in the facility as evidenced by three of 8 residents interviewed (Residents 1, 6, and 7).

Inspectors wroteBased on observation and staff interview, it was determined that the facility failed to ensure the facility was free from potential accident hazards and obstacles to safe mobility assistance devices.

Inspectors wroteBased on observation and staff interview, it was determined that the facility failed to correctly post nurse staffing information.

Inspectors wroteBased on a review of facility policy and clinical records, observations, and staff interview it was determined that the facility failed to ensure the consistent implementation of infection control practices designed to prevent the spread of scabies.