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F0550
D

Failure to Obtain Responsible Party Signature for Financial Documentation

Saxonburg, Pennsylvania Survey Completed on 11-13-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to ensure that the responsible party signed financial papers for a resident with moderate cognitive impairment. According to facility policy, residents must be informed of their rights both orally and in writing, and information should be provided in a manner the resident can understand, taking into account any health or mental status limitations. The clinical record review showed that a resident with a BIMS score of 11, indicating moderate impairment, was admitted with diagnoses including Multiple Sclerosis, muscle wasting and atrophy, and hyperlipidemia. Despite this cognitive status, the resident personally signed a Notice of Medicare Non-Coverage (NOMNC) form. There was no documentation that the responsible party was informed or that they signed the necessary financial papers related to the ending of Medicare coverage. During staff interview, the Nursing Home Administrator confirmed that residents with moderate impairment should not sign NOMNC forms and acknowledged the failure to have the responsible party complete the required documentation. This deficiency was cited under 28 Pa. Code 201.18(b)(2) Management and 28 Pa. Code 201.29(a) Resident rights.

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