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F0835
D

Failure to Prevent Resident Elopement Creates Immediate Jeopardy

Apollo, 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 Nursing Home Administrator (NHA) and Director of Nursing (DON) failed to effectively manage the facility, resulting in the elopement of two residents. Review of job descriptions, clinical records, and staff interviews revealed that both the NHA and DON did not fulfill their essential job duties to ensure compliance with federal and state regulations, specifically in preventing resident elopement. The incident created an immediate jeopardy situation for two of the 33 residents in the facility. The NHA and DON were notified of their failure to prevent the elopement, which was determined to be a result of inadequate management and supervision as outlined in their respective job descriptions.

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