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F0684
D

Failure to Follow Physician’s Orders for Stool Occult Blood Testing

Somerset, Pennsylvania Survey Completed on 02-23-2026

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

Facility staff failed to follow a physician’s order for a cognitively impaired resident with a history of gastrointestinal bleed who required assistance with care needs. A quarterly MDS assessment dated July 26, 2025, documented the resident’s cognitive impairment and care needs, and physician’s orders dated August 7, 2025, directed staff to obtain three stool samples and test them for occult (hidden) blood. Review of the resident’s August 2025 Treatment Administration Record showed that no stool samples were obtained or tested as ordered. In an interview on February 19, 2026, at 1:34 p.m., the Director of Nursing confirmed that staff did not obtain or test any stool samples for blood for this resident and acknowledged that they should have done so. This failure to carry out the physician’s orders for stool testing constituted noncompliance with 28 Pa. Code 211.12(d)(1)(3)(5) related to nursing services.

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