Wecare At The Green Home
Inspection history, citations, penalties and survey trends for this long-term care facility in Wellsboro, Pennsylvania.
- Location
- 37 Central Avenue, Wellsboro, Pennsylvania 16901
- CMS Provider Number
- 395318
- Inspections on file
- 16
- Latest survey
- December 30, 2024
- Citations (last 12 mo.)
- 0
Citation history
Health deficiencies cited at Wecare At The Green Home during CMS and state inspections, most recent first.
The facility did not maintain stair tower enclosures as required by NFPA 101 standards. A plastic storage tote was observed under the stairs at the 1st floor, North Exit, affecting two floors. This was confirmed during an exit interview with facility administrators.
The facility did not maintain a proper hazardous area enclosure on the second floor, as observed in the Mechanical Room, which had two unsealed penetrations in the concrete ceiling. This was confirmed during an exit interview with facility representatives.
The facility failed to maintain the automatic sprinkler system, with deficiencies observed in three locations across both floors. Issues included an unsealed penetration in a ceiling tile, a missing escutcheon, and a missing ceiling tile. These deficiencies were confirmed during an exit interview with facility representatives.
The facility failed to maintain proper latching of corridor doors, as observed in several locations on both floors. Doors in the Living Room, Resident Room B-17, Dr's Office, and Shower Room did not latch into their frames, with the Dr's Office door also not being smoke-tight. These deficiencies were confirmed during an exit interview with facility representatives.
The facility failed to provide quarterly personal fund statements to two residents, despite holding their funds and having agreements in place. Both residents and their families confirmed the lack of statements, and the facility had no evidence of compliance until questioned by surveyors.
The facility failed to provide physician-ordered mobility and range of motion (ROM) programs for three residents. One resident did not receive the prescribed ambulation and exercise program, another experienced a decline in ROM without intervention, and a third did not receive promised exercises post-stroke. The facility lacked evidence of implementing these programs as recommended.
A facility failed to ensure a resident's medication regimen was free from unnecessary medications, as the resident was prescribed Ativan in various dosages, including PRN orders, without documented justification or attempts at non-pharmacological interventions. Despite behaviors such as restlessness and chanting, the facility's antianxiety monitoring did not reflect noted anxiety, and pharmacy reviews did not address the PRN Ativan order or request a physician review for dose reduction.
A resident's medication administration records were found to be incomplete and inaccurate due to an LPN's failure to document timely and correctly. The LPN pre-documented the effectiveness of PRN Ativan and Morphine doses and recorded administration times hours after the actual events, leading to discrepancies in the resident's clinical records.
The facility failed to provide required immunization education for four residents who received the influenza vaccination for the 2024-2025 season. There was no documented evidence of education regarding the risks and benefits of the vaccination in their clinical records. An interview with the infection control preventionist confirmed these findings.
The facility did not screen, educate, or offer the COVID-19 vaccine to four newly hired staff members, including nurse aide trainees and an LPN, as required by CMS guidelines. An interview confirmed the lack of documentation and actions regarding the vaccination process.
The facility failed to provide a resident with the required Notice of Medicare Non-Coverage (NOMNC) when their Medicare A coverage ended. Despite a planned discharge and known end date of coverage, there was no evidence that the CMS-10123 form was given to the resident, as confirmed by interviews with the Nursing Home Administrator and the DON.
A facility failed to ensure accurate MDS assessments for a resident, leading to discrepancies in documenting a Stage 3 pressure ulcer. Initially, the ulcer was noted as present on admission, but later assessments incorrectly indicated it was not. An interview confirmed the error in coding the resident's pressure ulcer status.
The facility failed to maintain or improve the ability of two residents to perform activities of daily living. One resident with a prosthetic leg was not using it due to the absence of parallel bars and lack of staff training, despite therapy recommendations. Another resident did not consistently receive a restorative nursing program to maintain strength, with documentation showing frequent non-completion of the program.
A resident with chronic respiratory failure and COPD received supplemental oxygen at an incorrect flow rate of three liters per minute, contrary to the physician's order of two liters per minute. An LPN mistakenly believed she could adjust the flow based on oxygen saturation levels, leading to a discrepancy in care. The issue was reviewed with the facility's administration.
The facility failed to provide adequate nursing staff, resulting in delayed call bell responses for two residents. One resident, who requires assistance to use the bathroom, experienced wait times exceeding 15 minutes, with the longest being 34 minutes. Another resident faced similar delays, with one instance over an hour, impacting their toileting needs. These issues were discussed with the facility's administration.
A resident refused Metoprolol during a medication pass, and the LPN left the unsecured tablet on top of the medication cart. The LPN then left the cart unattended while administering medications to another resident, leaving the Metoprolol tablet unsecured and out of view.
A resident with natural teeth did not receive routine dental services for over a year. The last dental service was from a dentist over two years ago and from a hygienist about one and a half years ago. The facility confirmed the lack of routine dental care in accordance with the State plan.
Stair Tower Enclosure Deficiency
Penalty
Summary
The facility failed to maintain the stair tower enclosures in accordance with NFPA 101 standards. During an observation on December 30, 2024, at 11:36 am, a plastic storage tote was found stored under the stairs at the 1st floor, North Exit. This issue affected two of two floors in the facility. The presence of the storage tote was confirmed during an exit interview with the Facility Administrator, Facility Assistant Administrator, and a Facility Representative on the same day at 12:30 pm.
Plan Of Correction
The Facility submits this Plan of Correction under procedures established by the Department of Health in order to comply with the Department's directive to change conditions which the Department alleges is deficient under State and/or Federal Long Term Care Regulations. This Plan of Correction should not be construed as either a waiver of the facility's right to appeal or challenge the accuracy or severity of the alleged deficiencies or an admission of past or ongoing violation of State or Federal regulatory requirements. 1. The plastic storage tote, located under the stairs in the of the first-floor north exit, was removed and the work was documented in work order #20321918. The Facilities Manager or his designee will maintain compliance through monthly safety rounding to identify and correct issues related to stairways and exits. 2. This corrective action was completed on the day of the survey. The Facilities Manager is responsible to ensure that corrections are completed and documented in the maintenance work order program.
Hazardous Area Enclosure Deficiency on Second Floor
Penalty
Summary
The facility failed to maintain a proper hazardous area enclosure on the second floor. During an observation on December 30, 2024, at 11:01 am, it was noted that the Mechanical Room had two unsealed penetrations in the concrete ceiling. This deficiency was confirmed during an exit interview with the Facility Administrator, Facility Assistant Administrator, and Facility Representative #1 on the same day at 12:30 pm.
Plan Of Correction
The Facility submits this Plan of Correction under procedures established by the Department of Health in order to comply with the Department's directive to change conditions which the Department alleges is deficient under State and/or Federal Long Term Care Regulations. This Plan of Correction should not be construed as either a waiver of the facility's right to appeal or challenge the accuracy or severity of the alleged deficiencies or an admission of past or ongoing violation of State or Federal regulatory requirements. 1. The penetrations in the concrete ceiling of the second-floor mechanical room were repaired and the work was documented in work order #20321914. The Facilities Manager or his designee will maintain compliance through monthly safety rounding to identify and correct issues related to hazardous area enclosures. 2. This corrective action was completed on the day of the survey. The Facilities Manager is responsible to ensure that corrections are completed and documented in the maintenance work order program.
Sprinkler System Maintenance Deficiencies
Penalty
Summary
The facility failed to maintain the automatic sprinkler system in three specific locations, affecting both floors of the building. During an observation on December 30, 2024, it was noted that there was an unsealed penetration in a ceiling tile in the janitor's closet near Resident Room B-24 on the second floor. Additionally, the transportation garage on the first floor was missing an escutcheon in the ceiling, and the janitor's closet near the East Exit on the first floor was missing a ceiling tile. These deficiencies were confirmed during an exit interview with the Facility Administrator, Facility Assistant Administrator, and a Facility Representative.
Plan Of Correction
The Facility submits this Plan of Correction under procedures established by the Department of Health in order to comply with the Department's directive to change conditions which the Department alleges is deficient under State and/or Federal Long Term Care Regulations. This Plan of Correction should not be construed as either a waiver of the facility's right to appeal or challenge the accuracy or severity of the alleged deficiencies or an admission of past or ongoing violation of State or Federal regulatory requirements. a. The penetration in the ceiling tile in the second-floor janitor's closet, near resident room B-24 was repaired and the work was documented in work order #20321912. b. The escutcheon in the ceiling of the first-floor transportation garage will be replaced and the work will be documented in work order #20321923. c. The ceiling tile in the first-floor janitor's closet was replaced and the work was documented in work order #20321924. The Facilities Manager or his designee will maintain compliance through monthly safety rounding to identify and correct issues related to automatic sprinkler systems. All four of the corrective actions will be completed by February 4, 2025. The Facilities Manager is responsible to ensure that corrections are completed and documented in the maintenance work order program.
Failure to Maintain Corridor Door Latching
Penalty
Summary
The facility failed to maintain corridor openings in compliance with NFPA 101 standards, as observed during a survey on December 30, 2024. The survey revealed that several doors on both the first and second floors did not latch into their frames, compromising their ability to resist the passage of smoke. Specifically, the Living Room doors on the second floor, the Resident Room B-17 door, the Dr's Office door on the first floor, and the Shower Room door all failed to latch properly. Additionally, the Dr's Office door was noted to be not smoke-tight. These deficiencies were confirmed during an exit interview with the Facility Administrator, Assistant Administrator, and a Facility Representative. The failure of these doors to latch properly and maintain smoke-tight conditions indicates a lapse in maintaining the required fire safety standards, potentially affecting the safety of the facility's environment.
Plan Of Correction
The Facility submits this Plan of Correction under procedures established by the Department of Health in order to comply with the Department's directive to change conditions which the Department alleges is deficient under State and/or Federal Long Term Care Regulations. This Plan of Correction should not be construed as either a waiver of the facility's right to appeal or challenge the accuracy or severity of the alleged deficiencies or an admission of past or ongoing violation of State or Federal regulatory requirements. a. The closer of the second floor living room doors was adjusted to ensure latching and the work was documented in work order # 20321910. b. The door to resident room B-17 was adjusted to ensure latching and the work was documented in work order #20321911. c. The door to the Doctor's office on the first floor was repaired and adjusted to ensure that it latched and was smoke-tight. The work was documented in work order # 20321916. d. The door to the first-floor shower room was adjusted to ensure latching and the work was documented in work order #20321917. The Facilities Manager or his designee will maintain compliance through monthly safety rounding to identify and correct issues related to door closure and integrity. All four of the corrective actions were completed by January 2, 2025. The Facilities Manager is responsible to ensure that corrections are completed and documented in the maintenance work order program.
Failure to Provide Quarterly Personal Fund Statements
Penalty
Summary
The facility failed to provide quarterly personal fund statements to two residents, which is a requirement for managing residents' personal funds. Resident 19 was aware of the approximate amount in her personal funds account but did not receive a written statement at least quarterly. The clinical record for Resident 19 included a Resident Personal Fund Authorization form with an undated signature that did not specify the facility's obligation to provide quarterly statements or designate a recipient for the statement. Interviews with the Nursing Home Administrator and the Director of Nursing revealed that no staff could confirm the provision of personal fund statements to Resident 19. Similarly, Resident 40 and her mother confirmed that they did not receive quarterly statements of her personal funds, despite the facility holding money for her. The clinical record for Resident 40 included a signed Resident's Personal Fund Agreement, which stated that the facility would maintain a record of all transactions and provide an itemized quarterly statement. However, the Nursing Home Administrator confirmed that the facility had not provided these statements to Resident 40. The facility had no evidence of providing quarterly statements to either resident until questioned by surveyors.
Plan Of Correction
The Facility submits this Plan of Correction under procedures established by the Department of Health in order to comply with the Department's directive to change conditions which the Department alleges is deficient under State and/or Federal Long Term Care Regulations. This Plan of Correction should not be construed as either a waiver of the facility's right to appeal or challenge the accuracy or severity of the alleged deficiencies or an admission of past or ongoing violation of State or Federal regulatory requirements. 1. Residents 19 and 40 received a copy of their most recent quarterly statement during survey. 2. All residents who signed a Resident's Personal Fund Agreement have been received a copy of their most recent quarterly statement. 3. Education will be provided to the business office manager to provide and document receipt of quarterly statements for all residents who have signed a Resident's Personal Fund Agreement. 4. Quarterly audits will be completed x4 to ensure residents received quarterly statement with results presented in QAPI. 5. Compliance date: January 28, 2025.
Failure to Implement Physician-Ordered Mobility and ROM Programs
Penalty
Summary
The facility failed to provide physician-ordered services to maintain a resident's mobility and range of motion for three residents. Resident 71, who was planning to return home, had completed 12 weeks of therapy and was placed on a restorative nursing program for ambulation and lower extremity exercises. However, the facility did not consistently follow through with the prescribed ambulation program, as evidenced by incomplete documentation and insufficient ambulation distances recorded. There was no evidence that the recommended standing exercises were ordered or completed, and no communication was provided to indicate any issues with completing the program. Resident 11 was readmitted from a hospital stay with a physician's order for therapy screens to determine her care needs. The facility did not complete these screens, and her range of motion declined without any documented interventions. Initially assessed as having no range of motion limitations, subsequent assessments showed limitations in both upper and lower extremities, yet the facility did not implement any interventions to address this decline. Resident 14, who had a stroke resulting in left-sided weakness, reported not receiving the promised exercises from the nursing staff. Her care plan included participation in therapy and a restorative nursing program for range of motion, but there was no evidence that these programs were implemented. The facility confirmed the lack of evidence for the implementation of the recommended range of motion program for Resident 14.
Plan Of Correction
The Facility submits this Plan of Correction under procedures established by the Department of Health in order to comply with the Department's directive to change conditions which the Department alleges is deficient under State and/or Federal Long Term Care Regulations. This Plan of Correction should not be construed as either a waiver of the facility's right to appeal or challenge the accuracy or severity of the alleged deficiencies or an admission of past or ongoing violation of State or Federal regulatory requirements. 1. Residents 11, 14 and 71 have been evaluated by therapy to provide needed services and identify appropriate restorative program. 2. Whole house audit of residents discharged from therapy in the last 2 months with an ambulation and ROM program to ensure programs are on Kardex. Audit of previous month of MDSs to review for any residents with a decline in ROM and ensure appropriate intervention occurred. 3. Education to Restorative Nurse Coordinator about ensuring all RNPs are added to Kardex. Education to RNACs to elevate any coded declines of ROM to IDT. 4. Random audit of 3 residents coming off therapy caseload weekly x4 then monthly x2 to confirm ordered RNP on Kardex. Random audit of 3 MDS weekly x4 then monthly x2 to monitor for any decline in resident ROM. 5. Compliance date: January 28, 2025.
Failure to Justify PRN Ativan Administration
Penalty
Summary
The facility failed to ensure that a resident's medication regimen was free from potentially unnecessary medications. Specifically, Resident 12 was prescribed Ativan in various dosages, including routine and PRN (as needed) orders, which could result in the resident receiving up to 9 mg of Ativan in a 24-hour period. Despite the high potential dosage, there was no documentation justifying the need for the PRN Ativan, nor were non-pharmacological interventions attempted prior to administering the PRN doses. Clinical records and staff interviews revealed that Resident 12 exhibited behaviors such as rambling, restlessness, and chanting, but there was no significant change in her condition noted by her physician. The hospice social worker and staff documented instances of restlessness and anxiety, yet the facility's antianxiety monitoring did not reflect any noted anxiety or anxiousness. Despite this, PRN Ativan was administered multiple times without documented justification or attempts at non-medicinal interventions. The facility's pharmacy medication regimen reviews for November and December 2024 did not address the PRN Ativan order or request a physician review for a potential gradual dose reduction. This oversight was discussed with the Director of Nursing, highlighting a failure in the facility's processes to ensure appropriate medication management and documentation for Resident 12.
Plan Of Correction
The Facility submits this Plan of Correction under procedures established by the Department of Health in order to comply with the Department's directive to change conditions which the Department alleges is deficient under State and/or Federal Long Term Care Regulations. This Plan of Correction should not be construed as either a waiver of the facility's right to appeal or challenge the accuracy or severity of the alleged deficiencies or an admission of past or ongoing violation of State or Federal regulatory requirements. 1. Resident 12's physician reviewed Ativan orders. 2. All residents with PRN Ativan orders written for greater than 14 days were reviewed to confirm appropriate documentation, timeframe, and dosing. 3. Consultant pharmacist will review regulation on gradual dose reductions and limitations for timeframes of PRN Ativan use. 4. Audits of new PRN Ativan orders documentation, timeframes and total dose ordered will be completed weekly x4 then monthly x2 with results reported to QAPI. 5. Compliance date: January 28, 2025.
Inaccurate Medication Documentation by LPN
Penalty
Summary
The facility failed to ensure complete and accurate clinical documentation for a resident, identified as Resident 12, as evidenced by discrepancies in the medication administration records (MAR) maintained by an LPN, referred to as Employee 9. The clinical record review revealed that Resident 12 had several physician orders for Ativan and Morphine, with specific dosages and administration times. However, the MAR for October, November, and December 2024 showed multiple instances where Employee 9 documented medication administration and its effectiveness either significantly after the actual administration time or pre-documented the effectiveness before it could be accurately assessed. This included instances where the documentation was completed hours after the medication was administered or where the effectiveness was recorded before the time it was supposed to be evaluated. The discrepancies in documentation included pre-documenting the effectiveness of PRN Ativan and Morphine doses, as well as failing to timely document the administration of these medications. For example, on several occasions, Employee 9 documented the administration of Ativan and Morphine hours after they were given, and in some cases, recorded the effectiveness of the medication before the time it was supposed to be assessed. These actions led to incomplete and inaccurate clinical documentation, which was confirmed during an interview with the Director of Nursing.
Plan Of Correction
The Facility submits this Plan of Correction under procedures established by the Department of Health in order to comply with the Department's directive to change conditions which the Department alleges is deficient under State and/or Federal Long Term Care Regulations. This Plan of Correction should not be construed as either a waiver of the facility's right to appeal or challenge the accuracy or severity of the alleged deficiencies or an admission of past or ongoing violation of State or Federal regulatory requirements. 1. Interview with employee 9 reveals resident 12 received medications as ordered. 2. Employee 9 was coached on medication documentation at time of administration. 3. All licensed staff were educated to document at time of administration of ordered medications. 4. A random audit of documented medication administration times for five residents will be completed weekly x4 then monthly x2 with results reported to QAPI. 5. Compliance date: January 28, 2025.
Failure to Provide Immunization Education
Penalty
Summary
The facility failed to provide required immunization education for four out of five residents reviewed for influenza immunizations. Specifically, Residents 11, 15, 46, and 59 received the influenza vaccination for the 2024-2025 season without documented evidence of education regarding the risks and benefits of the vaccination being provided to them or their responsible parties. The vaccinations were administered on various dates in October and November 2024, but the clinical records lacked documentation of the necessary educational information. An interview with Employee 6, the infection control preventionist, confirmed these findings. The absence of documented education for these residents constitutes a failure to comply with the regulatory requirements for immunization education. This deficiency was identified during a review of select facility policies and procedures, clinical record reviews, and staff interviews, highlighting a gap in the facility's adherence to mandated educational protocols for vaccinations.
Plan Of Correction
The Facility submits this Plan of Correction under procedures established by the Department of Health in order to comply with the Department's directive to change conditions which the Department alleges is deficient under State and/or Federal Long Term Care Regulations. This Plan of Correction should not be construed as either a waiver of the facility's right to appeal or challenge the accuracy or severity of the alleged deficiencies or an admission of past or ongoing violation of State or Federal regulatory requirements. 1. Residents 11, 15, 46, and 59 or their responsible party have acknowledged they received education at the time of consenting/declining the influenza immunization. 2. The Infection Preventionist will review all current residents to ensure documentation of influenza education of risks and benefits of vaccination was provided to resident or responsible party. 3. Education for the Infection Preventionist regarding documentation requirement for provided education of the influenza immunizations. 4. Audits for documented education for influenza and pneumococcal to residents or families will be conducted weekly x4 then monthly x2 with results reported in QAPI. 5. Compliance date: January 28, 2025.
Failure to Screen and Educate New Hires on COVID-19 Vaccination
Penalty
Summary
The facility failed to comply with the CMS memo (QSO-21-19-NH) requirements regarding COVID-19 vaccination for newly hired staff. Specifically, the facility did not screen, educate, or offer the COVID-19 vaccine to four newly hired employees, including two nurse aide trainees, one licensed practical nurse, and one nurse aide. There was no documented evidence to show that these employees were medically screened for vaccine eligibility, educated on the risks and benefits of the vaccine, or offered the vaccine itself. An interview with the employee health staff confirmed the lack of documentation and actions regarding the COVID-19 vaccination process for these new hires. This deficiency was identified through a review of the facility's new hire list and was corroborated by the employee health staff, indicating a systemic failure to adhere to the required protocols for COVID-19 vaccination education and offering for new employees.
Plan Of Correction
The Facility submits this Plan of Correction under procedures established by the Department of Health in order to comply with the Department's directive to change conditions which the Department alleges is deficient under State and/or Federal Long Term Care Regulations. This Plan of Correction should not be construed as either a waiver of the facility's right to appeal or challenge the accuracy or severity of the alleged deficiencies or an admission of past or ongoing violation of State or Federal regulatory requirements. 1. Employees 1, 2, 3, and 4 were provided COVID-19 vaccination education and a list of nearby providers of the COVID-19 vaccination. 2. All new hires in the last two months were provided COVID-19 vaccination education and nearby providers of the vaccination. 3. Education provided to SDC of requirements to document COVID-19 screening, providing education on the COVID-19 vaccination and a list of nearby COVID-19 vaccination providers. 4. Audit of all new hire documentation will be conducted weekly x4 then monthly x2 for screening, education and providing a list of nearby providers for the COVID-19 vaccination with results reported to QAPI. 5. Compliance date: January 28, 2025
Failure to Provide Notice of Medicare Non-Coverage
Penalty
Summary
The facility failed to provide the required Notice of Medicare Non-Coverage (NOMNC) to a resident whose Medicare A coverage was ending. According to the review of clinical records and staff interviews, Resident 76's last covered day of Medicare A services was June 27, 2024, and the resident was discharged to home/self-care. Despite the planned discharge and the known end date of Medicare A coverage, there was no evidence that the facility provided the CMS-10123 form to Resident 76, which is necessary to inform the resident of the termination of services and their right to appeal. Interviews with the Nursing Home Administrator and the Director of Nursing confirmed that the facility had no documentation to show that the NOMNC was delivered to Resident 76. The facility also lacked evidence that Resident 76 had exhausted his available Medicare A covered days. The deficiency was identified during a review of the facility's compliance with regulations requiring notification to residents about changes in their payment coverage.
Plan Of Correction
The Facility submits this Plan of Correction under procedures established by the Department of Health in order to comply with the Department's directive to change conditions which the Department alleges is deficient under State and/or Federal Long Term Care Regulations. This Plan of Correction should not be construed as either a waiver of the facility's right to appeal or challenge the accuracy or severity of the alleged deficiencies or an admission of past or ongoing violation of State or Federal regulatory requirements. 1. Resident 76 was notified of remaining Medicare days. 2. Residents who discharged while still covered by Medicare A in the last two months were reviewed for issuance of CMS-10123 notice. 3. The RNACs were educated on providing notice to residents discharging with Medicare A days remaining. 4. Audits for CMS-10123 notice will be completed weekly x4 then monthly x2 with results presented in QAPI. 5. Compliance date: January 28, 2025.
Inaccurate MDS Assessment for Pressure Ulcer
Penalty
Summary
The facility failed to ensure complete and accurate Minimum Data Set (MDS) assessments for a resident, identified as Resident 59. A review of the resident's clinical record revealed discrepancies in the documentation of a Stage 3 pressure ulcer. An MDS assessment dated July 11, 2024, indicated that the resident had a Stage 3 pressure ulcer present on admission, with no other skin issues noted. However, a subsequent MDS assessment indicated that the same pressure ulcer was not present on admission. An interview with the Administrator confirmed that the MDS dated October 11, 2024, was coded in error regarding the resident's pressure ulcer status. This discrepancy highlights a failure in accurately assessing and documenting the resident's condition as required by the facility's protocols.
Plan Of Correction
The Facility submits this Plan of Correction under procedures established by the Department of Health in order to comply with the Department's directive to change conditions which the Department alleges is deficient under State and/or Federal Long Term Care Regulations. This Plan of Correction should not be construed as either a waiver of the facility's right to appeal or challenge the accuracy or severity of the alleged deficiencies or an admission of past or ongoing violation of State or Federal regulatory requirements. 1. Resident 59's MDS was corrected at the time of survey to reflect the Stage 3 pressure ulcer was not facility acquired. 2. All MDS for residents with facility acquired pressure ulcers in the last 2 months were reviewed for accuracy. 3. The RNACs were educated on accurate MDS coding of facility acquired pressure ulcers. 4. Audits will be completed for MDS coding of facility acquired pressure ulcers weekly x4 then monthly x2 with results reported to QAPI. 5. Compliance date: January 28, 2025
Failure to Implement Restorative Programs for Residents
Penalty
Summary
The facility failed to maintain or improve the ability of two residents to perform activities of daily living. Resident 24, who had a left leg amputation and was provided with a prosthetic leg, was not using it because the facility did not have parallel bars, which he had used in a previous facility for gait training. The staff used a mechanical lift for transfers and did not incorporate the prosthetic leg into his care plan, despite recommendations from physical therapy for a restorative nursing program that included the use of the prosthetic. Interviews with Resident 24 and his wife, as well as a nurse aide, confirmed the lack of use of the prosthetic and the absence of training for staff on its application. Resident 40, who was discharged from skilled therapy with recommendations to continue a restorative nursing program to maintain lower extremity strength, did not consistently receive these services. Documentation showed that the program was not completed on numerous days, with staff citing the resident was resting as the reason. The Nursing Home Administrator and the Director of Nursing confirmed the inconsistency in completing the restorative nursing program and acknowledged the lack of oversight by licensed staff to ensure the program was carried out as planned.
Plan Of Correction
The Facility submits this Plan of Correction under procedures established by the Department of Health in order to comply with the Department's directive to change conditions which the Department alleges is deficient under State and/or Federal Long Term Care Regulations. This Plan of Correction should not be construed as either a waiver of the facility's right to appeal or challenge the accuracy or severity of the alleged deficiencies or an admission of past or ongoing violation of State or Federal regulatory requirements. 1. Residents 24 and 40 are on therapy caseload to address needs and evaluate for appropriate restorative nursing program. 2. All residents with a prosthetic were reviewed to ensure documented use of prosthetic. All residents on a RNP for ADLs were reviewed for completion of program and elevation to IDT for recommendations for those not completing their program requirements. 3. The Restorative Nursing Coordinator was educated on reviewing program completion of RNP for ADLs and elevating to IDT for recommendations of any programs not completed. 4. Random audit of 5 RNP for ADLs will be completed weekly x4 then monthly x2 with results reported to QAPI. 5. Compliance date: January 28, 2025.
Failure to Administer Physician-Ordered Oxygen Flow Rate
Penalty
Summary
The facility failed to ensure the application of physician-ordered supplemental oxygen consistent with professional standards of practice for a resident. On two separate occasions, the resident was observed receiving supplemental oxygen at a flow rate of three liters per minute, despite having an active physician order for two liters per minute. The resident, who had a history of chronic respiratory failure and COPD, believed her oxygen was set correctly at three liters per minute. The plan of care required oxygen saturations to be checked and recorded every eight hours and as needed, with oxygen administered per the physician's order. A licensed practical nurse (LPN) mistakenly believed she was permitted to adjust the oxygen flow based on the resident's oxygen saturation levels, although the physician's order did not allow for such titration. Upon review, the LPN corrected the oxygen flow to align with the physician's directive. The deficiency was discussed with the Nursing Home Administrator and the Director of Nursing, highlighting the discrepancy between the physician's orders and the actual administration of oxygen to the resident.
Plan Of Correction
The Facility submits this Plan of Correction under procedures established by the Department of Health in order to comply with the Department's directive to change conditions which the Department alleges is deficient under State and/or Federal Long Term Care Regulations. This Plan of Correction should not be construed as either a waiver of the facility's right to appeal or challenge the accuracy or severity of the alleged deficiencies or an admission of past or ongoing violation of State or Federal regulatory requirements. 1. Resident 15's orders were changed by the physician to a titrate order. There was no harm to resident 15. 2. All residents with supplemental oxygen orders were reviewed and confirmed for wean vs titrate. 3. Education to licensed staff on titrate vs wean orders for supplemental oxygen. 4. Random audit of 5 residents on supplemental oxygen to ensure their oxygen setting follows their order. 5. Compliance date: January 28, 2025.
Insufficient Nursing Staff Leads to Delayed Call Bell Responses
Penalty
Summary
The facility failed to provide sufficient nursing staff to meet the needs of residents, specifically in relation to call bell response times. Resident 71 reported that she relies on staff assistance to use the bathroom due to her limited mobility and expressed frustration over long wait times after activating her call bell. The call bell activation logs for Resident 71 showed multiple instances where the response time exceeded 15 minutes, with the longest recorded wait being 34 minutes. Although no instance of a wait time over an hour was documented, the resident's concerns about delayed assistance were evident. Similarly, Resident 38 experienced significant delays in call bell responses, with several instances exceeding 15 minutes and one instance reaching over an hour. The resident reported having to wait for assistance with toileting and changing, sometimes resulting in sitting in a soaked bed. The call bell logs for Resident 38 corroborated these claims, showing multiple long wait times. The facility's staff acknowledged that the timing of nurse aide documentation might not align with the actual time of toileting, but the delays in response were still apparent. These findings were reviewed with the Nursing Home Administrator and Director of Nursing.
Plan Of Correction
The Facility submits this Plan of Correction under procedures established by the Department of Health in order to comply with the Department's directive to change conditions which the Department alleges is deficient under State and/or Federal Long Term Care Regulations. This Plan of Correction should not be construed as either a waiver of the facility's right to appeal or challenge the accuracy or severity of the alleged deficiencies or an admission of past or ongoing violation of State or Federal regulatory requirements. 1. Facility is meeting all DOH staffing ratio and PPD guidelines. Residents 38 and 71 will be interviewed weekly x4 weeks then monthly x2 months to monitor call bell response satisfaction. 2. The DON or designee will attend Resident Council monthly x3 to confirm satisfaction with call bell response time. 3. Staff was educated on responding to call bells within 15 minutes of activation. 4. Random audit of call bell reports for response times will be completed weekly x4 then monthly x2. Resident council response to call bell length and the random audit results will be reported to QAPI for review and recommendations. 5. Compliance date: January 28, 2025.
Medication Security Lapse During Administration
Penalty
Summary
The facility failed to ensure the secure storage of medications during a medication administration pass for a resident. During an observation on December 11, 2024, a licensed practical nurse (Employee 10) administered medications to a resident who refused to take her Metoprolol medication due to concerns about excessively lowering her blood pressure. Employee 10 removed the Metoprolol tablet from the medication cup and placed it in an open plastic cup on top of the medication cart, stating she would dispose of it later at the nurses' station. Subsequently, Employee 10 left the medication cart unattended in the hallway while administering medications to another resident in the same room. During this time, the unsecured Metoprolol tablet remained on top of the cart, out of Employee 10's view, from 8:54 AM to 8:58 AM. Upon returning to the cart, Employee 10 confirmed that the tablet was left unsecured. The surveyor discussed these concerns with the Nursing Home Administrator and the Director of Nursing later that day.
Plan Of Correction
The Facility submits this Plan of Correction under procedures established by the Department of Health in order to comply with the Department's directive to change conditions which the Department alleges is deficient under State and/or Federal Long Term Care Regulations. This Plan of Correction should not be construed as either a waiver of the facility's right to appeal or challenge the accuracy or severity of the alleged deficiencies or an admission of past or ongoing violation of State or Federal regulatory requirements. 1. No residents were harmed. 2. Employee 10 was immediately educated on proper storing of medications. 3. All licensed staff were educated on proper storing of medications. 4. A random audit of storing of medications will be conducted weekly x4 then monthly x2 with results reported to QAPI. 5. Compliance date: January 28, 2025.
Failure to Provide Routine Dental Services
Penalty
Summary
The facility failed to ensure routine dental services for a resident, identified as Resident 40, who was reviewed for dental concerns. An interview with Resident 40 revealed that she had natural teeth but had not received dental services in the past year, such as routine prophylactic cleaning. A review of the clinical records showed that the last professional dental service Resident 40 received was from a dentist on October 4, 2022, and from a dental hygienist on April 26, 2023. This indicates that Resident 40 had not received routine dental care for over a year. The Nursing Home Administrator confirmed that the facility did not provide routine dental services for Resident 40 in accordance with the State plan.
Plan Of Correction
The Facility submits this Plan of Correction under procedures established by the Department of Health in order to comply with the Department's directive to change conditions which the Department alleges is deficient under State and/or Federal Long Term Care Regulations. This Plan of Correction should not be construed as either a waiver of the facility's right to appeal or challenge the accuracy or severity of the alleged deficiencies or an admission of past or ongoing violation of State or Federal regulatory requirements. 1. Resident 40 was seen by a dentist on December 13, 2024. 2. All residents were reviewed for required dental visits. 3. Education was provided to the medical records tech regarding required dental services. 4. Random audit of dental visits will be completed monthly x3 with results reported to QAPI. 5. Compliance date: January 28, 2025.
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Citations used to create this checklist
Latest citations in Pennsylvania
Surveyors identified that a fire-rated separation door between building levels did not meet NFPA 101 multiple occupancy requirements. Initially, the basement separation door had holes where panic hardware had been removed and only a turning knob remained, compromising the door’s fire-rated function. On revisit, although panic hardware had been installed, the door still failed to latch properly in the frame due to friction. Facility leadership and maintenance staff acknowledged these door deficiencies.
Surveyors found that the facility’s Emergency Preparedness Plan was not compliant with regulatory requirements because it lacked a documented community-based all-hazards risk assessment and the facility-based hazard vulnerability analysis had not been updated on an annual basis. During document review and an interview with the Maintenance Director, it was confirmed that the community-based HVA was missing from the plan and that the existing facility-based assessment had last been updated in 2024, leaving the plan without current, comprehensive all-hazards risk assessments.
Surveyors observed that stair towers used as exits were not properly maintained, as multiple stair landings were being used for storage. Chairs were found stored on landings in several stairwells on one floor, and the Maintenance Director confirmed that these items were being kept within the stair towers.
Surveyors found that the common area soiled linen room on the second floor, classified as a hazardous area in a sprinklered location, had a door that failed to positively latch when tested. This door is required to self-close and latch to maintain proper separation for hazardous areas. The issue was confirmed with the Maintenance Director during the survey.
Surveyors found that oxygen storage requirements were not maintained when a freestanding oxygen cylinder was observed unsecured in a third-floor room and the C-Hall oxygen storage room door failed to close and latch due to a coordinator malfunction. The Maintenance Director confirmed these oxygen storage deficiencies during the survey exit interview.
Surveyors found that the facility failed to review and update its emergency preparedness policies and procedures on an annual basis. During document review, the facility could not provide a community-based HVA, which is required to inform updates to the emergency preparedness plan, and the facility-based HVA had not been updated as required. In an interview, the Maintenance Director confirmed both the missing community-based HVA and the lack of an annual update to the facility-based HVA.
Surveyors found that the facility’s Emergency Preparedness Plan lacked required policies and procedures for tracking the location of on-duty staff and sheltered patients during and after an emergency. The plan also did not include a method to document the specific name and location of any receiving facility or other site if staff and patients were relocated. During the exit interview, the Maintenance Director confirmed that these tracking and documentation procedures were not present in the plan, affecting the entire facility.
Surveyors found that the facility failed to develop and maintain required arrangements with other facilities and providers to receive patients if operations were limited or ceased. Document review showed that transfer agreements were missing, and this absence of formal arrangements to ensure continuity of services was confirmed by the Maintenance Director during the exit interview.
Surveyors determined that the facility’s emergency preparedness communication plan did not include any method for sharing appropriate information from the emergency plan with residents and their families or representatives. During document review and staff interviews, it was confirmed that the written plan lacked a defined process for communicating emergency planning information to residents and their representatives, and this omission affected the entire facility.
Two residents receiving PRN anti‑anxiety medications were not protected from potential chemical restraints when PRN lorazepam/Ativan orders lacked required 14‑day stop dates and physician re‑evaluation. One resident with schizoaffective disorder, dementia, and anxiety had a PRN Ativan order without a stop date that was administered multiple times over several months. Another resident with metabolic encephalopathy, heart failure, and peripheral vascular disease had a PRN lorazepam order without a stop date that was still being administered weeks later, with no documented physician reassessment. The DON confirmed that these PRN psychotropic orders should have included 14‑day limitations but did not.
Noncompliant Fire-Rated Separation Door Between Multiple Occupancies
Penalty
Summary
The facility failed to meet NFPA 101 multiple occupancy construction type requirements by not maintaining a compliant fire-rated separation door between building levels. During an observation in the basement, surveyors found that the building separation door had holes where the fire exit (panic) hardware had been removed, and the only remaining hardware was a turning knob, compromising the integrity of the fire-rated door. In a subsequent onsite revisit, surveyors observed that although panic hardware had been installed on the same fire-rated door, the door failed to latch properly in the frame due to friction. The administrator and maintenance staff confirmed the presence of the holes in the fire-rated door and later confirmed that the door continued to have a deficiency because it did not latch.
Plan Of Correction
The Facility submits this Plan of Correction under procedures established by the Department of Health in order to comply with the Department's directive to change conditions which the Department alleges is deficient under State and/or Federal Long Term Care Regulations. This Plan of Correction should not be construed as either a waiver of the facility's right to appeal or challenge the accuracy or severity of the alleged deficiencies or an admission of past or ongoing violation of State and Federal regulatory requirements. Please accept this plan of correction as the facility's written credible allegation of compliance such that all alleged deficiencies cited have been or will be corrected by the date or dates indicated. To remain in compliance with all federal and state regulations, the facility has taken or will take the actions set forth in the following plan of correction. 1. The correct fire rated hardware was ordered and will be installed on the basement building separation door. 2. Results will be shared with the Quality Assurance Performance Improvement Committee with corrections made as needed.
Failure to Maintain Current All-Hazards Emergency Preparedness Risk Assessments
Penalty
Summary
The deficiency involves the facility’s failure to maintain an Emergency Preparedness Plan that was based on and included both a documented facility-based and community-based risk assessment utilizing an all-hazards approach. During document review, surveyors found that the Emergency Preparedness Plan did not contain a documented community-based risk assessment. The plan therefore lacked the required community-based hazard vulnerability analysis (HVA) component that should identify and address community-level emergency events. Surveyors also determined that the facility-based risk assessment within the Emergency Preparedness Plan had not been updated annually as required. The last update to the facility-based HVA was documented in 2024, indicating that it was not current at the time of review. During the exit interview, the Maintenance Director confirmed both the absence of the community-based HVA and that the facility-based HVA had not received the required annual update.
Plan Of Correction
4.1. The facility will update the facility assessment to include the All Hazards Assessment annually. 4.2. The Director of Maintenance or designee Services will monitor bi-annually to meet compliance with E-006. Completion Date: 06/30/2026 Status: APPROVED Date: 06/09/2026
Improper Storage of Chairs in Exit Stair Towers
Penalty
Summary
Surveyors found that stairways and smokeproof enclosures used as exits were not properly maintained as required by NFPA 101. On one of five levels, multiple stair tower landings were being used for storage. During observations on May 4, 2026, chairs were stored on the landings of stair #2 on the third floor C-wing at 11:30 a.m., stair #3 on the third floor B-wing at 11:40 a.m., and stair #4 on the third floor A-wing at 11:50 a.m. In an exit interview on the same day at 1:30 p.m., the Maintenance Director confirmed the presence of this storage within the stair towers.
Plan Of Correction
4.1. The chairs were permanently removed from the third floor C-wing, stair # 2, the third floor B-wing, stair # 3, and the third floor A-wing, stair # 4 on Tuesday, May 5th, 2026. 4.2. The maintenance staff will be in-serviced on importance of verifying that stairwells are cleared Stairways and smokeproof enclosures used 4.3. The maintenance staff will perform monthly audits to confirm that stairwells are cleared. Audits will be completed for 6 months. 4.4. The maintenance director will monitor to meet the compliance
Soiled Linen Room Door Failed to Latch in Hazardous Area
Penalty
Summary
Surveyors identified a deficiency related to NFPA 101 hazardous area enclosure requirements when observing the soiled linen room on the second floor. During the survey, the common area soiled linen room door was tested and found to fail to positively latch. This room qualifies as a hazardous area in a sprinklered location, and the door is required to self-close and latch to maintain proper separation. The deficiency was confirmed during an exit interview with the Maintenance Director, who acknowledged the door problem. No residents or specific patient conditions were mentioned in the report, and no additional contributing actions or events beyond the failed latching mechanism of the soiled linen room door were described.
Plan Of Correction
K 03214.1. On the second floor, the common area soiled utility room door latch was repaired on May 4th, 2026. 4.2. The maintenance staff will be in-serviced to meet compliance requirements of K-0321; NFPA 101 Hazardous areas - enclosures. 4.3. The maintenance staff will perform monthly audits to meet compliance requirements of K-0321 to November 30th, 2026. 4.4. The maintenance director will monitor to meet the compliance requirements of K-0225. Completion Date: 06/30/2026 Status: APPROVED Date: 06/09/2026
Failure to Maintain Required Oxygen Cylinder Storage and Secured Storage Room
Penalty
Summary
Surveyors identified deficiencies in the facility’s compliance with NFPA 101 and NFPA 99 requirements for gas equipment cylinder and container storage. During observation on the third floor, surveyors found a freestanding oxygen cylinder in room 5352 at 11:30 a.m. This cylinder was not described as being secured or stored in accordance with the specified oxygen storage requirements, which include proper enclosure and handling precautions for cylinders available for immediate use in patient care areas. Further observation at 11:40 a.m. revealed that the C-Hall oxygen storage room door failed to close and latch due to a malfunctioning door coordinator. This condition meant the designated oxygen storage room was not being properly secured as required. During the exit interview on the same day at 1:30 p.m., the Maintenance Director confirmed the oxygen storage deficiencies observed by the surveyors.
Plan Of Correction
Completion Date: 06/30/2026 Status: APPROVED Date: 06/09/2026 4.1. The empty freestanding oxygen cylinder on the 3rd floor rom 5352 was removed & placed into the proper oxygen storage room on May 4th, 2026. The corridor malfunction identified on the c hall oxygen storage door will be repaired to ensure proper closure. 4.2. The maintenance staff will be in-serviced to meet compliance requirements of K-0923; NFPA 101 Gas equipment - Cylinder & container storage. 4.3. The maintenance staff will perform monthly audits to meet compliance requirements of K-0923 to November 30th, 2026. 4.4. The maintenance director will monitor to meet the compliance requirements of K-0923.
Failure to Annually Update Emergency Preparedness Policies and Risk Assessments
Penalty
Summary
The deficiency involves the facility’s failure to ensure that its emergency preparedness policies and procedures were reviewed and updated at least annually, as required. Surveyors cited that the facility did not have an emergency preparedness plan community-based risk assessment available for review. This community-based Hazard Vulnerability Analysis (HVA) is one of the required components used to update the facility’s emergency preparedness policies and procedures each year. During document review, surveyors found that the facility could not provide the community-based HVA and also confirmed that the facility-based HVA had not been updated annually as required. In an exit interview, the Maintenance Director acknowledged the absence of the community-based HVA and the missing annual update to the facility-based HVA, confirming that the emergency preparedness policies and procedures were not properly updated based on the emergency plan and risk assessment.
Plan Of Correction
4.1. The facility will update the emergency preparedness to include the community based risk assessment 4.2. The Director of Maintenance or designee Services will monitor bi-annually to meet compliance with E-013.
Missing Emergency Tracking System for Staff and Patients
Penalty
Summary
Surveyors identified a deficiency related to the facility’s Emergency Preparedness Plan, specifically the absence of required policies and procedures for tracking on-duty staff and sheltered patients during an emergency. During document review, the surveyor examined the facility’s Emergency Preparedness Plan and found that it did not contain a system to track the location of on-duty staff and sheltered patients in the facility’s care during an emergency. The review further showed that the plan lacked provisions to document the specific name and location of any receiving facility or other location if on-duty staff and sheltered patients were relocated during an emergency. In an exit interview, the Maintenance Director confirmed that these policies and procedures were missing from the Emergency Preparedness Plan, affecting the entire facility.
Plan Of Correction
4.1. The facility will update the emergency preparedness plan to include a system to track the location of on-duty staff and sheltered patients in the facility's care during an emergency; the specific name and location of the receiving facility or other location of on-duty staff and sheltered patients are relocated during an emergency. 4.2. The Director of Maintenance or designee will monitor bi-annually to meet compliance with E-0018.
Lack of Emergency Transfer Arrangements With Other Facilities
Penalty
Summary
The deficiency involves the facility’s failure to develop and maintain arrangements with other facilities and providers to receive patients if the facility experiences limitations or cessation of operations. During document review, surveyors determined that the facility did not have the required transfer agreements or documented arrangements in place as mandated under the emergency preparedness regulations, which require policies and procedures to ensure continuity of services to patients. On the date of the survey, at a specified time in the morning, the surveyor’s review of facility documentation showed that these arrangements were missing. In an exit interview later that day, the Maintenance Director confirmed that the transfer agreements were not in place, corroborating the surveyor’s findings that the facility lacked the necessary arrangements to ensure continuity of services in an emergency situation.
Plan Of Correction
4.1. The facility will update the emergency preparedness plan to provide arrangements with other facilities and other providers to receive patients in the event of limitations or cessation of operations to maintain the continuity of services to facility patients. 4.2. The Director of Maintenance or designee will monitor bi-annually to meet compliance with E-0025. Completion Date: 07/07/2026 Status: APPROVED Date: 06/09/2026
Failure to Include Resident/Family Communication Method in Emergency Plan
Penalty
Summary
Surveyors found that the facility failed to maintain and update an emergency preparedness communication plan that included a method for sharing information from the emergency plan with residents and their families or representatives. During document review and interview on May 4, 2026, at 8:30 a.m., the surveyor determined that the written emergency communications plan lacked any described process or method for communicating appropriate portions of the emergency plan to residents and their families or representatives, affecting the entire facility. In an exit interview with the Maintenance Director on the same day at 1:30 p.m., the Maintenance Director confirmed that the emergency communications plan did not include such a method for sharing information from the emergency plan with residents and their families or representatives. No specific residents, medical histories, or clinical conditions were identified in the report, and the deficiency pertained to the facility-wide emergency preparedness communication plan documentation and content.
Plan Of Correction
4.1. The facility will update the emergency communications plan to include a method of sharing information from the emergency plan with the residents and their families or representatives, affecting the entire facility. 4.2. The Director of Maintenance or designee will monitor bi-annually to meet compliance with E-0035.
Failure to Limit and Re‑Evaluate PRN Psychotropic Medications
Penalty
Summary
The deficiency involves the facility’s failure to ensure that residents were free from potential chemical restraints by not complying with federal requirements for PRN psychotropic medications. For one resident with schizoaffective disorder bipolar type, dementia, and anxiety disorder, the MDS showed cognitive impairment and the care plan identified mood problems, yelling out, and anxiety/restlessness. A physician ordered PRN Ativan for anxiety with no stop date specified. The MAR showed the PRN Ativan was administered multiple times over several months, including in January, March, and April 2026, without a 14‑day limitation or documented stop date. The DON stated that the PRN order was supposed to have a 14‑day stop date, confirming that the order did not meet regulatory requirements. For another resident with metabolic encephalopathy, heart failure, and peripheral vascular disease, a physician ordered PRN lorazepam every four hours for anxiety, again without a specified stop date. The MAR documented administration of lorazepam nearly a month after the order was written, with no evidence that the physician had re‑evaluated the continued use of the PRN anti‑anxiety medication beyond 14 days. The DON confirmed that no stop date had been added to this order. These omissions resulted in PRN psychotropic medications being available and used beyond 14 days without required time limitations or documented physician re‑evaluation, constituting a failure to ensure residents were free from potential chemical restraints and unnecessary drugs.
Plan Of Correction
Pharmacist will send out a re-education to all the providers regarding PRN psychotropics and end dates by May 4, 2026. Resident records for all residents receiving psychotropics were checked on April 30, 2026- no other orders were missing stop dates. New psychotropic orders added to Point Click Care dashboard on May 1, 2026- listing shows new orders and stop dates. Interdisciplinary team will review dashboard during clinical meeting for stop dates- any missing stop dates will be added. Charge nurses will audit order listing report for new psychotropic orders- 5 residents will be audited x 4 weeks, then 2 residents per week for 4 weeks, then random residents monthly. Audits will be added to quality indicators and reviewed at QAPI.
Self-audit
Pick a level of detail and, optionally, what to focus on — then generate a survey-ready checklist distilled from the most recent citations.
Beta · AI-generated — for reference only, not professional advice. Verify against current CMS guidance before relying on it. Assisto accepts no responsibility for how this checklist is used.
Citations used to create this checklist
Trusted data from CMS and state health departments
Every citation, penalty and Plan of Correction is sourced from public CMS records (latest release June 24, 2026) and official state health department websites — never guesswork.
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