Hagerstown Healthcare Center
Inspection Findings
F-Tag F0684
F 0684
B) Number of times?
Level of Harm - Minimal harm or potential for actual harm
C) Which Non-Pharmacological Interventions were attempted during the shift? 1)
Residents Affected - Few 2) 3) D) Effective? every shift for Behaviors.
Spaces labeled A, B, C, D were provided For day, evening and night shift to enter the assessment and intervention information as well as a space for staff to sign off as completed.
The order failed to identify individualized non-pharmacological interventions staff should implement to assist the resident if he/she displayed behavior problems.
During the interview on 10/23/25 at 10:00 AM, Staff #2 reviewed Resident #1's behavior monitoring. She acknowledged that it did not identify the non-pharmacological interventions staff should implement when resident #1 was exhibiting behaviors. When asked what she would do, she stated I would talk to him/her, redirect him/her, or offer something to read. When asked how she would know what Resident #1's individualized interventions were, she stated, Well, I know the resident I know what [he/she] likes. You gotta know your residents. When asked how someone who isn't familiar with the resident would know what to attempt, she stated I don't know, it should be written in the behavior monitoring record.
On 10/23/25 at 11:08 AM the above concerns were reviewed with the Administrator, the Mobile Director of Nursing, and Staff #1 the Infection Prevention Nurse.
FORM CMS-2567 (02/99) Previous Versions Obsolete
Event ID:
Facility ID:
If continuation sheet
Printed: 04/13/2026 Form Approved OMB No. 0938-0391
Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
B. Wing
A. Building
(X3) DATE SURVEY COMPLETED
10/23/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Hagerstown Healthcare Center
750 Dual Highway Hagerstown, MD 21740
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)
F-Tag F0842
F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Based on medical record review and staff interview, it was determined that the facility staff failed to keep complete and accurate medical records by failing to ensure a resident had only one unvoided MOLST in the medical record. This was evident for 1 (#3) of 4 residents reviewed during a complaint survey.The findings include: Maryland MOLST (Maryland Orders for Life Sustaining Treatment) is a portable and enduring medical order form covering options for cardiopulmonary resuscitation and other life-sustaining treatments.
The medical orders are based on a patient's wishes about medical treatments. Per the MOLST instructions: Updating the Form: The MOLST form shall be voided and a new MOLST form prepared when there is a change to any of the orders. If modified, the physician, NP, or PA shall void the old form and complete, sign, and date a new MOLST form. Voiding the Form: To void this medical order form, the physician, NP, or PA shall draw a diagonal line through the sheet, write VOID in large letters across the page, and sign and date below the line. A nurse may take a verbal order from a physician, NP, or PA to void the MOLST order form.
Keep the voided order form in the patient's active or archived medical record.On 10/22/25 at 1:30 PM, a
review of Resident #3's electronic medical record (EMR) was conducted. In the Miscellaneous section of
the EMR, a review of the documents scanned into the EMR revealed voided MOLST forms and copies of
the corresponding original, unvoided MOLST form:- There was a scanned copy of an unvoided MOLST dated 7/7/25 and a copy of the 7/7/25 MOLST that was voided on 7/17/25- There was a scanned copy of an unvoided MOLST dated 7/17/25 and a copy of the 7/17/25 MOLST that was voided on 9/22/25.- There was
a scanned copy of an unvoided MOLST dated 9/22/25 and a copy of the 9/22/25 MOLST that was voided
on 10/14/25.- There was a scanned copy of an unvoided MOLST dated 10/14/25 and a copy of the 10/14/25 that was voided on 10/15/25.On 10/23/25 at 11:00 AM, during an interview, Staff #5, Social Worker (SW) stated that resident MOLST forms were uploaded in the EMR. The SW stated that when a new MOLST was created, the old MOLST would be voided; a copy of the new MOLST and a copy of the voided MOLST would then be uploaded into the EMR. The SW stated that a copy of the original, unvoided MOLST that corresponded with the voided MOLST would be kept in the resident's EMR because medical records were not to be deleted, and having voided and unvoided MOLST forms in the EMR showed a trail.Following the interview, the concerns with Resident #3 having more than one unvoided MOLST in the EMR and the guidance that a resident have only one active MOLST in his/her medical record were discussed with the Nursing Home Administrator (NHA) and the SW, who acknowledged the concerns, and offered no further comments at that time
Event ID:
Facility ID:
If continuation sheet
HAGERSTOWN HEALTHCARE CENTER in HAGERSTOWN, MD inspection on recent inspection.
Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.
Frequently Asked Questions
- What is an F-tag violation?
- F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
- Were these violations corrected?
- Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
- How often do nursing home inspections happen?
- CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
- What should families do about these violations?
- Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in HAGERSTOWN, MD, (5) Report new concerns to state authorities.
- Where can I see the full inspection report?
- Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from HAGERSTOWN HEALTHCARE CENTER or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.