Fairview Manor

each witness; and evidence of the investigation should be documented.After completion of the investigation, the evidence should be analyzed: and the Nursing Home Administrator [NHA] will determine if the suspicion is substantiated or unsubstantiated; ensure the involved resident's plan of care is reviewed and revised, as appropriate, consistent with the results of the investigation; determine if modifications to existing policies and procedures [or new policies and procedures] are needed to prevent similar incidents or injuries from occurring in the future; complete staff training, if appropriate, as determined by the results of the investigation; and implement any other measures as deemed necessary by the investigation.

Resident R1's clinical record revealed an original admission date of 2/11/25, and readmission date of 11/11/25, with diagnoses that included dependence on renal dialysis [medical treatment that performs the function of the kidneys by removing waste, toxins, and excess fluid from the blood when the kidneys are unable to do so naturally], open wounds of the right foot, stage three kidney disease, and gout [form of arthritis that causes pain and swelling in your joints (usually your big toe)].

Interdepartmental progress notes dated 11/04/25, between revealed that:Resident R1 returned from dialysis at 9:30 a.m. in his/her wheelchair. At approximately 11:00 a.m. staff observed a large amount of blood on the floor and on the left foot with a blood clot to foot, large amount of blood soaked in the sock. A statement made by Resident R1 at that time indicated that the transport staff bumped into the curb when they brought him/her back.Resident's left foot was bleeding heavily from four of five toes.

Abrasion present on all four toes.

Great toe with a 0.5cm x 1.0cm x 0.1cm open area.

The other toes with 0.2cm x 0.3cm x 0.1 cm abrasions.

Heavily bleeding from all abrasion areas.Staff were unable to get bleeding on toes to stop.

Left great toe had tissue missing from the end of the toe, fourth toe was missing the toenail, and the nail bed was bleeding, second and third toe were bleeding as well.

Toes were cleaned and pressure dressing was applied.Departmental progress notes on 11/04/25, at 10:18 p.m. identified staff removing pressure dressing from the left foot toes began to bleed.

Area cleansed and rewrapped.

Review of email communication dated 11/05/25, between the NHA and the contracted transport company indicated that the driver was unaware of injuries occurring to Resident R1's toes.

During an interview on 2/25/26, at 1:35 p.m. the NHA confirmed that he/she was unable to locate further documentation of interviews and investigation notes regarding the injuries to Resident R1's left toes. 28 Pa.

Code 201.14(a) Responsibility of licensee 28 Pa.

Code 201.18 (b)(1)(3)(e)(1) Management 28 Pa.

Code 211.10(d) Resident care policies 28 Pa.

Code 211.12 (d)(1)(2)(5) Nursing services Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided.

For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.

LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER TITLE (X6) DATE REPRESENTATIVE'S SIGNATURE

395572 02/26/2026

Fairview Manor 900 Manchester Road Fairview, PA 16415