Abbeyville Skilled Nursing And Rehabilitation Cent

Based on review of facility documents and staff interviews, it was determined that the facility failed to provide in a timely manner, notice of Medicare non coverage (payment) for two of seven residents (Resident R1 and R14).Findings include: Review of CMS guidelines, Medicare provider or health plan must deliver a completed copy of the Notice of Medicare Non-Coverage (NOMNC) to beneficiaries/enrollees receiving covered skilled nursing, home health (including psychiatric home health), comprehensive outpatient rehabilitation facility, and hospice services.

The NOMNC must be delivered at least two calendar days before Medicare covered services end or the second to last day of service if care is not being provided daily.

The Skilled Nursing Facility Advanced Beneficiary Notice of Non-Coverage, (SNF ABN) must be issued to Medicare Fee -for-Service (original Medicare) beneficiaries who are receiving care in a Skilled Nursing Facility (SNF) when: Medicare is expected to deny coverage and when the SNF wants to charge the beneficiary for the non-covered services.

Review of the clinical record indicated Resident R1 was discharged from skilled services and discharged from the facility on 7/1/25.

Review of the electronic medical record failed to reveal a NOMNC or progress notes that indicated communication of the information contained in a NOMNC to Resident R1's family member, who is responsible for Resident R1's billing statement.

Review of Resident R1's paper chart failed to reveal a NOMNC for Resident R1.

Review of the clinical record indicated Resident R14 was discharged from skilled services and discharged from the facility on 8/1/25.

Review of the electronic medical record failed to reveal a NOMNC or progress notes that indicated communication of the information contained in a NOMNC to Resident R14.

During an interview on 8/4/25, at 1:17 p.m.

Director of Social Services Employee E8 confirmed that the facility was not able to provide evidence that a NOMNC was issued to the resident or resident representative for Residents R1 and R14.

During an interview on 8/7/25, at approximately 2:30 p.m. the Nursing Home Administrator confirmed that the facility failed to provide in a timely manner, notice of Medicare non coverage (payment) for two of seven residents. 28 Pa.

Code 201.14(a) Responsibility of licensee. 28 Pa.

Code 201.18(b)(2) Management. 28 Pa.

Code 201.29(a): Resident rights.

Facility ID:

IDENTIFICATION NUMBER:

A.

Building

COMPLETED

08/19/2025

STREET ADDRESS, CITY, STATE, ZIP CODE

Abbeyville Skilled Nursing and Rehabilitation Cent

100 Abbeyville Road Lancaster, PA 17603

SUMMARY STATEMENT OF DEFICIENCIES

Review of Resident R1's practitioner notes failed to reveal documentation of an evaluation related to Resident R1's facility discharge.

During an interview on 8/7/25, at approximately 2:30 p.m. the Nursing Home Administrator confirmed that had Attending Physician Employee E7 reviewed Resident R1's total program of care, including medications and treatments, he would have been aware Resident R1 was recertified for an additional four weeks of SNF care. 28 Pa.

Code; 211.12(a)(c)(d)(1)(3)(5) Nursing Services. 28 Pa.

Code 211.2(a) Physician Services 28 Pa.

Code: 211.5 (f)(g)(h) Clinical records.

Facility ID:

IDENTIFICATION NUMBER:

A.

Building

COMPLETED

08/19/2025

STREET ADDRESS, CITY, STATE, ZIP CODE

Abbeyville Skilled Nursing and Rehabilitation Cent

100 Abbeyville Road Lancaster, PA 17603

SUMMARY STATEMENT OF DEFICIENCIES

Review of the facility policy, Person Centered Care Plan dated 10/20/24, indicated, Care plan includes measurable objectives and timetables to meet a patient's medical, nursing, nutrition, and mental and psychosocial needs that are identified in the comprehensive assessments for newly admitted patients.

The interdisciplinary team, in conjunction with the patient and or patient representatives as appropriate, will establish the expected goals and outcomes of care, the type, amount, frequency and duration of care, and any other factors related to the effectiveness of care.

Review of the clinical record indicated Resident R1 was admitted to the facility on [DATE].

Review of Resident R1's full care plan including revision history, from admission [DATE]) through discharge (7/1/25) failed to include a plan of care developed for discharge.

Review of the clinical record indicated Resident R6 was admitted to the facility on [DATE].

Review of Resident R6's full care plan including revision history, from admission [DATE]) through discharge (7/16/25) failed to include a plan of care developed for discharge.

Review of the clinical record indicated Resident R7 was admitted to the facility on [DATE].

Review of Resident R7's full care plan including revision history, from admission [DATE]) through discharge (7/17/25) failed to include a plan of care developed for discharge.

Review of the clinical record indicated Resident R8 was admitted to the facility on [DATE].

Review of Resident R8's full care plan including revision history, from admission [DATE]) through discharge (7/24/25) failed to include a plan of care developed for discharge.

Review of the clinical record indicated Resident R15 was admitted to the facility on [DATE].

Review of Resident R15's full care plan including revision history, from admission [DATE]) through discharge (7/16/25) failed to include a plan of care developed for discharge.

During an interview on 8/7/25, at approximately 2:30 p.m. the Nursing Home Administrator confirmed the facility failed to develop a person-centered care plan related to discharge for five of five residents. 28 Pa.

Code 211.12(d)(5) Nursing services.

Facility ID:

IDENTIFICATION NUMBER:

A.

Building

COMPLETED

08/19/2025

STREET ADDRESS, CITY, STATE, ZIP CODE

Abbeyville Skilled Nursing and Rehabilitation Cent

100 Abbeyville Road Lancaster, PA 17603

SUMMARY STATEMENT OF DEFICIENCIES

Review of a physician's order dated 7/26/25, indicated that Resident R3 left foot wound was to be cleansed with Vashe, pat dry, apply Therahoney (medical-grade honey) and covered with bordered gauze.

Review of Resident R3's TAR for August 2025, failed to reveal documentation that wound care was completed for Resident R3's left foot wound on 8/2/25.

Review of Resident R3's progress notes failed to reveal a documented reason for the lack of wound care on 8/2/25.

Review of the clinical record revealed Resident R4 was admitted to the facility on [DATE].

Review of the facility diagnosis list on 8/4/25, revealed diagnoses of heart failure, peripheral vascular disease (PVD, circulatory condition in which narrowed blood vessels reduce blood flow to the limbs), and acquired absence of other right toes.

Review of Resident R4's care plan for at risk for skin breakdown related to decreased mobility- has R anterior foot amputation and Coccyx (base of the spinal column) area initiated on 7/30/25, failed to include any goals or interventions related to Resident R4's actual skin breakdown.

Review of a physician's order dated 7/30/25, indicated that Resident R4 R Foot amputation site- cleanse incisions with nss, apply perform and cover with a dry dressing and kling every day shift for incision care.

Review of a physician's order dated 7/31/25, indicated that Resident R4 NSS.

Gently dry.

Apply sm (small) amt zinc-oxide barrier cream and cover with bordered foam. every day shift for wound care.

Review of Resident R4's TAR for August 2025, failed to reveal documentation that wound care was completed for Resident R4's right foot wound or coccyx on 8/2/25.

Review of Resident R4's progress notes failed to reveal a documented reason for the lack of wound care on 8/2/25.

Review of the clinical record revealed Resident R5 was admitted to the facility on [DATE].

Review of the MDS dated [DATE], included diagnoses of leukemia (type of cancer that affects the blood and bone marrow), deep vein thrombosis (DVT, is a blood clot that forms in a deep vein, usually in the leg or pelvis), and syncope (fainting or passing out).

Review of Resident R5's care plan for at risk for skin breakdown initiated on 7/28/25, indicated for staff to observed Resident R5's skin for signs/symptoms of skin breakdown.

Review of a physician's order dated 8/1/25, indicated that Resident R5 R Foot amputation site- cleanse incisions with nss, apply perform and cover with a dry dressing and kling every day shift for incision care.

Review of a physician's order dated 7/31/25, indicated that for Resident R5's Bilateral shin abrasions- cleanse with NSS.

Gently dry.

Apply single layer, small piece of Xeroform to wound bed and cover with bordered gauze.

Review of Resident R5's TAR for August 2025, failed to reveal documentation that wound care was completed for Resident R5's leg wounds on 8/3/25.

Review of Resident R5's progress notes failed to reveal a documented reason for the lack of wound care on 8/3/25.

During an interview on 8/4/25, at approximately 4:00 p.m. the Director of Nursing confirmed the facility failed to provide prescribed treatment and services related to the wounds for four of six residents. 28 Pa.

Code: 211.12(d)(1)(5) Nursing services.

Facility ID:

IDENTIFICATION NUMBER:

A.

Building

COMPLETED

08/19/2025

STREET ADDRESS, CITY, STATE, ZIP CODE

Abbeyville Skilled Nursing and Rehabilitation Cent

100 Abbeyville Road Lancaster, PA 17603

SUMMARY STATEMENT OF DEFICIENCIES

During an interview on 8/4/25, at 9:49 a.m.

Licensed Practical Nurse (LPN) Employee E2 confirmed that the call light panel at the nurses' station ([NAME]) did not activate.

During an observation on 8/4/25, at 9:54 a.m. staff were asked to activate the call lights in rooms [ROOM NUMBER]. At this time, Nurse Aide (NA) Employee E4 confirmed that the call light panel at the nurses' station ([NAME]) did not activate.

During an interview on 8/4/25, at 9:59 a.m.

Unit Manager (UM) Employee E3 was asked if the call light panel was operable. UM Employee E3 motioned to the light fixture at the hallway intersection and stated, That one's not working.

During an observation on 8/4/25, at 10:00 a.m. UM Employee E3 was asked to activate the call light in room [ROOM NUMBER].

The light above the door illuminated, but the panel at the nurses' station ([NAME]) did not activate.

When asked how long the call light panels at the nursing stations had not been operating, UM Employee E3 stated, No idea.

Review of the Nurse Call System Inspection Log indicated on 5/5/25, that the call light system on the [NAME] nursing unit was down.

Review of the Nurse Call System Inspection Log indicated on 6/2/25, that the call light system on the [NAME] nursing unit still not working.

This old system don't have part for this system.

Review of the Nurse Call System Inspection Log indicated on 7/16/25, that the call light system on the [NAME] nursing unit not working.

During an interview on 8/4/25, at 10:28 a.m. the Director of Nursing and Maintenance Employee E5 confirmed that the call light panel on the [NAME] nursing unit, the [NAME] nursing unit, and the call light panel shared nursing station for Roosevelt and Arcadia did not activated at the centralized location, and further confirmed that the facility did not utilize any communication devices that would alert staff members directly of a call light activation.

During an interview on 8/4/25, at 10:30 a.m. the Director of Nursing confirmed that the facility failed to maintain a fully functioning resident call bell system that allows residents to call for staff assistance through a communication system which relays the call directly to a staff member or to a centralized staff work area in four of five nursing units. 28 Pa Code 207.2(a) Administrators responsibility 28 Pa Code 205.28 (c)(1)(4) Nurses station

Facility ID: