Woodhaven Health & Rehab Center

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

she needs it and her legs are swollen. Otherwise, suggest switching to daily dose. Review of a progress note dated 7/21/25, at 9:04 a.m. indicated, Resident has increase resp (respirations) with use of accessory muscles. Lungs have wheezes bil (bilaterally, both sides) with scattered crackles bil. Pulse ox is 90% with oxygen at 3 liters via nasal cannula. Resident has increased confusion during verbal interaction. Resident is easy to arouse with verbal stimuli. Heart rate strong and strong and reg. Cap refill (capillary refill) is less than 3 sec. VSS (vital signs stable) resident is afebrile. RNS (Registered Nurse Supervisor) aware and will make MD (Doctor of Medicine) aware during AM (morning) rounds. Review of a physician's note dated 7/21/25, at 11:03 a.m. indicated, Patient seen for increased LE (lower extremity) edema. Daughter had called in expressing concern in swelling in her legs. Patient is seen in her room this morning. The note further stated suspect CHF congestive heart failure. Review of a progress note dated 7/22/25, at 1:02 p.m. indicated that the physician was advised of a 13-pound weight gain. Review of the weight records indicated that Resident Resident R1 had a 23-pound weight gain, not 13-pound. Review of a physician's note dated 7/23/25, at 9:46 a.m. indicated, Patient seen for follow-up of recent visits for leg swelling and weight gain. This morning, nursing noted her HR (heart rate) to be elevated to 120s. Patient was started on increased dose of Lasix yesterday for finding of LLL (left lower lobe of the lung) fluid on CXR (chest x-ray). During an interview on 8/27/25, at approximately 12:45 p.m. the Nursing Home Administrator and the Director of Nursing confirmed the facility failed to provide treatment and services related to heart failure for one of three residents. 28 Pa. Code: 211.12(d)(1)(3)(5) Nursing services.

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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

09/03/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Woodhaven Health & Rehab Center

2400 McGinley Road Monroeville, PA 15146

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 0742 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

appointments in July would be changed. Review of provider office visit notes dated 8/19/25, indicated, [Urology provider] stated there have been 4 appointments scheduled for this patient and [facility] had cancelled 3 of these appointments and had reported to [Urology provider] the did not have a escort for the appointment. The last appointment (4th appointment) was a no show. During an interview on 9/3/25, at approximately 12:00 p.m. the Nursing Home Administrator confirmed the facility failed to schedule ordered appointments and failed to make certain residents with intellectual disabilities receive appropriate services for one of three residents. 28 Pa. Code 201.14(a) Responsibility of licensee. 28 Pa. Code 201.18 (b)(1)(3)(e)(1) Management. 28 Pa. Code 201.29 (a)(j) Resident rights. 28 Pa. Code 211.16 (a) Social services. 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services.

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

09/03/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Woodhaven Health & Rehab Center

2400 McGinley Road Monroeville, PA 15146

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 0745 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Faslodex injection: Cancelled.4/29/25, Faslodex injection: Cancelled.4/30/25, Abdominal CT: Cancelled.5/01/25, Faslodex/labs: Cancelled.5/13/25, Three-month follow-up: Cancelled.5/21/25, Abdominal CT: Cancelled.5/27/25, Faslodex injection: Cancelled.5/29/25, Faslodex injection: Cancelled.6/02/25, DXA (type of bone density x-ray): Cancelled.6/05/25, Faslodex/labs: No show.6/26/25, Faslodex injection: Cancelled.7/03/25, Faslodex injection: Cancelled.7/10/25, Faslodex injection: No show.7/31/25, Faslodex injection: Cancelled.8/07/25, Faslodex injection: No show. During an interview on 9/3/25, at approximately 12:00 p.m. the Nursing Home Administrator confirmed the facility failed to schedule ordered appointments and failed to provide transportation for one of three residents. 28 Pa. Code 201.14(a) Responsibility of licensee. 28 Pa. Code 201.18 (b)(1))(3)(e)(1) Management. 28 Pa. Code 201.29 (a)(j) Resident rights. 28 Pa. Code 211.2 (a) Physician services. 28 Pa. Code 211.16 (a) Social services. 28 Pa.

Code 211.12(d)(1)(3)(5) Nursing services.

Event ID:

Facility ID:

If continuation sheet