F-F684 on May 30, 2025. Residents Affected - Few 28 Pa. Code 211.12(d)(1)(5) Nursing Services.
FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 9 of 14 395726 Department of Health & Human Services Printed: 08/26/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 395726 B. Wing 06/05/2025
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Harmon House Health & Rehab Center 601 South Church Street Mount Pleasant, PA 15666
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 0694 Provide for the safe, appropriate administration of IV fluids for a resident when needed.
Level of Harm - Minimal harm or 19102 potential for actual harm Based on review of policies and clinical records, as well as staff interviews, it was determined that the facility Residents Affected - Some failed to ensure that physician's orders were obtained for flushing intravenous (IV) catheters, and/or that intravenous catheters were flushed according to the facility's policy for two of 39 residents reviewed (Residents 54, 61) who had long-term intravenous catheters.
Findings include:
The facility's policy regarding flushing intravenous catheters (a thin tube placed in a vein that can be used for
an extended period of time to deliver fluids and/or medications), dated August 14, 2024, revealed that specific flush orders must be obtained, documented and submitted to the pharmacy. Flushing is performed to ensure and maintain catheter patency and to prevent the mixing of incompatible medications/solutions. All peripheral vascular access devices are flushed between incompatible medications with normal saline or other flush solution as recommended by the manufacturer.
An admission Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) for Resident 54, dated May 19, 2025, revealed that the resident was cognitively intact and was dependent for daily care needs.
Physician's orders for Resident 54, dated May 16, 2025, included orders to insert an IV catheter (a thin, flexible tube that is placed in a vein to administer fluids) and start Normal Saline at 80 milliliters (ml)/hour (hr).
A nursing note, dated May 16, 2025, at 10:00 a.m., revealed that the nursing supervisor was called to Resident 54's room due to a change in condition. Resident 54 was lethargic, was not responsive, and vital signs were within normal limits. The Certified Registered Nurse Practioner (CRNP - a registered nurse with advanced training to assess patient needs, order and interpret diagnostic and laboratory tests, diagnose disease, prescribe medications and formulate treatment plans) was at the bedside and ordered an IV catheter to be inserted with Normal Saline infusing at 80 ml/hr. The IV catheter was inserted without difficulty with excellent blood return and it flushed well.
Review of Resident 54's Medication Administration Records (MAR's) for May 2025 revealed no documented evidence that the IV catheter was inserted, the resident received Normal Saline at 80 ml/hr, or that the IV was flushed.
Interview with the Director of Nursing on June 4, 2025, at 1:57 p.m. confirmed that there was no documented evidence that Resident 54 had an IV inserted with Normal Saline infusing at 80 ml/hr or that the IV was flushed.
An admission Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) for Resident 61, dated May 25, 2025, revealed that the resident was cognitively intact, had IV access, and received an antibiotic.
FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 10 of 14 395726 Department of Health & Human Services Printed: 08/26/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 395726 B. Wing 06/05/2025
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Harmon House Health & Rehab Center 601 South Church Street Mount Pleasant, PA 15666
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 0694 Physician's orders for Resident 61, dated May 23, 2025, included orders for staff to flush the resident's midline using 10 ml of 0.9 percent sodium chloride before and after medication administration, followed by 30 Level of Harm - Minimal harm or units of Heparin three times a day (6:00 a.m., 2:00 p.m., 9:00 p.m.). potential for actual harm Physician's orders for Resident 61, dated May 29, 2025, included orders for the resident to receive 720 Residents Affected - Some milligrams (mg) of Daptomycin (an antibiotic) intravenously (IV) once a day (5:00 a.m.) and 1 gram of Cefepime (an antibiotic) intravenously every 12 hours (8:00 a.m., 8:00 p.m.).
A nursing note, dated May 30, 2025, at 12:28 a.m. revealed the resident was receiving Cefepime and Daptomycin for osteomyelitis (bone infection) of the left heel.
Resident 61's Medication Administration Records (MAR's) for May and June 2025 revealed that the resident received IV Cefepime at 8:00 a.m. May 29 through June 4, 2025; however, there was no documented evidence that staff flushed the resident's midline catheter before and after the administration.
Interview with the Director of Nursing on June 5, 2025, at 11:45 a.m. confirmed that there was no documented evidence that Resident 61's midline was flushed before and after the administration of Cefepime at 8:00 a.m.
28 Pa. Code 211.12(d)(3)(5) Nursing services.
FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 11 of 14 395726 Department of Health & Human Services Printed: 08/26/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 395726 B. Wing 06/05/2025
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Harmon House Health & Rehab Center 601 South Church Street Mount Pleasant, PA 15666
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 0867 Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action. Level of Harm - Minimal harm or potential for actual harm 31760
Residents Affected - Some Based on review of the facility's plans of correction for previous surveys, and the results of the current survey, it was determined that the facility's Quality Assurance Performance Improvement (QAPI) committee failed to maintain compliance with nursing home regulations and ensure that plans to improve the delivery of care and services effectively addressed recurring deficiencies.
Findings include:
The facility's deficiencies and plans of correction for State Survey and Certification (Department of Health) surveys ending June 27, 2024, and April 22, 2025, revealed that the facility developed plans of correction that included quality assurance systems with audits to ensure that the facility-maintained compliance with cited nursing home regulations. The results of the audits were to be reported to the QAPI committee for review. The results of the current survey, ending June 5, 2025, identified repeated deficiencies regarding accuracy of Minimum Data Set (MDS) assessments (mandated assessment of a resident's abilities and care needs), issues with intravenous therapy, and following infection control practices.
The facility's plan of correction for a deficiency regarding a failure to ensure that MDS assessments were accurate upon submission, cited during the survey ending June 27, 2024, revealed that the facility developed
a plan of correction that included completing audits and reporting the results of the audits to the QAPI committee for review. The results of the current survey, cited under