Epworth Healthcare And Rehabilitation Center

F-F656, revealed that the facility's QAPI committee failed to successfully implement their plan to ensure ongoing compliance with regulations regarding the development of comprehensive care plans.

The facility's plan of correction for a deficiency regarding a failure to update residents' care plans, cited

during the survey ending February 8, 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

F-F657, revealed that the facility's QAPI committee failed to successfully implement their plan to ensure ongoing compliance with regulations regarding updating residents' care plans.

The facility's plan of correction for a deficiency regarding the meeting professional standards, cited during the survey ending September 17, 2024, revealed that the facility would complete audits and report the results of

the audits to the QAPI committee for review. The results of the current survey, cited under

F-F658, revealed that the facility's QAPI committee failed to successfully implement their plan to ensure ongoing compliance with regulations regarding meeting professional standards.

The facility's plan of correction for a deficiency regarding quality of care, cited during the surveys ending and June 4, 2024 and July 22, 2024, revealed that the facility would complete audits and report the results of the audits to the QAPI committee for review. The results of the current survey, cited under

F-F684, revealed that

the facility's QAPI committee failed to successfully implement their plan to ensure ongoing compliance with regulations regarding quality of care

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 19 of 21 395393 Department of Health & Human Services Printed: 09/11/2025 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 395393 B. Wing 01/10/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Cedarwood Rehabilitation & Healthcare Center 951 Washington Avenue Tyrone, PA 16686

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 The facility's plan of correction for a deficiency regarding accident hazards, cited during the surveys ending and December 11, 2024, revealed that the facility would complete audits and report the results of the audits Level of Harm - Minimal harm or to the QAPI committee for review. The results of the current survey, cited under

F-F689, revealed that the potential for actual harm facility's QAPI committee failed to successfully implement their plan to ensure ongoing compliance with regulations regarding accident hazards. Residents Affected - Few

The facility's plans of correction for deficiencies regarding failure to provide menus made in advance and followed, cited during the surveys ending December 11, 2024, revealed that the facility developed plans 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

F-F803, revealed that the facility's QAPI committee failed to maintain compliance with the regulation regarding following menus as posted.

The facility's plans of correction for deficiencies regarding failure to provide nutritious and palatable food service, cited during the surveys ending December 11, 2024, revealed that the facility developed plans 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

F-F804, revealed that the facility's QAPI committee failed to maintain compliance with the regulation regarding nutritious and palatable food service.

The facility's plans of correction for deficiencies regarding failure to prepare, store, and serve food under sanitary conditions, cited during the surveys ending February 8, 2024 and December 11, 2024, revealed that

the facility developed plans 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

F-F812.

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

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

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 20 of 21 395393 Department of Health & Human Services Printed: 09/11/2025 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 395393 B. Wing 01/10/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Cedarwood Rehabilitation & Healthcare Center 951 Washington Avenue Tyrone, PA 16686

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 0921 Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 38012

Residents Affected - Few Based on observations and staff interviews, it was determined that the facility failed to provide comfortable temperatures for one of three dining rooms in the facility (fourth floor Dining Room).

Findings include:

Observations in the fourth floor dining room on January 7, 2025, at 11:40 a.m. revealed that there were five residents waiting for lunch. The temperature in the dining room was 64 degrees Fahrenheit.

Observations in the fourth floor dining room on January 9, 2025, at 12:16 p.m. revealed that there were five people eating there and the temperature ranged from 60 to 70 degrees Fahrenheit.

Interview with the Maintenance Director on January 7, 2025, at 11:40 a.m. revealed that the doors to the fourth floor dining room were closed and the heat was not circulating into the dining room from the hallways.

He indicated that when the doors were open, the dining room was warm. At 2:20 p.m. the temperature in the fourth floor dining room was 73.4 degrees Fahrenheit.

Interview on January 9, 2025, at 2:18 p.m. with the owner of the heating, ventilation, and air conditioning (HVAC company) company that came to the facility on [DATE REDACTED], revealed that the dampers were slightly open to the outside and once closed the cold air stopped circulating into the dining room and the dining room temperatures were within normal range.

Interview with the Maintenance Director on January 7, 2025, at 11:40 a.m. and again on January 8, 2025, at 12:22 p.m. revealed that the temperature was outside the acceptable parameters in the fourth floor dining room. He further stated staff would need to leave the doors open to the dining room so that heat from the hallway could enter the dining room.

28 Pa. Code 207.2(a) Administrator's Responsibility.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 21 of 21 395393