Wayne Woodlands Manor
Inspection Findings
F-Tag F0697
F 0697 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
provider order. September 5, 2025, at 11:20AM- Hydrocodone/Acetaminophen 5/325mg was administered for a pain scale 7 despite the provider order. September 6, 2025, at 1:33PM- Hydrocodone/Acetaminophen 5/325mg was administered for a pain scale 9 despite the provider order. September 7, 2025, at 04:47AMHydrocodone/Acetaminophen 5/325mg was administered for a pain scale 9 despite the provider order.
September 8, 2025, at 07:41AM- Hydrocodone/Acetaminophen 5/325mg was administered for a pain scale 7 despite the provider order. September 8, 2025, at 7:51PM- Hydrocodone/Acetaminophen 5/325mg was administered for a pain scale 8 despite the provider's order. September 9, 2025, at 08:13AMHydrocodone/Acetaminophen 5/325mg was administered for a pain scale 8 despite the provider order.
September 9, 2025, at 8:14PM- Hydrocodone/Acetaminophen 5/325mg was administered for a pain scale 7 despite the provider order. September 10, 2025, at 5:18PM- Hydrocodone/Acetaminophen 5/325mg was administered for a pain scale 7 despite the provider's order. September 12, 2025, at 08:44AMHydrocodone/Acetaminophen 5/325mg was administered for a pain scale 7 despite the provider order.
September 13, 2025, at 08:17AM- Hydrocodone/Acetaminophen 5/325mg was administered for a pain scale 7 despite the provider order. September 14, 2025, at 06:39AM- Hydrocodone/Acetaminophen 5/325mg was administered for a pain scale 6 despite the provider order. September 14, 2025, at 7:10PMHydrocodone/Acetaminophen 5/325mg was administered for a pain scale 9 despite the provider order.
September 15, 2025, at 05:49AM- Hydrocodone/Acetaminophen 5/325mg was administered for a pain scale 6 despite the provider order. September 15, 2025, at 8:20PM- Hydrocodone/Acetaminophen 5/325mg was administered for a pain scale 7 despite the provider order. September 16, 2025, at 10:19AMHydrocodone/Acetaminophen 5/325mg was administered for a pain scale 7 despite the provider order.
September 16, 2025, at 7:51PM- Hydrocodone/Acetaminophen 5/325mg was administered for a pain scale 7 despite the provider order. September 17, 2025, at 02:37AM- Hydrocodone/Acetaminophen 5/325mg was administered for a pain scale 7 despite the provider order. September 17, 2025, at 08:54AMHydrocodone/Acetaminophen 5/325mg was administered for a pain scale 7 despite the provider order.
September 17, 2025, at 4:31PM- Hydrocodone/Acetaminophen 5/325mg was administered for a pain scale 8 despite the provider order. The clinical record did not contain documentation explaining clinical reasoning for these administrations when the pain levels did not meet the ordered parameters.An interview was conducted on November 21, 2025, at 12:35 PM with the Director of Nursing to review the findings related to CR1. 28 Pa. Code 211.10(d) Resident care policies.28 Pa Code 211.12 (d)(3)(5) Nursing Services.
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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
11/21/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Wayne Woodlands Manor
37 Woodlands Drive Waymart, PA 18472
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-Tag F0757
F 0757 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
9, 2025, at 2:40 PM, all indicated no changes in the resident's condition that would justify initiating Macrobid prior to receiving culture results. A review of the October 2025 Medication Administration Record revealed the resident received two doses of Macrobid before laboratory confirmation of an infection requiring antibiotic therapy and before the organism's resistance to Macrobid was known. The clinical
record did not contain any documentation of urinary symptoms that would meet clinical criteria for initiating empiric antibiotic therapy (use of antibiotics before laboratory results are known). The facility was unable to provide documentation of McGeer's criteria, a standardized set of infection surveillance criteria used in long-term care settings to determine when an infection is present. These criteria require documented urinary symptoms to justify antibiotic treatment, and no such symptoms were documented. During an
interview with the Director of Nursing (DON) on November 20, 2025, at 1:15 PM, the DON reviewed the clinical findings with the surveyor. The DON acknowledged the documented sequence of events and discussed that the antibiotic had been started before culture confirmation and without documented clinical symptoms. 28 Pa. Code 211.10 (c) Resident care policies.28 Pa. Code 211.12 (d)(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
11/21/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Wayne Woodlands Manor
37 Woodlands Drive Waymart, PA 18472
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-Tag F0773
F 0773 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
Provide or obtain laboratory tests/services when ordered and promptly tell the ordering practitioner of the results. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review and staff interview, the facility failed to ensure that laboratory and diagnostic test results were promptly provided to the ordering physician for one of twenty sampled residents (Resident CR1).Findings include: A review of resident CR 1's record revealed the resident was admitted to the facility
on [DATE REDACTED], with diagnoses to include chronic obstructive pulmonary disorder (a condition caused by damage to the airways or other parts of the lung) and muscle weakness. A review of a quarterly Minimum Data Set assessment (MDS, a federally mandated standardized assessment process conducted periodically to plan resident care) dated August 11, 2025, revealed that Resident CR 1 had intact cognition with a BIMS score of 13 (Brief Interview for Mental Status, a tool within the Cognitive Section of the MDS that is used to assess the resident's attention, orientation, and ability to register and recall new information;
a score of 13-15 indicates cognition is intact). A nursing progress note dated October 9, 2025, at 8:03 AM documented a phone call from the resident's family reporting the resident was experiencing uncontrolled head and neck pain following a fall within the facility. A cervical spine x-ray (a diagnostic test that uses radiographs to visualize the bones of the neck) was completed on October 9, 2025, at 11:24 AM. The x-ray report identified an apparent right-lung infiltrate, which is an abnormal substance or fluid in lung tissue that can occur for various reasons, including infection. The report recommended clinical correlation and a follow-up chest x-ray. A review of Resident CR1's clinical record revealed no documentation that the physician was notified of the abnormal x-ray findings. The clinical record also revealed no documentation that the recommended follow-up chest x-ray had been completed. During an interview on November 21, 2025, at approximately 12:00 PM, the Director of Nursing (DON) reviewed the above findings with the surveyor. The DON did not provide an explanation for the absence of documentation showing the physician had been notified of the abnormal results or had reviewed the x-ray findings. The DON confirmed that it is
the facility's responsibility to ensure the physician is promptly provided with laboratory and diagnostic test results. 28 Pa Code 211.2 (d)(3) Medical director. 28 Pa Code 211.12 (d)(3) Nursing services.
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WAYNE WOODLANDS MANOR in WAYMART, PA inspection on recent inspection.
Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.
Frequently Asked Questions
- What is an F-tag violation?
- F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
- Were these violations corrected?
- Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
- How often do nursing home inspections happen?
- CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
- What should families do about these violations?
- Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in WAYMART, PA, (5) Report new concerns to state authorities.
- Where can I see the full inspection report?
- Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from WAYNE WOODLANDS MANOR or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.