Weatherwood Healthcare And Rehabilitation Center

F-F758

28 Pa. Code 211.2 (d)(3)(9) Medical director.

28 Pa. Code 211.9 (k) Pharmacy services.

28 Pa. Code 211.12 (d)(3) Nursing services.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 13 of 18 395464 Department of Health & Human Services Printed: 09/17/2025 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 395464 B. Wing 07/12/2024

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

Forest Hills Rehabilitation & Healthcare Center 1000 Evergreen Avenue Weatherly, PA 18255

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 0842 Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 43944

Residents Affected - Some Based on review of clinical records and staff interview, it was determined that the facility failed to maintain accurate and complete clinical records, according to professional standards of practice for three residents out of 35 sampled (Resident 127, 149, and 178).

Findings include:

According to the American Nurses Association Principles for Nursing Documentation, nurses document their work and outcomes and provide an integrated, real-time method of informing the health care team about the patient status. Timely documentation of the following types of information should be made and maintained in

a patient record to support the ability of the health care team to ensure informed decisions and high quality care in the continuity of patient care: Assessments, Clinical problems, Communications with other health care professionals regarding the patient, Communication with and education of the patient, family, and the patient's designated support person and other third parties.

According to the Title 49, Professional and Vocational Standards, Department of State, Chapter 21 State Board of Nursing Subsection 21.11 (a) The register nurse assesses human responses and plans, implements and evaluates nursing care for individuals or families for whom the nurse is responsible. In carrying out this responsibility, the nurse performs all of following functions: (4) Carries out nursing care actions which promote, maintain, and restore the well-being of individuals (6)(b) The registered nurse is fully responsible for all actions as a licensed nurse and is accountable to clients for the quality of care delivered and Subsection 21.18. (a)(5) document and maintain accurate records.

According to the Title 49, Professional and Vocational Standards, Department of State, Chapter 21 State Board of Nursing Subsection 21.145. (a) The licensed practical nurse (LPN) is prepared to function as a member of a health-care team by exercising sound nursing judgement based on preparation, knowledge, skills, understanding and past experiences in nursing situations. The LPN participates in the planning, implementation, and evaluation of nursing care in settings where nursing takes place.

A review of Resident 127's clinical record revealed that the resident was admitted to the facility on [DATE REDACTED], with diagnoses that included cerebral infarction (occurs when the blood supply to part of the brain is blocked or reduced and prevents brain tissue from getting oxygen and nutrients), muscle weakness, and lack of coordination.

A review of Resident 149's clinical record revealed that the resident was admitted to the facility on [DATE REDACTED], with diagnoses that included chronic obstructive pulmonary disease (COPD - is a common, preventable and treatable disease that is characterized by persistent respiratory symptoms like progressive breathlessness and cough), emphysema (is a lung condition that causes shortness of breath due to damage to the air sacs

in the lungs (alveoli) and over time, the surface area of the lungs is reduced and the amount of oxygen reaching the bloodstream is decreased).

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 14 of 18 395464 Department of Health & Human Services Printed: 09/17/2025 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 395464 B. Wing 07/12/2024

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

Forest Hills Rehabilitation & Healthcare Center 1000 Evergreen Avenue Weatherly, PA 18255

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 0842 A review of information dated April 16, 2024, at 1:00 p.m., submitted by the facility revealed that bed bugs were found in Residents 127 and 149's room and that both residents were relocated to two separate rooms. Level of Harm - Minimal harm or potential for actual harm A review of Resident 127's clinical record, conducted during the survey ending July 12, 2024, revealed no documented evidence of the bed bugs in the resident's room and evidence that the resident was assessed Residents Affected - Some for any physical effects, such as bites, rash, swelling or skin irritation.

There was also no documented evidence that Resident 127's representative was informed of the temporary room change and the reason.

A review of Resident 149's clinical record, conducted during the survey ending July 12, 2024, revealed no documented evidence of the bed bugs in the resident's room and evidence that the resident was assessed for any physical effects, such as bites, rash, swelling or skin irritation.

There was also no documented evidence that Resident 149's representative was informed of the temporary room change and the reason.

During an interview with the Director of Nursing (DON) on July 11, 2024, at 11:20 a.m., revealed that when

the bed bugs were found the nursing performed skin assessments, but did not document the assessment in

the resident's clinical record.

The DON confirmed that Resident 127 and 149's clinical records did not include documented evidence of the bed bugs, physical assessment of the residents, and any measures taken with the residents related to the bed bugs.

Review of the clinical record revealed that Resident 178 was admitted to the facility on [DATE REDACTED], with diagnoses to include anoxic brain damage, hypertension, and disorientation.

Nursing noted on June 6, 2024, at 1:34 AM that a nurse aide informed the nurse that Resident 178 stated that she wanted to kill herself. The nurse spoke with resident, who stated that she does not have a plan, but does wish to die.

A Social Services note dated June 6, 2024, at 3:16 PM indicated that a support visit held with resident secondary to suicidal ideations. Resident is alert, oriented to person, resting in bed, without appearing in any distress, speaking calmly. The resident did confirm not wishing to hurt herself and denies any suicidal ideations at this time. Resident appeared to feel safe within her surroundings and did not voice any concerns. Referral made for psych services. Resident 178 does not receive any psychotropic medications, according to the entry.

A review of a psychiatry note dated June 10, 2024, at 12:00 AM indicated that the resident was seen for an initial psychiatric evaluation. She admits to anxiety, depression, and racing thoughts. Tearful throughout visit and per staff, her mood is very anxious. Sleep waivers, appetite limited. Denies suicidal/homicidal ideation). Resident has been compliant with psychotropic medications with no adverse effects noted. No problems reported per staff or nurses, notes. No concerns noted during visit today. The continued use of psychotropics is in accordance with relevant current standards of practice and any attempted dose reduction would be likely to impair the resident's function or exacerbate their underlying psychiatric disorder.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 15 of 18 395464 Department of Health & Human Services Printed: 09/17/2025 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 395464 B. Wing 07/12/2024

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

Forest Hills Rehabilitation & Healthcare Center 1000 Evergreen Avenue Weatherly, PA 18255

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 0842 A review of the resident's medication administration record (MAR) for the month of June 2024, revealed however, that the resident was not prescribed, nor received any psychotropic medications at the time of the Level of Harm - Minimal harm or psychiatry note dated June 10, 2024. potential for actual harm

The psychiatry note dated June 10, 2024, at 12:00 AM did not reference awareness of the resident's Residents Affected - Some statement that she was going to kill herself, and wished to die. The psych note also inaccurately documented that the resident was receiving psychotropic medications, when no physician orders, for psychotropic medications, were in effect and the resident had not been prescribed psych meds at that time

Interview with the Director of Nursing (DON) on July 11, 2024, at approximately 9:25 AM, confirmed that there was no documented evidence in the resident's psychiatry note dated June 10, 2024, at 00:00 hours (12:00 AM), of the resident's statement of suicidal ideations, and that the note inaccurately documented that

the resident was receiving psychotropic medications.

28 Pa. Code 211.5 (f)(iii) Medical records.

28 Pa. Code 211.12 (c)(d)(1)(5) Nursing services.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 16 of 18 395464 Department of Health & Human Services Printed: 09/17/2025 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 395464 B. Wing 07/12/2024

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

Forest Hills Rehabilitation & Healthcare Center 1000 Evergreen Avenue Weatherly, PA 18255

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 0849 Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 48276

Residents Affected - Some Based on observation, clinical record review, and staff interview, it was determined that the facility failed to ensure the coordination of hospice services with facility services to meet the resident's needs on a daily basis for two out of 35 residents sampled (Residents 98 and 101).

Findings include:

Clinical record review revealed Resident 101 was admitted to the facility on [DATE REDACTED], with diagnoses that included dementia (a condition characterized by the loss of cognitive functioning such as thinking, remembering, and reasoning, to such an extent that it interferes with a person's daily life and activities) and atherosclerotic heart disease (a condition characterized by the thickening or hardening of arteries caused by

a buildup of plaque in the inner lining of an artery).

Resident 101's care plan, revised April 5, 2024, indicated that the resident has a terminal prognosis with hospice care related to end-of-life diagnoses of cerebral atherosclerosis with a planned intervention indicating that nursing staff will collaborate with the hospice team to ensure the resident's spiritual, emotional, intellectual, physical, and social needs are met. The resident's care plan also indicated that hospice nurse aides are scheduled to visit Resident 101 every Tuesday and Friday at 12:00 PM, and a hospice registered nurse will visit every Tuesday at 12:00 PM. Resident 101's care plan indicated that integrated care will be provided by facility nursing staff and external hospice staff, ensuring the resident's physical and psychosocial needs are met.

A physician's order was noted April 6, 2024, for Resident 101 to receive hospice care for a diagnosis. However, a review of the resident's clinical record revealed no documented evidence of that Resident 101 was diagnosed with Parkinson's disease.

A review of the clinical record revealed that Resident 98 was admitted to the facility on [DATE REDACTED], with diagnoses that included Parkinson's disease (a disease that causes unintended or uncontrollable movements, such as shaking, stiffness, and difficulty with balance and coordination) and quadriplegia (severe or complete loss of motor function in all four limbs).

Resident 98's care plan, dated April 5, 2024, revealed that the resident had a terminal prognosis and was under the care of a hospice provider related to Parkinson's disease. Resident 98's care plan indicated that integrated care will be provided by facility nursing staff and hospice staff, ensuring the resident's physical and psychosocial needs are met. An intervention was planned for nursing staff to collaborate with the hospice team to ensure the resident's spiritual, emotional, intellectual, physical, and social needs are met.

The care plan indicated that hospice nurse aides are scheduled to visit Resident 98 Monday through Friday at 10 AM, and a hospice registered nurse will visit every Tuesday, Thursday, and Friday at 11:30 AM.

A physician's order was noted on April 6, 2024, for Resident 98 to receive hospice care related to a diagnoses of Parkinson's disease.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 17 of 18 395464 Department of Health & Human Services Printed: 09/17/2025 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 395464 B. Wing 07/12/2024

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

Forest Hills Rehabilitation & Healthcare Center 1000 Evergreen Avenue Weatherly, PA 18255

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 0849 When reviewed at the time of the survey ending July 12, 2024, there was no documented evidence in Resident 98's and 101's clinical records of the communication between hospice nurse aides and hospice Level of Harm - Minimal harm or registered nurses and facility nursing staff. potential for actual harm

An observation on July 11, 2024, at approximately 10:00 AM revealed Resident 98 and Resident 101's Residents Affected - Some hospice communication binder in the 2nd floor nursing station. When reviewed binder contained no documented evidence of the care provided by the hospice registered nurses or hospice nurse aides.

During an interview on July 11, 2024, at approximately 1:00 PM, the Director of Nursing (DON) was unable to provide documented evidence that hospice staff was communicating the care and services provided

during their scheduled visits with Residents 98 or 101. The DON stated that communication information should be kept in each resident's hospice communication binder to coordinate care and ensure the resident's physical and psychosocial needs are met.

28 Pa. Code 211.5 (f)(ii)(iii) Medical records.

28 Pa. Code 211.10 (c) Resident care policies.

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 18 of 18 395464