Inspection·October 23, 2024

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy, review of clinical documentation and staff interview it was determined the facility failed to have accurate narcotic count sheets from shift to shift, failed to document the disposition of narcotics accurately, and failed to identify discrepancies between Medication Administration Records and narcotics count sheets for three of five closed record residents (CR Resident R1, CR2, and CR3). Review of facility policy Management of Controlled Drugs, dated 8/24/23, indicated Schedule II to V controlled drugs must be disposed of in accordance with federal and state regulations. Review of facility documentation shift count ( a tool used for nursing to confirm the narcotic count is accurate shift to shift ongoing/off-going) for 3rd floor indicated the following: 10/6/24 status of count: blank with no response - no nurse coming on duty signature 10/16/24 no nurse coming on duty signature 10/17/24 no nurse going off duty signature 10/18/24 no nurse going off duty signature 10/22/24 no nurse coming on duty signature Review of Closed Record Resident R1 was admitted to the facility on [DATE], and CTB on 10/7/24. Review of clinical record indicated CR Resident R1 was admitted with the following diagnosis: acute kidney failure (kidneys can't filter waste from blood) and diabetes mellitus (too much sugar in the blood), which remained curtain as of MDS (minimum data set a periodic assessment of resident needs) dated 9/30/24. Review of facility documentation controlled drug administration record tablet - fentanyl 12.5 mcg/hr patch, with CTB (ceased to breath) written on the form has destroyed written on the form but does not indicate how many were destroyed. Hydrocodone 325 mg - CTB destroyed but does not indicate how many were destroyed. Review of CR Resident R2 was admitted to the facility on [DATE], with the following diagnosis Thrombocytopenia (bleeding into tissue), and unspecified cirrhosis of the liver ( damage from a variety (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 2 Event ID: 395011 Printed: 05/15/2026 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 395011 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/23/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Platinum Ridge Ctr for Rehab & Healing 1050 Broadview Boulevard Brackenridge, PA 15014 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)