Health inspection·December 5, 2025

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy, clinical record review, and staff interview, it was determined that the facility failed to notify a resident representative of a resident to resident abuse incident for one of four residents (Resident R1).Review of the Resident Assessment Instrument 3.0 User's Manual effective October 2025, indicated that a Brief Interview for Mental Status ( BIMS) is a screening test that aids in detecting cognitive impairment. The BIMS total score suggests the following distributions: 13-15: cognitively intact8-12: moderately impaired0-7: severe impairment Review of the facility policy, Abuse, Neglect, and Exploitation dated 2/14/25, indicated that it is the policy of the facility to provide protections for the health, welfare, and rights of each resident. Review of the clinical record indicated Resident R1 was admitted to the facility on [DATE]. Review of the Minimum Data Set (MDS - periodic assessment of resident care needs) dated 8/12/25, included diagnoses of heart failure (a progressive heart disease that affects pumping action of the heart muscles) and dementia (a group of symptoms that affects memory, thinking and interferes with daily life). Review of Section C: Cognitive Patterns revealed a BIMS score of 07. Review of Resident R1's clinical record indicated that her child was her emergency contact and responsible party. Review of Resident R1's plan of care initiated 5/9/25, indicated Resident has an impaired mood status related to anxiety, dementia, admission to a skilled nursing facility, and a recent CVA (cardiovascular accident stroke). Review of the clinical record indicated Resident R2 was admitted to the facility on [DATE]. Review of the MDS dated [DATE], included diagnoses of diabetes (a metabolic disorder in which the body has high sugar levels for prolonged periods of time) and dementia. Review of Section C: Cognitive Patterns revealed a BIMS score of 04. Review of Resident R2's clinical record indicated that her child was her emergency contact and responsible party. Review of Resident R2's plan of care initiated 10/14/25, indicated Resident R2 has behaviors of combativeness, resisting care, anxiety, and wandering. Review of a progress note dated 10/15/25, at 9:10 p.m. indicated, Resident (Resident R2) witnessed standing over roommate (Resident R1) stating I need to change you Roommate witnessed crying saying she's scared. Attempted to redirect pt (patient) when she became irate saying she is trying to work. Review of Resident R1's progress notes failed to reveal any documentation of the incident or notification to Resident R1's representative of the incident. Review of a progress note dated 11/4/25, at 11:13 a.m. indicated, Resident (Resident R2) observed standing over her roommate (Resident R1) who was in her bed yelling at her stating that she stole her belongings. Resident extremely difficult to redirect. Review of Resident R1's progress notes failed to reveal any documentation of the incident or notification to Resident R1's representative of the incident. During an interview on 12/5/25, at approximately 3:20 p.m. the Director of Nursing confirmed the facility failed to notify a resident representative of a resident to resident abuse incident for one of four residents. 28 Pa. Code 201.14(a) Responsibility of licensee.28 Pa. Code 201.18(b)(e)(1) Management.28 Pa. Code (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 5 Event ID: 395028 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 395028 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Squirrel Hill Wellness and Rehabilitation Center 2025 Wightman Street Pittsburgh, PA 15217 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)