Inspection·December 29, 2022

F 0604 Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy and clinical record review, and resident and staff interview, it was determined the facility failed to identify bilateral leg straps as potential restraint or implement interventions and monitor the use of bilateral leg straps for one of one resident reviewed (Resident R30). Residents Affected - Few Findings include: Review of facility policy Restraints dated 3/2/22, indicated physical restraints are any manual, physical or mechanical device, material, or equipment, attached or adjacent to the resident's body that the individual cannot remove easily which restricts freedom of movement or normal access to the body. Examples include but are not limited to, leg restraints. Review of Resident R30's Minimum Data Set (MDS - periodic assessment of care needs) dated 10/28/22, indicated the resident was admitted to the facility on [DATE], Brief Interview for Cognitive Status indicated little to no impairment, and current diagnosis included high blood pressure, diabetes, and arthritis. During an observation and interview on 12/28/22, at 12:57 p.m., revealed Resident R30 was seated in a wheelchair with both feet placed on the wheelchair leg rests. Long velcro straps were wrapped around each of Resident R30's lower legs and attached to the individual leg rests. Resident R30 stated the straps were to prevent feet from falling off the leg rests while seated and I can not remove them. Review of Resident R30's current physician orders reviewed on 12/28/22, did not include orders for bilateral leg straps. During an interview on 12/28/22, at 2:05 p.m. Physical Therapist Employee E2 revealed that Resident R30 had no recommendation for the use of bilateral leg straps, or being evaluated for legs straps, and the leg straps have been in use since prior to 2021 when he started working at the facility. Therapy Employee E2 confirmed that therapy has not evaluated Resident R30 for the use of the leg straps. Review of Resident R30's plan of care revised 12/22/22, did not include interventions for the use of bilateral leg straps while in the wheelchair. Review of Resident R30's clinical record on 12/28/22, did not include documentation of evaluation, or monitoring for the use of bilateral leg straps. (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 6 Event ID: 395032 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 395032 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/29/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE McMurray Hills Rehabilitation and Healthcare Cente 249 West McMurray Road McMurray, PA 15317 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)