Health inspection·October 27, 2023

F 0557 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions. Based on a review of facility policies, observations and staff interviews it was determined that the facility failed to provide a dignified dining experience to the residents of one of five nursing units/country kitchen (Building Two, Floor Two). Findings include: A review of facility policy Resident Rights dated 10/18/23, indicated that residents of the facility have a right to a dignified existence. During an observation on 10/19/23, at 9:00 a.m., it was revealed that the facility was utilizing disposable styrofoam products to serve the residents their breakfast meal for residents of the Building Two, Floor Two Nursing unit/Country Kitchen. During an interview on 10/19/23, at 9:30 a.m., the Food Service Manager Employee E1 confirmed that the facility's dish machine located at Building Two, Floor Two Nursing unit/Country Kitchen had been non operational for an extended undetermined length of time, Food Service Manager Employee E1 also confirmed that the facility was using disposable styrofoam products to serve residents all of their meals. During an interview on 10/19/23, at 2:30 p.m., the Nursing Home Administrator confirmed that the facility was utilizing disposable styrofoam products to serve all meals to the residents located at Building Two, Floor Two Nursing Unit/Country Kitchen and failed to to provide the resident with a dignified dining experience for an extended undetermined length of time. PA Code: 201.29(k) Resident Rights 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: 395034 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 395034 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vincentian Home 111 Perrymont Road Pittsburgh, PA 15237 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)