Health inspection·February 9, 2024

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, clinical record review, and staff interviews, it was determined that the facility failed to ensure that residents received treatment and care in accordance with standards of practice and physicians' orders regarding surgical site care which resulted in a failure of timely care for three of five residents (Residents R1, R2, and Closed Record CR1). Residents Affected - Few Findings Include: A review of the facility policy, Skin Assessment dated 4/26/23, indicated: -Non-pressure related skin conditions include but is not limited to skin tear, arterial ulcer, venous ulcer, foot problem, surgical wound, rash, cut, laceration, open lesion, or burn. -The licensed nurse will complete a head to toe skin assessment within two to six hours of admission/readmission to identify the presence of any skin issue. -If a non-pressure area is identified, will document a complete assessment on the N. Adv Skin Only Evaluation and reassess weekly until healed. -Describe the treatment order and response to treatment. Review of admission record indicated Resident R1 was admitted to the facility on [DATE]. Review of Resident R1's Minimum Data Set (MDS- a periodic assessment of care needs) dated 1/31/24, indicated diagnoses of heart failure (a condition in which the heart doesn't pump blood as well as it should), high blood pressure, and left hip fracture. Section C indicated a Brief Interview for Mental Status (BIMS) score of 13 - cognitively intact. Review of Resident R1's Skin Only Evaluation dated 1/25/24, indicated post-surgical (after an operation) Aquacel (wound dressing) intact to left hip. Review of Resident R1's Skilled Evaluation V6.3 dated 2/1/24, indicated no skin issues. Review of Resident R1's Hospital Final Report document dated 1/25/24, indicated Aquacel dressing until post-op day seven. May shower. After post-op day seven clean wound with alcohol and apply 4x4 dressing and tape. Must cover for showers. Review of Resident R1's Treatment Administration Records (TAR) dated January and February 2024, (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 3 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 02/09/2024 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)