Health inspection·May 2, 2025

F 0554 Allow residents to self-administer drugs if determined clinically appropriate. 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, observations and staff interview, it was determined that that the facility failed to determine it was safe to self-administer medications, did not have a current order or care plan to self-administer medications, or an interdisciplinary assessment for one of five residents (Resident R302). Residents Affected - Few Findings include: Review of the facility policy Self-Administration of Medications by Residents last reviewed 3/19/25, indicated self-administration of medication is the ability of a resident to take medications independently without assistance from another person. The resident shall be assessed for competency using the assessment for self-administration of medications. The results shall be documented in the resident's record and care plan. Specific orders for self-administration of medication shall be documented in the resident's medical record and care plan. Each resident's medication shall be clearly labeled by the prescribing pharmacy. Review of the facility policy Skin and Wound Assessment last reviewed 3/19/25, indicated residents identified with a pressure ulcer or non-pressure related skin conditions will be monitored for evidence of further breakdown or complication. Verify a physician's order for the procedure. Review of the facility policy Medications Administration last reviewed 3/19/25, indicated medications shall be administered only upon the order of physicians and physician extenders who are authorized and have been granted clinical privileges to write such orders. Licensed nurses shall administer prescribed medications, fluids and treatments. Review of the admission record indicated Resident R302 was admitted to the facility on [DATE], with diagnosis that included irritable bowel syndrome (IBS- a gastro-intestinal disorder that causes abdominal pain, bloating and changes in bowel patterns), overactive bladder (sudden urges to urinate that are hard to control), and dysphagia (difficulty in swallowing). During an interview and observation completed on 4/28/25, at 10:51 a.m. Resident R302 voiced that she has frequent episodes of incontinence and her bottom was raw, bleeding and sore. Resident 302 stated I wash and clean myself and apply Aquaphor ointment and desitin cream, and further stated I would like a good look over when I get my shower. The Aquaphor ointment was observed sitting next to the commode in her bathroom. During an interview completed on 4/28/25, at 10:58 a.m. Registered Nurse (RN) Employee E1 confirmed the Aquaphor ointment was in Resident R302's bathroom and stated, there is not a label, I think her family brought it in for her to use. (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 11 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 05/02/2025 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)