Health inspection·July 9, 2024

F 0602 Protect each resident from the wrongful use of the resident's belongings or money. Level of Harm - Minimal harm or potential for actual harm Based on staff interview, record review, and policy review, it was determined that the facility failed to ensure a resident was free from financial exploitation for one of three residents reviewed (Resident 1). Residents Affected - Few Findings include: A review of the facility policy, titled Abuse, Neglect, Exploitation or Misappropriation-Reporting and Investigation, last revised September 2022, stated, if resident abuse, neglect, exploitation, misappropriation of resident property or injury of unknown source is suspected, the suspicion must be reported immediately to the administrator, and to other officials according to state law. Exploitation is defined as: An act or course of conduct by a caretaker or other person against an older adult or an older adult's resources, without the informed consent of the older adult or with consent obtained through misrepresentation, coercion or threats of force, that results in monetary, personal or other benefit, gain or profit for the perpetrator or monetary or personal loss to the older adult. A review of the clinical record for Resident 1 on July 8, 2024, at 10:00 AM, revealed clinical diagnoses that included dementia (irreversible, progressive degenerative disease of the brain, resulting in loss of reality contact and functioning ability) and age-related cognitive decline (subtle to severe thinking speed and decline of attention span). A review of Resident 1's Quarterly MDS (Minimum Data set- a periodic assessment of the resident) dated July 5, 2024, reveals a BIMS (brief interview of mental status) score of 6 out of a possible 15, indicating cognitive status is severely impaired. Select document review revealed that a representative from a contracted financial company entered Resident 1's room and had the resident sign a authorization form to withdrawal money from the resident's bank account. Further review revealed that the financial power of attorney (POA) for Resident 1 was never notified about an authorization form or withdraw of $12.000.00 from Resident 1's account; and was only made aware when she went to the bank in April 2024 to make a withdraw for payment to the facility. During an interview with the Nursing Home Administrator (NHA) on July 8, 2024, the NHA confirmed that he informed the financial POA that the consent for the withdraw was obtained by Resident 1 in error, and due to incapacitation of Resident 1, the financial POA should have provided the consent. 28 Pa. Code 201.18(b)(2) Management 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: 395074 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 395074 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/09/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Spring Creek Rehabilitation and Nursing Center 1205 South 28th Street Harrisburg, PA 17111 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)