Inspection·October 25, 2023

F 0625 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave. Based on review of clinical records, as well as staff interviews, it was determined that the facility failed issue a bed-hold notice at the time of an anticipated leave of absence from the facility for one of four residents reviewed (Resident 2). Findings include: A discharge with return anticipated Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) for Resident 2, dated August 5, 2023, required supervision with personal hygiene needs, required extensive assistance with toileting and dressing, and had diagnoses that included osteoarthritis of the left hip. Nurse's notes for Resident 2, dated September 5, 2023, at 6:02 a.m. revealed that the resident was transferred to the hospital for a scheduled surgery. There was no documented evidence that the resident and/or the responsible party was notified about the facility's bed-hold policy at the time of this transfer to the hospital. Interview with the Nursing Home Administrator on October 23, 2023, at 11:11 a.m. confirmed that there was no documented evidence that a bed-hold notice was issued to Resident 2 or her responsible party at the time of the transfer to the hospital. 28 Pa. Code 201.29(d) Resident rights. 28 Pa. Code 211.5(f) Clinical records. 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: 395090 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 395090 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Windber Woods Senior Living & Rehabilitation Ctr 277 Hoffman Avenue Windber, PA 15963 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)