Inspection·March 12, 2024

F 0658 Ensure services provided by the nursing facility meet professional standards of quality. Level of Harm - Minimal harm or potential for actual harm Based on review of Pennsylvania's Nursing Practice Act, residents' clinical records, personnel files, and the licensed practical nurse job description, as well as staff interviews, it was determined that the facility failed to ensure that the nurse documented treatments accurately for one of 10 residents reviewed (Resident 6). This deficiency was cited as past non-compliance. Residents Affected - Few Findings include: The Pennsylvania Code, Title 49, Professional and Vocational Standards, State Board of Nursing, 21.148. Standards of nursing conduct (a)(5)(8) indicated that the licensed practical nurse was to document and maintain accurate records. Not to falsify or knowingly make incorrect entries into the patient's record or other related documents. The facility's licensed practical nurse job description, dated May 8, 2018, revealed that the licensed practical nurse was to chart nurses' notes in an informative and descriptive manner that reflects the care provided to the resident, as well as the resident's response to the care, and perform routine charting duties as required and in accordance with the facility's established charting and documentation policies and procedures. Physician's order for Resident 6, dated January 10, 2024, revealed that staff were to cleanse the resident's left shin with wound cleanser, then apply Xeroform gauze (a sterile, non-adhering protective dressing consisting of absorbent, fine-mesh gauze impregnated with a petrolatum), and secure with border foam dressing (a highly absorbent self-adherent silicone foam dressing) every other day and as needed on dayshift for an abrasion (an area damaged by scraping or wearing away). A review of Resident 6's January 2024 Treatment Administration Record (TAR) revealed that Licensed Practical Nurse 1 documented as having completed the treatment to Resident 6's left shin on January 14, 2024. However, a review of Licensed Practical Nurse 1's personnel file revealed a disciplinary action, dated January 15, 2024, indicating that on the morning of January 15, 2024, as the wound nurse was completing treatments on Resident 6 and it was noted that the resident had an intact dressing on the left lower leg dated January 12, 2024. According to physician's orders, the treatment to Resident 6's left lower leg wound was ordered for every other day, on day shift (7:00 a.m. to 3:00 p.m.) and should have been completed on January 14, 2024. However, as noted by the intact dressing, this treatment was not performed since January 12, 2024. Upon further investigation, Resident 6's TAR indicated that the treatment had been completed by Licensed Practical Nurse 1 on January 14, 2024. Interview with the Nursing Home Administrator on March 11, 2024, at 4:00 p.m. confirmed that (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 7 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 03/12/2024 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)