Health inspection·April 30, 2025

F 0695 Provide safe and appropriate respiratory care for a resident when needed. 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, staff interviews, and clinical record review, it was determined that the facility failed to provide appropriate respiratory care for two of four residents (Resident R1 and R2). Residents Affected - Few Findings include: Review of facility policy Respiratory Therapy dated 1/2/25, indicated the purpose of this procedure is to guide prevention of infection associated with respiratory therapy tasks and equipment. Change the oxygen nasal cannula (a medical device that provides supplemental oxygen to patients through two prongs inserted into the nostrils) every seven days, or as needed. Store the mask and plastic tubing from the nebulizer (small machine that turns liquid medicine into a mist that can be easily inhaled) in a plastic bag, marked with date and resident ' s name, between uses. Review of the clinical record indicated Resident R1was admitted to the facility on [DATE]. Review of Resident R1's Minimum Data Set (MDS - a periodic assessment of care needs) dated 3/20/25, indicated diagnoses of heart failure (a progressive heart disease that affects pumping action of the heart muscles), chronic obstructive pulmonary disease (COPD, a group of progressive lung disorders characterized by increasing breathlessness), and respiratory failure (occurs when the lungs can not properly exchange gases). MDS Section O-Special treatments, procedures and program C1 is marked, indicating oxygen therapy. Section G1 is marked, indicating BiPAP (Bi-level Positive Airway Pressure-a non-invasive ventilation method that uses pressurized air to assist in breathing). Review of a physician's active orders dated 4/28/25, indicated to administer oxygen at 2 liters per minute per nasal cannula. Change oxygen tubing every week. Review of a physican's active orders dated 4/28/25, indicated BiPAP with Oxygen at 2 liters per minute. Apply at bedtime and remove in the morning. During an observation on 4/29/25, at 10:30 a.m. Resident R1 was laying in her bed receiving two liters per minute of oxygen via nasal cannula. No date was present on the oxygen nasal cannula. Two BiPAP masks were laying on the bedside nightstand and failed to be stored in a bag, when not in use. During an interview on 4/29/25, at 10:45 a.m. Licensed Practical Nurse (LPN) Employee E1 confirmed that no date was present on Resident R1's nasal cannula tubing and that two BiPAP mask were not properly stored in a bag. Review of the clinical record indicated Resident R2 was admitted to the facility on [DATE]. (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 2 Event ID: 395146 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 395146 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Canterbury Place 310 Fisk Street Pittsburgh, PA 15201 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)