F 0550
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or
her rights.
Based on clinical record review, resident interview, and observation, it was determined that the facility failed
to provide timely assistance with care in a manner that maintained dignity for two of 24 sampled residents.
(Residents 30, 86)
Findings include:
Clinical record review revealed that Resident 30 had mild cognitive impairment and required assistance
from staff to get out of bed. According to the care plan, she also had depressed mood and would call out at
times. The care plan indicated that staff was to respond to her requests for care and allow the resident to
make decisions about her activities. On June 4, 2024, at 10:09 a.m., the resident was observed in bed and
her call light was on. The resident stated, I want to get out of bed. Between 10:09 and 10:38 a.m., the call
light remained on, and several staff members walked by the room without assisting the resident. At 10:38
a.m., a staff member turned off the call light and left the room without assisting the resident. The resident
began to call out, Help me! until staff assisted her at 11:07 a.m.
Clinical record review revealed that Resident 86 was incontinent of urine, was able to communicate her
needs, and required assistance to use the toilet. According to the care plan, staff was to assist the resident
to the toilet frequently and upon request. On June 5, 2024, at 10:49 a.m., the resident turned on her call
light. At that time she stated, I need to use the bathroom. At 10:52 a.m., a nurse entered the room and
turned off her call light without assisting her to the bathroom. Staff did not assist the resident until 11:30
a.m.
28 Pa. Code 211.12(d)(1)(5) Nursing services.
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:
395250
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
395250
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
06/06/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Holy Family Manor
1200 Spring Street
Bethlehem, PA 18018
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)
F 0684
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Level of Harm - Minimal harm
or potential for actual harm
Based on clinical record review and observation, it was determined that the facility failed to implement
physician's orders for one of 24 sampled residents. (Resident 45)
Residents Affected - Few
Findings include:
Clinical record review revealed that Resident 45 had diagnoses that included muscle weakness, dementia,
and Parkinson's disease. Review of the Minimum Data Set assessment, dated May 15, 2024, revealed that
the resident had cognitive impairment. Review of the care plan revealed the resident has a potential for
impaired skin integrity and staff was to apply Dermasaver gloves (gloves for skin protection) to both arms
while the resident was in the wheelchair. On June 18, 2023, a physician ordered that staff to apply a
Tubigrip (an elastic bandage for support) to the right hand under the Dermasaver glove. On June 4, 2024,
at 1:12 p.m. and 2:07 p.m., and again on June 5, 2024, at 10:47 a.m. and 12:25 p.m., Resident 45 was
observed in a wheelchair without the Dermasaver gloves or Tubigrip in place. There was no documented
evidence that the resident had refused application of the Dermasaver gloves or Tubigrip.
28 Pa. Code 211.12(d)(1)(5) Nursing services.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395250
If continuation sheet
Page 2 of 2
