Health inspection·September 7, 2023

F 0558 Reasonably accommodate the needs and preferences of each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review and staff interview, it was determined that the facility failed to accommodate one resident's needs for assistive positioning devices during wheelchair transport of one of three resident reviewed (Resident 74). Residents Affected - Few Findings include: Review of clinical records revealed Resident 74 was admitted to the facility on [DATE], with diagnoses to include aneurysm of carotid artery (a bulge in one of the arteries supplying blood to the brain), muscle weakness and need for assistance with personal care. An admission Minimum Data Set assessment (MDS- a federally mandated standardized assessment process conducted periodically to plan resident care) dated May 22, 2023, indicated that the resident required total dependence of two+ persons physical assist for transfers. Review of the resident's Occupational Therapy Evaluation dated May 16, 2023, revealed that the resident was unable to sit unsupported, and was dependent (requires 100% assist, or 2 or more helpers) for repositioning in a standard wheelchair. A nursing progress note dated May 25, 2023, at 8:05 AM, revealed that the resident was out on a doctor's appointment transported by a transportation company in a facility issued wheelchair. A nurses note dated May 25, 2023, at 12:45 PM revealed that the resident returned to the facility following the appointment. Upon the resident's return, the transport attendant reported to the facility that he had to go into the doctor's office to get help with the resident's transport and obtain a different wheelchair with leg rests because the resident was sliding down in the wheelchair the facility had provided. The transport attendant transferred Resident 74 into the other wheelchair with leg rests obtained from the physician's office. The facility-provided wheelchair in which the resident was did not have leg rests at the time she was picked up for the appointment. The transport attendant borrowed a wheelchair with leg rests from the physician's office to return the resident to the facility. Interview with the Director of Rehab on September 7, 2023, at 12:45 PM revealed Resident 74 was dependent for transfers and mobility and is unable to reposition herself in the wheelchair. The Director of Rehab confirmed that leg rests on the resident's wheelchair are necessary for positioning and safety. Interview with the Director of Nursing on September 7, 2023, at 1:30 PM confirmed that the resident Page 1 of 2 395265 395265 09/07/2023 Pavilion at St Luke Village, The 1000 Stacie Drive Hazleton, PA 18201

F 0558 Level of Harm - Minimal harm or potential for actual harm required wheelchair leg rests, and that the facility failed to provide them for the outside physician appointment on May 25, 2023. 28 Pa. Code 211.12(d)(3)(5) Nursing services Residents Affected - Few 395265 Page 2 of 2