Health inspection·October 17, 2023

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. Based on review clinical records and resident and staff interviews it was determined that the facility failed to provide care in a manner and environment, which promotes each resident's quality of life by failing to respond timely to residents' request for assistance as evidenced by experiences reported by seven residents out of 15 interviewed (Residents 8, 21, 22, 23, 73, 74, and 102). Findings include: A review of resident clinical record and a facility provided BIMS (brief interview mental status - a tool that assesses cognitive status) report and random interviews conducted on October 17, 2023, with 15 alert and oriented residents, to include 8 residents residing on the 100 unit, and 7 residents residing on the 300 unit, revealed that 7 residents' interviews voiced concerns regarding staff's failure to respond to their requests for assistance and provide needed care and services in a timely manner. During interviews, the residents relayed that they feel the facility is not adequately staffed because they wait extended periods of time for staff to respond to their requests for assistance, including untimely responses to their requests via the nurse call bell system. Of those residents interviewed on October 17, 2023, 4 of 8 residents residing on the 100 unit, and 3 of 7 residents residing on the 300 unit, expressed similar concerns as described above. Interview with Resident 23 on October 17, 2023, at approximately 9:09 AM, revealed that he feels that short staffing is a problem in the facility because he waits up to 45 minutes to an hour for staff to answer his call bell. The resident stated that these waits occur mostly on 2nd shift (evening shift) of nursing duty, and that there have been times he has soiled himself while waiting for the call bell to be answered. Interview with Resident 22 on October 17, 2023, at approximately 9:14 AM, revealed he waits up to 45 minutes for staff to answer his call bell. The resident stated that these waits occur mostly on 2nd shift (evening shift) of nursing duty, and believes the facility could use more help. He further stated that there have been times he has soiled himself while waiting for the call bell to be answered. Interview with Resident 21 on October 17, 2023, at approximately 9:20 AM, revealed that the resident stated that she waits 30 minutes for staff to answer her call bell, and these waits occur on all shifts of nursing duty. (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 5 Event ID: 395286 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 395286 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Broad Mountain Health and Rehabilitation Center 500 West Laurel Street Frackville, PA 17931 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)