Inspection·June 24, 2024

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on facility policy review, clinical and facility record review, facility submitted documents, and staff interviews, it was determined that the facility failed to provide adequate supervision to prevent elopement for one of six residents (Resident R1). Review of the facility policy Resident Elopement dated 1/17/24, indicated cognitively impaired residents at risk for elopement will be appropriately monitored to reduce the potential for injury. Elopement is defined as a resident leaving the physical structure of the facility without knowledge of facility staff. Review of the clinical record revealed Resident R1 was admitted to the facility on [DATE]. Review of the Minimum Data Set (MDS - periodic assessment of resident care needs) dated 4/1/24, included diagnoses of diabetes (a metabolic disorder in which the body has high sugar levels for prolonged periods of time), arthritis (inflammation of one or more joints, causing pain and stiffness), and dementia (a group of symptoms that affects memory, thinking and interferes with daily life). Review of an Elopement Risk Assessment completed on 3/26/24, indicated Resident R1 was at risk for elopement. Review of the physician's order dated 3/26/24, indicated Resident R1 was ordered a Wanderguard (security bracelet that alerts when an identified resident approaches a monitored door). Review of Resident R1's plan of care for Potential for elopement and associated injury related to exit seeking behavior initiated 3/26/24, included goals of check resident's whereabouts frequently, redirect from exits as needed based on behavior, and wanderguard device - check placement and function each shift. Review of a progress note dated 3/27/24, at 1:09 p.m. indicated Resident R1 had removed his Wanderguard bracelet. Review of a progress note dated 5/11/24, at 3:45 p.m. indicated that Resident R1 was observed walking outside, and was redirected inside. Resident R1 refused to have Wanderguard bracelet reapplied. Review of a progress note dated 6/7/24, at 2:20 p.m. indicated, Resident was observed walking outside in the parking lot. When questioned resident stated he just wanted to move the car to a different space. Resident has removed multiple wanderguards, four found in room in drawer that he has (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: 395289 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 395289 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wecare at South Hills Rehabilitation and Nrsg Ctr 201 Village Drive Canonsburg, PA 15317 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)