Inspection visit
Inspection
16 citations recorded
Inspector’s narrative
What the inspector wrote
This survey cited 16 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
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 review of facility policy and clinical records, observations, and staff interview, it was determined
that the facility failed to provide resident privacy and dignity regarding an exposed urinary catheter (a tube
placed and held in the bladder to drain urine) bag for one of 27 residents reviewed (Resident R78).
Findings include:
Review of a facility policy entitled, Catheter, Urinary Bag, Care of dated 8/16/23, indicated, Maintain the
dignity of the catheterized resident by concealing the urinary bag from public view in a privacy bag .
Review of Resident R78's clinical record revealed an admission date of 9/11/23, with diagnoses that
included Urinary Tract Infection; Resistance to Multiple Antibiotics, (occurs when bacteria change in a way
that makes antibiotics less effective against them); Benign Prostatic Hyperplasia, (the flow of urine is
blocked due to the enlargement of prostate gland); and Obstructive and Reflux Uropathy, (urine cannot flow
through the urinary tract due to an obstruction and backs up into the kidneys).
Observations on 10/24/23, at 10:18 a.m., and 10/25/23, at 10:18 a.m. revealed Resident R78 laying in
his/her bed and with his/her urinary drainage bag visible from the hallway without a privacy bag.
During an interview on 10/25/23, at 10:22 a.m. Registered Nurse Employee E3, confirmed that the catheter
drainage bag should be covered to ensure resident privacy and dignity.
28 Pa. Code 201.14(a) Responsibility of licensee
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 6
Event ID:
395292
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
395292
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/27/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Wesbury United Methodist Commu
31 North Park Ave Ext
Meadville, PA 16335
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 0583
Keep residents' personal and medical records private and confidential.
Level of Harm - Minimal harm
or potential for actual harm
Based on review of facility policy, observations, and staff interview, it was determined that the facility failed
to provide resident privacy during medication administration for one of 27 residents reviewed (Resident R4).
Residents Affected - Few
Findings include:
Review of facility policy entitled Confidentiality and Non-Disclosure Policy dated 8/16/23, indicated a
secured computer application will not be left unattended while signed on.
During observation of medication administration for Resident R4 on 10/24/23, at 4:10 p.m. Licensed
Practical Nurse (LPN) Employee E1 prepared medications for a resident from Village Center Hall
medication cart parked in the middle of hall in front of the resident room with the computer open sitting on
top of medication cart. LPN Employee E1 then proceeded into resident room to administer medications to a
resident in the room, after administering medication the nurse walked over to the roommate behind a
privacy curtain. LPN Employee E1 did not cover resident/medication information that was on the computer
on top of the medication cart. LPN Employee E1 was unable to view the computer on top of the medication
cart parked in the middle of the hallway outside the resident room.
During an interview on 10/24/23, at the time of the observation, LPN Employee E1 confirmed that he/she
left the medication cart with the computer open and did not cover resident/medication information that was
on the computer on top of the medication cart. Employee E1 also confirmed that resident information is to
be covered when not within view.
28 Pa. Code 201.14(a) Responsibility of licensee
28 Pa. Code 211.12(d)(1)(5) Nursing services
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395292
If continuation sheet
Page 2 of 6
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
395292
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/27/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Wesbury United Methodist Commu
31 North Park Ave Ext
Meadville, PA 16335
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 0584
Level of Harm - Minimal harm
or potential for actual harm
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited
to receiving treatment and supports for daily living safely.
Based on review of facility policy, observation, and staff interview, it was determined that the facility failed to
maintain a clean homelike environment for one of four neighborhoods (Town Square).
Residents Affected - Few
Findings include:
Review of a facility policy entitled Cleaning of Resident Wheelchairs dated 8/16/23, indicated that all
wheelchairs are to be cleaned quarterly and daily as needed by housekeeping personnel.
Observation on 10/25/23, at 10:22 .a.m. revealed Resident R32's wheelchair was soiled with dried liquid
substances that also had a build-up of some debris on the left side of the wheelchair and on the left larger
wheel. Observation also revealed that Resident R32's wheelchair's bilateral armrests were cracked,
peeling, and torn.
During an interview on 10/25/23, at 10:25 a.m. Registered Nurse Employee E3 confirmed that Resident
R32 had damaged wheelchair armrests with cracked, peeling and torn protective covering and that the left
side of the wheelchair was dirty and in need of cleaning.
28 Pa. Code 201.18(b)(1) Management
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395292
If continuation sheet
Page 3 of 6
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
395292
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/27/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Wesbury United Methodist Commu
31 North Park Ave Ext
Meadville, PA 16335
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 review of facility policy and clinical records, observations and staff interview, it was determined
that the facility failed to follow physician's orders for treatments for one of 27 residents reviewed (Resident
R21).
Residents Affected - Few
Findings include:
Review of a facility policy entitled, Oxygen Therapy and Equipment dated 8/16/23, indicated that Humidified
O2 [oxygen] bottles will be changed on a weekly basis by night shift or sooner if needed by any shift when
the distilled water is used.
Review of Resident R21's clinical record revealed an admission date of 6/30/19, with diagnoses that
included Chronic Obstructive Pulmonary Disease, (COPD - a condition that obstructs air flow in the lungs
with symptoms of difficulty breathing, coughing and shortness of breath); chronic kidney disease (condition
where the kidneys gradually lose their ability to properly filter waste and excess fluids from the blood); and
circulatory system disorder, (condition that affects the structural and/or functional abilities of the heart and
or the blood vessels, causing fatigue and/or shortness of breath).
Review of Resident R21's clinical record revealed a physician's order to Humidify O2 - change weekly and
date when in use - Once Weekly for O2 Use.
Review of Resident R21's October 2023 treatment record revealed the humidifier bottle was changed on
10/22/23.
Observations on 10/25/23, at 11:21 a.m., 10/26/23, at 2:18 p.m., and 10/27/23, at 10:20 a.m. revealed that
Resident R21's oxygen humidifier bottle was dated for 10/14/23.
During an interview on 10/27/23, at 10:26 a.m. Registered Nurse Employee E3 confirmed that the oxygen
humidifier bottle was dated 10/14/23, and was not changed per physician's orders.
28 Pa. Code 211.10(d) Resident care policies
28 Pa. Code 211.12(d)(1)(5) Nursing services
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395292
If continuation sheet
Page 4 of 6
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
395292
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/27/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Wesbury United Methodist Commu
31 North Park Ave Ext
Meadville, PA 16335
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 0695
Provide safe and appropriate respiratory care for a resident when needed.
Level of Harm - Minimal harm
or potential for actual harm
Based on review of clinical records, observations, and staff interview, it was determined that the facility
failed to maintain proper care of respiratory equipment for one of 27 residents reviewed (Resident R12).
Residents Affected - Few
Findings include:
Review of Resident R12's clinical record revealed an admission date of 5/26/23, with diagnoses that
included Alzheimer's Disease, (brain disorder that destroys memory and thinking skills and, eventually, the
ability to carry out simple tasks); sleep related non-obstructive alveolar hypoventilation, (breathing that is
too slow and/or shallow during sleep); and dependence on supplemental oxygen.
Review of Resident R12's physician's order dated 5/26/23, revealed oxygen ordered at two liters per minute
via nasal cannula (tubing into the nostrils to administer oxygen) every shift.
Observations on 10/26/23, at 10:10 a.m. and 10/27/23, at 10:23 a.m. revealed that R12's oxygen
concentrator had a significant amount of white dust and white cobweb substances obstructing the
concentrator's air inlet port.
During an interview on 10/27/23, at 10:26 a.m. Registered Nurse Employee E3, confirmed that the oxygen
concentrator air inlet area should not be obstructed with white dust and cobweb substances.
28 Pa. Code 211.12(d)(1)(5) Nursing services
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395292
If continuation sheet
Page 5 of 6
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
395292
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/27/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Wesbury United Methodist Commu
31 North Park Ave Ext
Meadville, PA 16335
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 0761
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted
professional principles; and all drugs and biologicals must be stored in locked compartments, separately
locked, compartments for controlled drugs.
Based on review of facility policy, observations, and staff interviews, it was determined that the facility failed
to label a multi-dose vial of insulin, and a multi-dose insulin pen (medication to treat elevated blood sugar
levels) with the date they were opened in one of three medication carts (300 Hall) and failed to prevent the
opportunity for potential unauthorized access of medications on one of four medication carts observed
(Village Center Hall).
Findings include:
Review of a facility policy entitled Medication, Storage of dated 8/16/2023, indicated that medications will
be dated when opened, and discarded according to pharmacy policy/procedure.
Observation on 10/25/23, at 11:20 a.m. of the 300 Hall medication cart revealed one opened Lantus
(long-acting) multi-dose insulin pen, and one opened Humalog (short-acting) multi-dose insulin vial without
an open date and labeled to discard after 28 days opened.
During an interview at the time of the observation, Licensed Practical Nurse (LPN) Employee E2 confirmed
that insulin should be dated when opened and he/she could not tell when the opened insulin should be
discarded.
During an interview on 10/27/23, at 12:32 p.m. the Director of Nursing confirmed that the opened
multi-dose pen of Humalog and multi-dose vial of Lantus insulin should have been labeled with an open
date.
Review of a facility procedure entitled, Medication Pass Guidelines dated 8/16/2023, indicated that
medication cart is always visible to the nurse or locked.
Observation on 10/24/23, at approximately 4:10 p.m. revealed that LPN Employee E1 prepared medications
for a resident from Village Center Hall medication cart parked in the middle of hall in front of the resident
room. LPN Employee E1 then proceeded into resident room to administer medications to a resident in the
room, after administering medication they nurse walked over to the roommate behind a privacy curtain.
LPN Employee E1 did not securely lock the Village Center East Hall medication cart. LPN Employee E1
was unable to view medication cart and drawers of the medication cart from behind the privacy curtain
while unattended.
During an interview on 10/24/2023, at the time of the observation, LPN Employee E1 confirmed that he/she
left the medication cart unlocked while it was parked in the middle of the hallway in front of the resident's
doorway, which was out of view while he/she was talking with roommate behind privacy curtain. LPN
Employee E1 also confirmed that the medication cart was to be locked when out of view.
28. Pa. Code 201.18(b)(1) Management
28. Pa. Code 211.9(a)(1) Pharmacy services
28 Pa. Code 211.12(d)(1)(5) Nursing services
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395292
If continuation sheet
Page 6 of 6
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Back to topCitations
16 citations recorded*CMS
What do CMS severity letters mean?
Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.
General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.
Each letter combines severity with scope: how many residents the deficiency affected.
F550 - Resident Rights
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
F583 - Privacy and Confidentiality
Keep residents' personal and medical records private and confidential.
F584 - Safe Environment
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
F684 - Quality of care
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
F695 - Respiratory care, including tracheostomy care and tracheal suctioning
Provide safe and appropriate respiratory care for a resident when needed.
F761 - Labeling of Drugs and Biologicals
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
- 0223GeneralS&S Cno actual harm
Provide exit doors that are held open by devices that will automatically close on the activation of a fire alarm or smoke detector.
- 0271GeneralS&S Dpotential for harm
Have exits that are accessible at all times.
- 0291GeneralS&S Dpotential for harm
Install emergency lighting that can last at least 1 1/2 hours.
- 0353GeneralS&S Epotential for harm
Inspect, test, and maintain automatic sprinkler systems.
- 0363GeneralS&S Dpotential for harm
Install corridor and hallway doors that block smoke.
- 0372GeneralS&S Bno actual harm
Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
F712 - Frequency of physician visits
Have simulated fire drills held at unexpected times.
F918 - Bathroom Facilities
Have generator or other power source capable of supplying service within 10 seconds.
F923 - Have adequate outside ventilation by means of windows, or mechanical
Have proper medical gas storage and administration areas.
- 0200GeneralS&S Epotential for harm
Meet other general requirements.
FAQ · About this visit
Common questions about this visit
What happened during the October 27, 2023 survey of Wesbury United Methodist Commu?
This was a inspection survey of Wesbury United Methodist Commu on October 27, 2023. The surveyor cited 16 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at Wesbury United Methodist Commu on October 27, 2023?
Yes, 16 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her right..."
What type of survey was this?
This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.
SourceView on CMS Care Compare
Next steps
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Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.