Inspection·September 13, 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 a review of facility policies, resident medical records, facility submitted documents, and staff interviews it was determined that the facility failed to provide adequate supervision to be aware of a resident's departure from the facility for one of six residents (Resident R1). Findings include: A review of facility Safety and Supervision of Residents date 1/1/24, indicated that the facility takes an initialized resident centered approach to resident safety including implementing interventions with adequate supervision. A review of facility Wandering and Elopements policy dated 1/1/24, indicated that the facility implements interventions for at risk resident that show behaviors of wandering and elopement. The facility will implement strategies and interventions documented in the resident's care plan. Review of Resident R1's medical record indicated that the resident was admitted to the facility on [DATE], with the the diagnoses of alcohol dependence, back pain, muscle weakness, and depression Review of an Elopement Risk Assessment completed on 6/11/24, indicated Resident R1 was at risk for elopement. Review of Resident R1's plan of care for Potential for Elopement and repeatedly removing wanderguard initiated 7/18/23, provided evidence that the facility failed to implement initialized interventions to maintain the resident's safety due to the resident noncompliance with wanderguard monitoring. Review of progress notes dated 9/8/24 indicated that the resident was seen outside the facility at approximately 2:50 am. It was determined that Resident R1 broken the window in her room and exited through the window. She removed her wheelchair, three totes, a potted plant and a box of chocolates and was pushing the wheelchair with her belongings when observed. She had walked through a court yard area and exited through an open gate and then proceeded to walk around the building when she was noticed by staff. Resident R1 confirmed that she want out of the facility. She stated that if she was not going to left to leave she would get out on her own. She stated to staff that she was going to hitchhike to [NAME] and that she had been planning on breaking the window for two weeks. During an interview on 9/12/24, at 12:30 pm the Director of Nursing (DON) confirmed that Resident R1 was known to be exit seeking, at risk for elopement, and failed to wear a wanderguard. The DON confirmed that the facility failed to implement initialized interventions to maintain the safety of Resident R1 as required which resulted in the facility's failure to provide adequate supervision for a resident at risk for elopement. 28 Pa. Code 201.14(a) Responsibility of licensee. 28 Pa. Code 201.18(b)(e)(1) Management. 28 Pa. Code 201.20(b)(1) Staff Development. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395295 If continuation sheet Page 2 of 3 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 395295 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wecare at Murrysville Rehab and Nursing Center 3300 Logan Ferry Road Murrysville, PA 15668 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 0689 28 Pa. Code 201.29(a) Resident rights. Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code 211.10(c)(d) Resident care policies. 28 Pa. Code 211.11(d) Resident care plan. Residents Affected - Few 28 Pa Code 211.12(d)(1)(2)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395295 If continuation sheet Page 3 of 3