Health inspection·October 30, 2024

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Actual harm Based on clinical record and hospital record review, policy review, and staff interviews, it was determined that the facility failed to implement treatment and care in accordance with professional standards of practice, which resulted in actual harm, evidenced by a urinary tract infection and septic shock for one of three residents reviewed (Resident 1), and failed to follow physician orders for one of three residents reviewed (Resident 1). Residents Affected - Few Findings include: Review of the facility policy, titled Collecting a Urine Specimen from a Closed Drainage System, read, in part, The purpose of this procedure is to obtain an uncontaminated urine specimen from a resident with a catheter. The policy included steps in the specimen collection procedure to prevent specimen contamination. These steps included Wash your hands thoroughly before beginning the procedure, cleanse the speci-port with the alcohol swab, do not touch the inside of the specimen container, place the lid on the specimen container, do not touch the inside of the lid. Review of facility policy, titled Catheter Care, Urinary, last revised September 2014, read, in part, The purpose of this procedure is to prevent catheter-associated urinary tract infections. The following information should be recorded in the resident's medical record: The date and time that the catheter care was given. The signature and title of the person recording the data. Review of Resident 1's clinical records revealed diagnoses that included history of urinary tract infections (UTI), pressure ulcer of sacral region, stage 4 (wound that occurs when the skin and tissue are damaged by prolonged pressure), hypertension (high blood pressure) and need for assistance with personal care. Resident 1 had an order for a foley catheter (a tube inserted into the bladder to drain urine). Resident 1 also had an order for foley catheter care every shift, with a start date of September 26, 2024. Review of Resident 1's September 2024 and October 2024 TAR (Treatment Administration Recorddocumentation for treatments/medication administered or monitored), failed to reveal catheter care was completed on September 28, 2024, in the AM; October 3, 2024, in the AM; and October 17, 2024, in the PM. Further review of the clinical record revealed lab results from October 14, 2024, which noted an elevated white blood cell (WBC - blood cells that fight infection) of 18.1 (normal is 4.5-11) Review of Physician orders revealed an order dated October 14, 2024, for Doxycycline Hyclate Tablet (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 4 Event ID: 395347 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 395347 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/30/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oak Hill Center for Rehabilitation and Nursing 1020 North Union Street Middletown, PA 17057 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)