Health inspection·August 10, 2023

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 interviews, it was determined that the facility failed to maintain resident dignity for one of two residents (Resident R189) with urinary catheters (tubing inserted into the bladder to drain urine into a bag) and two of 13 residents (R70 and R185) observed during medication administration. Findings include: Review of the facility policy entitled, Urinary Catheterization dated January 2023, revealed The continuous drainage bag is to be concealed with an outer bag to enhance resident privacy and dignity both when resident is in bed and out of bed. Review of Resident R189's clinical record revealed an admission date of 4/12/23, with diagnoses that included Adult Failure to Thrive (Adult loss of appetite, decreased food intake, weight loss and resident is less active than normal), Major Depressive Disorder (a mood disorder causing a feeling of sadness and loss of interest in normal activities), and Neuromuscular Dysfunction of the Bladder (a condition that affects the bladder's ability to store and empty urine properly). Observation on 8/08/2023, at 11:30 a.m. and 8/09/2023, at 9:20 a.m. revealed Resident R189's urinary catheter bag hanging from the resident's bed uncovered exposing the bag with urine to be viewed easily by all who walked by the room and/or by all who entered the room. During an interview on 8/09/2023, at 9:20 a.m. Licensed Practical Nurse (LPN) Employee E1 confirmed that Resident R189's urinary catheter bag was hanging from the bed with urine visible and that the catheter bag should have been covered to protect Resident R189's privacy/dignity. Review of the facility policy entitled, Administering medications via enteral feeding tube dated January 2023, revealed Procedure: 1. Identify resident, assure privacy. Medications should not be administered in pubic areas. During a medication pass observation on 8/08/2023, at 4:47 p.m. i was observed that LPN Employee E4 failed to pull the curtain or close the door to resident room when taking a blood glucose reading, and administering an insulin injection to Resident R70. LPN Employee E4 entered the room of Resident R70, and explained what he/she was there for, proceeded to obtain Resident R70's blood glucose reading. After obtaining the blood glucose reading, LPN Employee E4 left the room and returned to the medication cart to obtain the order of insulin for Resident R70. LPN Employee E4 returned to the resident room, entered the room with two other residents in the room, explained to Resident R70 that he/she would be administering insulin. LPN Employee E4 then proceeded to expose Resident R4's abdomen (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 6 Event ID: 395361 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 395361 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pleasant Ridge Manor East/West 8300 West Ridge Road Girard, PA 16417 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)