Health inspection·November 1, 2023

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Based on review of facility policies, clinical records, and facility documentation, and staff interview, it was determined that the facility failed to maintain complete and accurate records for three of 12 residents reviewed (Residents R1, R2, and R3). Findings include: Review of a facility policy entitled Resident Incident Reporting indicated that: all resident incidents are identified and tracked for compliance to assure follow-up on all resident incidents and provide treatment as appropriate; at the time of the incident staff will complete the Resident Incident Report including family/physician notification; all incidents are reviewed and care planned; and incidents are forwarded to the Director of Nursing (DON), Administrator (NHA), and Medical Director (MD) for review and comments if applicable. Review of Resident R1's clinical record revealed an admission date of 2/22/22, with diagnoses that included brain injury, epilepsy (brain disorder that causes recurring, unprovoked seizures), inability to speak, tracheostomy (a procedure to help air and oxygen reach the lungs by creating an opening into the trachea [windpipe] from outside the neck), and quadriplegia (paralysis that affects all a person's limbs and body from the neck down). The clinical record also revealed a physician's order dated 9/18/23, at 11:50 p.m. to obtain an x-ray of the left pointer finger as soon as possible. Review of Resident R1's departmental progress notes revealed that on 9/19/23, at 8:17 a.m. staff Licensed Practical Nurse (LPN) documented discussed with second shift supervisor left pointer finger swollen, bruised, and possibly broken; at 11:00 a.m. x-ray to left pointer finger as soon as possible to rule out fracture, and may apply ice to finger; and at 2:11 p.m. an x-ray obtained at 11:30 a.m. Review of Resident R1's x-ray results dated 9/19/23, at 11:52 a.m. revealed no fracture nor dislocation of the left pointer finger. Further review of Resident R1's clinical record revealed lack of evidence that an investigation was initiated for an injury of unknown origin, or that the resident's representative was notified of the change in condition/injury and possible fracture. During an interview on 11/01/23, at 12:30 p.m. the Assistant Director of Nursing (ADON) and Administrator (NHA) confirmed that there was not evidence that an investigation was initiated or that Resident R1's family was notified of the injury and that there should have been an investigation initiated and notification to family. (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: 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 11/01/2023 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)